[Follicular cyst steadily pushes tooth upwards, with all the consequences thereof]. / Folliculaire cyste drukt gebitselement steeds hoger, met alle gevolgen van dien.

A 60-year-old man was referred to an oral and maxillofacial surgeon with discomfort caused by pressure on the left-hand side of the maxilla. Examination revealed a very elevated third molar in contact with the orbital floor and infundibulum, and, possibly, a follicular cyst. On account of the threat to the orbital floor, it was first decided to decompress the cyst and place an in situ drain. After 4 months, the tooth and cyst could be removed and the diagnosis of a follicular cyst was confirmed.Auteursinformatie.

A conscious minimally invasive approach to remove follicular cysts and infundibular keratinizing acanthomas in five dogs.

Follicular cysts and infundibular keratinizing acanthomas are common benign cutaneous lesions in dogs. Current treatment options include surgical excision under general anaesthesia, cryotherapy, carbon dioxide laser and retinoids, each with potential disadvantages. We describe a conscious, minimally invasive, surgical excision procedure with high success rate and no complications in five dogs.

Les kystes folliculaires et les acanthomes kératinisant infundibulaires sont des lésions cutanées bénignes fréquentes chez le chien. Les options de traitement actuelles comprennent l'exérèse chirurgicale sous anesthésie générale, la cryothérapie, le laser au dioxyde de carbone et les rétinoïdes, chacun présentant des inconvénients potentiels. Nous décrivons une procédure d'exérèse chirurgicale consciente, peu invasive, avec un taux de réussite élevé et aucune complication chez cinq chiens.

Los quistes foliculares y los acantomas queratinizantes infundibulares son lesiones cutáneas benignas comunes en perros. Las opciones de tratamiento actuales incluyen la escisión quirúrgica bajo anestesia general, crioterapia, láser de dióxido de carbono y retinoides, cada uno con posibles desventajas. Describimos un procedimiento de escisión quirúrgica consciente, mínimamente invasivo, con una alta tasa de éxito y sin complicaciones en cinco perros.

Cistos foliculares e acantomas infundibulares queratinizantes são lesões cutâneas benignas em cães. As opções terapêuticas existentes atualmente são excisão cirúrgica sob anestesia geral, crioterapia, laser de dióxido de carbono e retinoides, cada um com desvantagens potenciais. Nós descrevemos aqui um procedimento de excisão cirúrgica minimamente invasivo, consciente, com um grande potencial de sucesso e sem complicações em cinco cães.

Hyperreactio Luteinalis (Multiple Luteinized Follicle Cysts): A Report of 10 Cases.

Hyperreactio luteinalis is a rare entity arising in pregnancy and in the setting of gestational trophoblastic diseases (ie choriocarcinoma, molar pregnancy) that presents with, typically, bilateral ovarian enlargement due to numerous follicle cysts. While the phenomenon is benign and spontaneously regresses following delivery or treatment, a specimen may be seen in pathology when oophorectomy or cystectomy is performed to exclude malignancy or to manage acute complications such as torsion. Such resections may exhibit overlapping microscopic features with cystic granulosa cell tumors. We thus reviewed 10 cases of hyperreactio luteinalis in the setting of pregnancy, the largest pathologic cohort to date, to highlight notable features of this disorder. Patients ranged from 22 to 30 yr old. Most patients (n=6) presented at time of cesarean section with incidentally discovered ovarian masses. Three patients presented in the postpartum period, and 1 underwent surgery at 28 wk gestation due to the finding of a unilateral ovarian mass. The ovaries ranged from 8.5 to 29 cm and were multicystic and bilateral in 8 of the cases. Histologic examination demonstrated multiple, variably sized cystic follicles lined by a granulosa cell layer of varying thickness and theca cells with marked eosinophilic cytoplasm. Stromal edema was often prominent, with theca cells occasionally noted in nests, cords, and as single cells in foci of edema. Mitoses were generally seen more often in the granulosa cell layer (mean=2.6 per high power fields) compared with the theca cell layer (mean=1 per 10 high power fields). This series documents the key features of hyperreactio luteinalis that differentiate it from the other benign mass forming lesions encountered in pregnancy, most notably large solitary follicle cyst of pregnancy and puerperium, as well as cystic granulosa cell tumors, especially the juvenile variant, which may also present during pregnancy. Of particular use in differentiating them from juvenile granulosa cell tumor is the absence of pale or vacuolated cytoplasm and solid growth of granulosa cells in cases of hyperreactio luteinalis.

Incidence and clinical significance of lesions presenting as a scalp mass in adult patients.

