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Year : 2017  |  Volume : 60  |  Issue : 1  |  Page : 97-98
Trichoblastic carcinoma of the scalp with rippled pattern

1 Department of Pathology, Istanbul Training and Research Hospital, Istanbul, Turkey
2 Department of Plastic Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey

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Date of Web Publication14-Feb-2017


Trichoblastic carcinoma (TC) is a rare type of malignancy which is derived from the hair follicles. In this paper, we report a case with TC on the scalp characterized with rippled pattern. There have been reports of rippled pattern in trichoblastomas, sebaceomas, and basal cell carcinomas. To the best of our knowledge, this is the first case in the literature to report a rippled pattern in TCs.

Keywords: Rippled pattern, scalp, trichoblastic carcinoma

How to cite this article:
Leblebici C, Altinel D, Serin M, Okcu O, Yazar SK. Trichoblastic carcinoma of the scalp with rippled pattern. Indian J Pathol Microbiol 2017;60:97-8

How to cite this URL:
Leblebici C, Altinel D, Serin M, Okcu O, Yazar SK. Trichoblastic carcinoma of the scalp with rippled pattern. Indian J Pathol Microbiol [serial online] 2017 [cited 2021 May 10];60:97-8. Available from: https://www.ijpmonline.org/text.asp?2017/60/1/97/200024

   Introduction Top

Trichoblastic carcinoma (TC) is a rare type of malignancy which is derived from the hair follicles. It has been reported in various locations including lip, alar region, pinna, vulva, eyelid, and coccyx.[1] It can arise from trichoblastoma and therefore is also named as malignant trichoblastoma.

Low-grade TC is considered to be similar to basal cell carcinoma, whereas high-grade ones are considered to present squamous cell carcinoma-like behavior. Lymphatic metastasis has been reported in several cases including a case with chronic lymphocytic leukemia.[2]

   Case Report Top

A 35-year-old female patient who was referred to our clinic with a small mass on the left side of the scalp. The mass was asymptomatic for the past 8 years up until a few months ago when symptoms such as itching and pain began. The physical examination revealed a superficial subcuticular mass with 7 mm diameter on the frontotemporal region of the scalp. Excision of the mass without any skin resection was performed under local anesthesia. The mass was diagnosed as low-grade TC. A re-excision with 5 mm margin was performed 3 weeks after the first operation [Figure 1]. Part of deep temporal fascia was also excised during the surgery. The patient was released from the clinic on the same day. Second histopathological examination also confirmed the previous diagnosis. The surgical margins were free from malignant cells. No additional treatment was performed. Nine months after the surgery, the patient was feeling well with no sign of recurrence.
Figure 1: Re-excision was planned with a 5 mm margin. Four dots in the middle marks, the location of the first incision

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Histopathological examination revealed dermal basaloid epithelial tumor lobules with a multinodular growth pattern located in the dermis. The stroma comprised stellate or spindled fibroblasts which were condensed around tumor lobules. There were no connections to the epidermis. Some of these lobules were partially or totally necrotic. Focal infiltrative area with smaller islands of tumor cells was found in adjacent tissues. Within the tumor lobules, most cell nuclei were arranged in a prominent palisaded fashion, formed parallel rows of epithelial ribbons, and the cells arranged in rippled pattern resembling Verocay bodies. Focal nuclear atypia was detected [Figure 2]. Immunohistochemical staining for CD10 showed stromal staining around the nests of tumor cells without epithelial staining. Bcl-2 was weakly positive [Figure 3]. Chromogranin, synaptophysin, androgen receptor, epithelial membrane antigen, carcinoembryonic antigen, CK20, and CD34 stainings were negative.
Figure 2: Histology of the tumor. (a) The tumor showing multinodular growth pattern in collagenous stroma (H and E, ×20). (b) Tumoral cell nest showing rippled pattern, in which the basaloid tumor cells were arranged in a palisading fashion forming parallel rows of epithelial ribbons (H and E, ×100). (c) Solid tumoral nest composed of small basaloid cells with central necrosis (comedo necrosis) (H and E, ×100). (d) Infiltrative areas of the tumor composed of basaloid cells with nuclear atypia (H and E, ×200)

