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Year : 2021  |  Volume : 64  |  Issue : 4  |  Page : 842-843
A long-standing solitary papule on nose: A diagnostic challenge


1 Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
2 Department of Pathology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

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Date of Submission26-May-2020
Date of Decision14-Jul-2020
Date of Acceptance14-Sep-2020
Date of Web Publication20-Oct-2021
 

How to cite this article:
Choudhary S, Srivastava A, Gadkari R. A long-standing solitary papule on nose: A diagnostic challenge. Indian J Pathol Microbiol 2021;64:842-3

How to cite this URL:
Choudhary S, Srivastava A, Gadkari R. A long-standing solitary papule on nose: A diagnostic challenge. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Nov 28];64:842-3. Available from: https://www.ijpmonline.org/text.asp?2021/64/4/842/328567




A solitary papular lesion over face is difficult to diagnose on clinical ground alone. A wide variety of differentials ranging from closed comedone, sebaceous hyperplasia, milia, dermal melanocytic nevus, and tumors like syringoma, trichoepithelioma (TE), and hidrocystoma are the possibilities. In such cases, histopathological examination is the only way to solve the diagnostic dilemma.

A 40-year-old female patient presented to the dermatology OPD with 8-year history of a single, asymptomatic, raised, nonprogressive skin lesion over the nose. Cutaneous examination revealed a single, skin-colored, translucent, nontender papule over the left ala of nose measuring 3 mm in size [Figure 1]. The lesion was excised by using 3-mm biopsy punch. Being solitary lesion of 3 mm, biopsy served both diagnostic and therapeutic purpose, that too without the risk of cosmetically worrisome scar. Excisional biopsy of the lesion revealed multiple horn cysts in the epidermis and islands of basaloid cells in the dermis with absence of nuclear atypia and mitotic figures. There was no retraction artifact noticed between the islands of basaloid cells and surrounding stroma [Figure 2]. On the basis of clinical presentation and histopathological findings, the diagnosis of solitary TE was established.
Figure 1: Single, translucent, skin-colored papule on nose

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Figure 2: Epidermis with multiple horn cysts. The underlying dermis shows islands of basaloid cells with solid and adenoid pattern (H&E, 10×)

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Solitary TE does not follow an inheritance pattern and is usually firm, non-ulcerated nodule usually <2 cm in diameter. If larger than this size, it is termed as giant solitary TE.[1],[2] Histopathologically, solitary and multiple forms of TE are similar.[1] Solitary TE is found commonly in young adults and is often located on the middle facial area. This is due to the high number of sebaceous glands in this region.[3] Other conditions that may clinically mimic solitary TE and are commonly seen in the facial region include milia, closed comedones, sebaceous hyperplasia, dermal melanocytic nevus, and other tumors like syringoma and hidrocystoma. All these may be differentiated from solitary TE only on the basis of histopathology. A close histopathological mimicker of solitary TE is basal cell carcinoma (BCC).[2] Histopathological features suggestive of BCC include epidermal ulceration, very few keratinous cysts, minimal stroma, dense inflammation, tumor lobules in adenoid and cystic patterns with basaloid epithelium forming peripheral palisade and presence of retraction artifact.[2] In the present case, however, clinical presentation with a small, long-standing, nonprogressive lesion without ulceration was against the possibility of BCC. This case is being reported for the rare clinical presentation of solitary TE and to highlight the importance of histopathology in confirming the accurate diagnosis in such small, solitary facial lesions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Teli B, Thrishuli PB, Santhosh R, Amar DN, Rajpurohit S. Giant solitary trichoepithelioma. South Asian J Cancer 2015;4:41-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gupta A, Ali MJ, Mishra DK, Naik MN. Solitary trichoepithelioma of the eyelid: A clinico-pathological correlation. Int J Trichol 2015;7:80-1.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Stoica LE, Dascălu RC, Pătraşcu V, Ciurea RN, Brănişteanu DE, Georgescu DM, et al. Solitary trichoepithelioma: Clinical, dermatoscopic and histopathological findings. Rom J Morphol Embryol 2015;56:827-32.  Back to cited text no. 3
    

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Correspondence Address:
Sanjiv Choudhary
Department of Dermatology, All India Institute of Medical Sciences, Nagpur, Plot No. 2, Sec- 20, MIHAN, Nagpur - 441 108, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_610_20

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