BACKGROUND: Lesions initially presenting as a scalp mass are quite common entities with a wide spectrum of causes. They may be directly related to the scalp itself or may be secondary stigmata of an underlying process in the skull. The rate and clinical significance of the differential diagnosis of these lesions are not well studied in the adult population. METHODS: Three hundred sixty patients were operated on for scalp masses at our hospital between January 2011 and February 2014. The patients were defined retrospectively by using the hospital coding system for scalp lesions. Among these patients, 15 were excluded for being younger than 16 years old. RESULTS: A total of 345 patients, consisting of 172 females (49.9 %) and 173 males (50.1 %), were included in the study. The mean age at diagnosis was 44.3 (16-89). There were no mortalities during the follow-up period (mean 17.99 months). Mean numbers of scalp lesions and surgeries were 1.25 and 1.18, respectively. There were 32 distinct histopathological diagnoses, the 5 most common being trichilemmal cyst, epidermal cyst, lipoma, nevus and sebaceous cyst in order of frequency. The rate of "clinically significant" pathologies, meaning malignancies or those needing follow-up, was around 7.8 %. The incidence of correct preoperative diagnosis with respect to the departments was 13-27 %. CONCLUSIONS: Our series indicated that generally scalp masses were underestimated and detailed preoperative diagnostic workup or interdisciplinary consultations were not performed regularly. The overall incidence of clinically significant lesions warrants a high degree of vigilance for accurate diagnosis and management of these lesions, because their etiology can be so variable and challenging.

Orbital malign trichilemmal tumor with cerebral involvement.

Proliferating trichilemmal tumor is a rare encountered neoplasm. This neoplasm is usually benign, but it may be locally aggressive. To the best of our knowledge, magnetic resonance (MR) imaging features of cerebral involvement of this unusual neoplasm have not been described. We report the MR imaging findings of a case of malign proliferating trichilemmal tumor, with cerebral involvement.

Hereditary trichilemmal cysts: a proposal for the assessment of diagnostic clinical criteria.

Trichilemmal cysts (TCs) can occur as sporadic lesions or in hereditary-familial settings with autosomal dominant transmission. These entities have not been widely analyzed in their peculiar aspects yet. The aim of this study was to describe a cohort of patients with diagnosis of TCs through a clinical and biomolecular characterization, intended to highlight some effective diagnostic criteria for their identification. Among 149 cases of this study, 24 cases of TCs (16.1%) arose in patients with at least one first-degree relative with diagnosis of TCs. Peculiar findings concerning hereditary lesions included the multiple presentation with an early onset age. On the basis of clinical evaluation, we propose a panel of clinical and histologic criteria for the diagnosis of hereditary TCs, which includes: (i) the diagnosis of TCs in at least two first-degree relatives or in three first- or second-degree relatives in two consecutive generations; (ii) at least one of the patients with TCs diagnosed <45 years; and (iii) the diagnosis of multiple or giant (>5-cm lesions) or rare histopathologic features (proliferating and ossifying) TCs.

Cystic tricholemmal carcinoma in situ.

An 89-year-old man presented with a clinically cystic 4-mm papule on the left temple. The clinical impression was a benign cyst. Pathologic examination revealed a small, symmetric-appearing, well-circumscribed, dermal-based cystic lesion with markedly atypical-appearing clear to squamoid cells lining the cyst wall, consistent with carcinoma in situ involving the cyst. The cells showed abundant glycogen-containing cytoplasm (confirmed by Periodic acid Schiff stains with and without diastase), consistent with tricholemmal differentiation, and areas of tricholemmal/pilar-type keratinization (without a granular layer), consistent with tricholemmal carcinoma in situ, most likely arising in a tricholemmal/pilar cyst. Ki-67 and p53 immunohistochemical stains were strongly positive (with more than 20% of nuclei staining on Ki-67 and more than 80% on p53) in the cyst-lining cells, further supporting the interpretation of carcinoma in situ. Multiple deeper level sections were examined but did not show any evidence of an associated invasive carcinoma. Tricholemmal (pilar) cysts are common benign adnexal lesions and atypia/dysplasia or carcinoma in situ arising within them is exceedingly rare. Previously, only one case of a tricholemmal cyst with carcinoma in situ has been reported. That case was associated with an atypical fibroxanthoma. We report only the second case of tricholemmal carcinoma in situ, most likely involving a tricholemmal cyst, which was not associated with another tumor or evidence of invasive carcinoma.

Recurrent proliferating trichilemmal tumor of the vulva: a case report.