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Figure 3: Immunohistochemistry of the tumor. (a) Stromal cells are positive for CD10 around tumoral lobules (×100). (b) Tumoral basaloid cells are weak positive for bcl-2 (×200)

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   Discussion Top

TC is a malignant neoplasm arising from the hair follicle. About twenty cases have been reported in the literature. Most common presentation is on the scalp and face. Mean age at the time of presentation seems to be lower than basal cell carcinomas. There are reports of metastatic spread on few cases. In our case, the lesion presented asymptomatic for over 8 years. This suggests that malignant transformation might have occurred in a preexisting trichoblastoma. One of the most important aspects of this neoplasm is that it contains basal cells as in basal cell carcinoma. Characteristic palisading and clefting is the major distinguishing point between these two entities. There have been reports of rippled pattern in trichoblastomas,[3],[4],[5],[6] sebaceomas,[7],[8],[9] and basal cell carcinomas.[10] These tumors were included in the differential diagnosis. Trichoblastomas do not demonstrate infiltrative growth pattern and central comedo necrosis which were present in this case. In contrast to sebaceomas, in this case, there was no sebaceous differentiation both morphologically and immunohistochemically. Basal cell carcinoma was ruled out due to conspicuous stroma around tumoral lobules, lack of epidermal origin, absence of retraction artifact, and stromal CD10 staining. To the best of our knowledge, this is the first case in the literature to report a rippled pattern in TC. In conclusion, we believe that the differential diagnosis of these pathologies can have a crucial impact on the management and follow-up of the patients.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Le Hémon A, Nuccio A, Thiéry G, Coulet O, de Biasi C, Cribier B, et al. Trichoblastic carcinoma on the lip. Ann Dermatol Venereol 2010;137:669-71.  Back to cited text no. 1
Regauer S, Beham-Schmid C, Okcu M, Hartner E, Mannweiler S. Trichoblastic carcinoma (”malignant trichoblastoma”) with lymphatic and hematogenous metastases. Mod Pathol 2000;13:673-8.  Back to cited text no. 2
Akasaka T, Imamura Y, Mori Y, Iwasaki M, Kon S. Trichoblastoma with rippled-pattern. J Dermatol 1997;24:174-8.  Back to cited text no. 3
Yamamoto O, Hisaoka M, Yasuda H, Nishio D, Asahi M. A rippled-pattern trichoblastoma: An immunohistochemical study. J Cutan Pathol 2000;27:460-5.  Back to cited text no. 4
Graham BS, Barr RJ. Rippled-pattern sebaceous trichoblastoma. J Cutan Pathol 2000;27:455-9.  Back to cited text no. 5
Swick BL, Baum CL, Walling HW. Rippled-pattern trichoblastoma with apocrine differentiation arising in a nevus sebaceus: Report of a case and review of the literature. J Cutan Pathol 2009;36:1200-5.  Back to cited text no. 6
Ansai S, Kimura T. Rippled-pattern sebaceoma: A clinicopathological study. Am J Dermatopathol 2009;31:364-6.  Back to cited text no. 7
Kiyohara T, Kumakiri M, Kuwahara H, Saitoh A, Ansai S. Rippled-pattern sebaceoma: A report of a lesion on the back with a review of the literature. Am J Dermatopathol 2006;28:446-8.  Back to cited text no. 8
Misago N, Narisawa Y. Rippled-pattern sebaceoma. Am J Dermatopathol 2001;23:437-43.  Back to cited text no. 9
Misago N, Tsuruta N, Narisawa Y. Rippled-pattern basal cell carcinoma. J Dermatol 2012;39:632-5.  Back to cited text no. 10

Correspondence Address:
Dr. Merdan Serin
Kavakli Sk., Eksioglu Sit, B Blok D: 54, Atasehir, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.200024

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