Proliferating trichilemmal tumor (PTT) is a rare but morphologically distinct tumor that usually arises on the scalp of elderly women. It is composed of multiple cysts consisting of squamous epithelium with trichilemmal keratinization without granular layer interposition. Vulvar proliferating trichilemmal cyst is very rare, with, to the best of our knowledge, only 3 cases previously reported in the literature. We describe a 39-year-old woman with recurrent PTT on the left labium majus of the vulva, which had been excised from the same side 5 years before. She had a palpable nodule, approximately 2 cm in size, which was firm, mobile, and nontender; without erythema and ulceration; and covered by normal skin on the vulva. There was no inguinal lymphadenopathy. The lesion was removed by wide surgical excision; because of the tissue elasticity, primary closure was possible. The pathology result was reported as proliferating trichilemmal carcinoma with tumor-free margins. Although local recurrence after wide excision is rare, we recommend complete excision for treatment of PTT and long-term follow-up because of the possibility of recurrence.

Trichofolliculoma: a rare variant of hair follicle hamartoma.

Trichofolliculoma is a rare hair follicle hamartoma, which is often regarded as a hair follicle tumor. Mostly, it presents as a papule or nodule, involving the skin of the face and scalp area. A central, dilated keratin plugged ostium with vellus hair(s) is often present. We report a 19-year-old woman with typical clinical and histopathological findings of trichofolliculoma.

Umbilicated nodule over eyebrow.

Trichofolliculoma is a pilosebaceous follicle hamartoma in which several hairs are formed within single pilosebaceous unit and protrude out of single orifice. Herein we report a 45-year-old woman with a trichofolliculoma of the eyebrow.

[A diagnosed follicular cyst turned out to be a squamous cell carcinoma]. / Een gediagnosticeerde folliculaire cyste bleek een plaveiselcelcarcinoom.

A 50-year-old man had undergone a complicated removal of tooth 48 which initially seemed related to a follicular cyst. Subsequently, it turned out that a squamous cell carcinoma had probably developed from the follicular cyst. The patient underwent excision of the tumour, hemimandibulectomy, a neck dissection, and reconstruction of the mandibula using a metal plate, followed by postoperative local radiotherapy. This type of development of a squamous cell carcinoma presents very rarely. From the literature, it can be concluded that the prognosis is unfavourable and that the tumour tends to grow aggressively. In case of abnormal wound healing after the removal of a tooth (with a follicular cyst), it is recommended to examine representative tissue histologically.

Fresh-frozen human bone graft to repair defect after mandibular giant follicular cyst removal: a case report.

The purpose of this article is to report the clinical, radiographical and histological findings about a case of a young woman affected by a mandibular giant follicular cyst. Conservative tumor resection was followed by immediate reconstructive treatment using fresh frozen human bone graft, instead of autologous bone graft, as material for bone regeneration. Follicular cyst is a benign, non invasive lesion with slow but progressive growth. Radiological and histological examination of the lesion confirmed the presence of a follicular cyst which underwent biopsy evaluation before enucleation. According to literature, conservative treatment was performed with optimal prognosis. At 24 months post surgery no evidence of recurrency was objective; the CT scan revealed optimal bone formation inside the reconstructed site. The use of fresh frozen bone allograft, thanks to its osteoinductive and osteoconductive properties, can be a safe choice for reconstruction of bone defects after jaw cysts removal.

[Perforating and ruptured trichilemmal cyst with metaplastic ossification]. / Perforierende rupturierte Trichilemmalzyste mit metaplastischer Ossifikation.

Trichilemmal cysts can occur as multiple scalp lesions and may have a familial history. Metaplastic ossification, as seen in several traumatic, inflammatory or neoplastic conditions, however, seems to be an exceedingly rare event in trichilemmal cysts and might be associated with previous rupture.

[Folliculosebaceous cystic hamartoma: anatomo-clinical study]. / Hamartome folliculo-sébacé kystique : étude anatomoclinique.

BACKGROUND: Folliculosebaceous cystic hamartoma (FSCH) is a relatively recently described malformation with follicular and sebaceous components and a particular type of stroma with adipocytes. We conducted an anatomo-clinical study in order to clarify the clinical and histological characteristics of FSCH. MATERIALS AND METHODS: We included all cases of FSCH diagnosed between 1985 and February 2011 at our dermatopathology laboratory. Clinical information was obtained from medical records and requests for histological examination. RESULTS: We studied 25 cases of FSCH in 25 patients of mean age 51 years. The sex ratio was 1.3. The mean disease duration was 9 years. Lesions were described mainly as flesh-colored, occasionally pedunculated nodules and were found primarily on the face (60%). The diagnosis of FSCH had never been mentioned by the clinician. Histological examination revealed in all cases one or more follicular cystic structures surrounded by sebaceous glands in a stroma containing adipocytes. A number of variants were identified, such as the presence of a mucinous stroma, a neuroid component with protein S 100 expression, and rudimentary hair follicles in adjacent dermis. One case involved a proliferating cyst while another was on the scalp in the area of pre-existing radiodermatitis. Only one relapse was noted, 5 years after the initial excision. DISCUSSION: FSCH is a benign, underdiagnosed lesion, localized on the face, particularly on the nose. It is dome-shaped or pedunculated and grows slowly. Differential diagnoses include nevus lipomatosus superficialis and "sebaceous" trichofolliculoma. FSCH can be readily identified by the presence of adipocytes and a fibrous stroma. One case was unique in its appearance of a large pedunculated nodule with a proliferating cyst. Prior to the invidualization of this entity, such cases were interpreted as nevus lipomatosus superficialis or "sebaceous" trichofolliculoma, although their histological appearance was inconsistent with such a diagnosis.

Management and outcomes of adnexal torsion: a 5-year experience.

PURPOSE: To discuss the surgical results of patients with diagnosis of adnexal torsion. METHODS: One hundred and fifty patients with diagnosis of adnexal torsion who presented to our clinic between January 2005 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of mass, operation time, and duration of hospitalization were recorded and compared between the patients who had laparoscopy to those who had laparotomy. The pathological results of patients were also recorded. RESULTS: Fifty-eight patients were treated laparoscopically while 92 patients had laparotomy. The most frequent presenting symptom was pelvic pain (96%). Laparoscopy group consisted of young patients with low parity; operation and hospital stay time was shorter in laparoscopy group. Velocity loss in Doppler ultrasonography was noted in 81.3% of the patients. Of the laparotomy group 35 postmenopausal patients had hysterectomy and bilateral salpingo-oopherectomy, and staging surgery was done for 16 of them. The pathological finding was found to be malignant in four and borderline serous tumor in four patients. CONCLUSION: Laparoscopy is preferred for young patients who want to preserve their fertility. Because of high risk of malignancy in postmenopausal ovarian masses presenting with torsion; frozen section should be used. If not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.

Patholologic fracture of the mandible after removal of follicular cyst.

OBJECTIVE: The objective of the study was to report a 61-year-old man who presented a complication after mandibular follicular cyst removal. METHODS: The patient underwent surgery, via intraoral approach: removal of the lesion and the dental follicle with curettage and extraction of the mandibular right third molar. Two weeks after surgery, the patient reported a slight malocclusion. The x-ray showed a fracture near the right mandibular angle. The fracture was treated by application of a long mandibular plate. RESULTS: Two years after surgery, the patient is asymptomatic. Inferior alveolar nerve sensitivity returned completely. CONCLUSIONS: In the reported case, a satisfactory result was obtained after the treatment of the complication confirmed by postoperative x-rays.

Follicular cyst of the jaw developing into a keratocyst in a patient with unrecognized Gorlin-Goltz syndrome.

Gorlin-Goltz (GG) syndrome is an inherited autosomal dominant condition. Its diagnosis may be clinically confirmed by checking either major or minor signs that define the diagnostic criteria. It may occur that, although GG syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed into an always complex clinical panel. We introduce an example in this report. Throughout a 20-year clinical history characterized by the lack of proper diagnosis and missed follow-up operations, a patient with GG syndrome underwent partial amputation of the jaw after severe complications. A 52-year-old man required an implant-prosthetic rehabilitation since becoming edentulous after a partial resection of the jaw due to a keratocyst, which was later reconstructed through a free fibula flap. The observation of a typical phenotype and various symptoms that succeeded for longer than 20 years, with anamnestic evaluation and clinical examination, led us to suspect a complex pathologic condition such as GG syndrome, which was not previously considered, although the patient had undergone several polyspecialistic evaluations. Diagnosis has been eventually confirmed by a genetic study, which was always mandatory. The simultaneous presence of muscular and skeletal malformations, basocellular nevi, and multiple cysts of the jaw can represent signs linking to a condition such as GG syndrome. There are many syndromes involving the head and neck region, and specialists are supposed to be alerted when faced with similar typical expressions associated with a characteristic soma so as to avoid delays in diagnosing the syndrome.

Multiple perianal infundibular follicular cysts in a dog.

This case report describes a 7-year-old male cocker spaniel dog with multiple perianal infundibular follicular cysts. Clinically the dog had moderate anal sacculitis, peri-anal pruritus causing it to 'scoot' and lick the area. On examination of the perianal area, there were over 100 firm, well circumscribed papules, ranged from 0.2 to 0.5 cm in diameter with a central pore, and were found in the perianal region. Alopecia was present in the perianal region. The skin tissue in the perianal region resected surgically was submitted for histological examination. Microscopically, the tissue revealed multiple dilated cysts filled with keratins and the papules corresponded to infundibular follicular cysts. The affected dog showed moderate anal sacculitis. Anal sacculitis commonly causes repeated scooting or licking the area around the anus. Therefore, the multiple follicular cysts in the present case appear to be primarily a sequela to chronic external trauma to the perianal area, probably in response to anal sacculitis. To the best of the authors' knowledge, the present report is the first documented case of multiple perianal infundibular follicular cysts in a dog.