Benign follicular tumors

Abstract: Benign follicular tumors comprise a large and heterogeneous group of neoplasms that share a common histogenesis and display morphological features resembling one or several portions of the normal hair follicle, or recapitulate part of its embryological development. Most cases present it as clinically nondescript single lesions and essentially of dermatological relevance. Occasionally, however, these lesions be multiple and represent a cutaneous marker of complex syndromes associated with an increased risk of visceral neoplasms. In this article, the authors present the microscopic structure of the normal hair follicle as a basis to understand the type and level of differentiation of the various follicular tumors. The main clinicopathological features and differential diagnosis of benign follicular tumors are then discussed, including dilated pore of Winer, pilar sheath acanthoma, trichoadenoma, trichilemmoma, infundibuloma, proliferating trichilemmal cyst/tumor, trichoblastoma and its variants, pilomatricoma, trichodiscoma/fibrofolliculoma, neurofollicular hamartoma and trichofolliculoma. In addition, the main syndromes presenting with multiple follicular tumors are also discussed, namely Cowden, Birt-Hogg-Dubé, Rombo and Bazex-Dupré-Christol syndromes, as well as multiple tumors of follicular infundibulum (infundibulomatosis) and multiple trichoepitheliomas. Although the diagnosis of follicular tumors relies on histological examination, we highlight the importance of their knowledge for the clinician, especially when in presence of patients with multiple lesions that may be the cutaneous marker of a cancer-prone syndrome. The dermatologist is therefore in a privileged position to recognize these lesions, which is extremely important to provide further propedeutic, appropriate referral and genetic counseling for these patients.

Three different clinical faces of the same histopathological entity: hair follicle nevus, trichofolliculoma and accessory tragus

AbstractBACKGROUND:Hair follicle nevus is a rare, congenital hamartoma with follicular differentiation characterized histologically by numerous, tiny, mature hair follicles. Trichofolliculoma, the histopathological features of which are quite similar to those of hair follicle nevus, is also a hamartoma that differs from hair follicle. Accessory tragus is a relatively common, benign congenital abnormality of the external ear with an incidence rate of 1 to 10 per 1,000 live births.OBJECTIVE:This study seeks to assess the discriminatory value of currently available, histological criteria in the differential diagnosis of hair follicle nevus, accessory tragi and trichofolliculoma.METHODS:Twenty-one patients comprising 9 cases of hair follicle nevus, 8 accessory tragi patients and 4 trichofolliculoma cases, were recruited to perform the study.RESULTS:There were 10 males and 11 females in the study group. No significant difference was observed between the three study groups in terms of age, gender or histopathological parameters such as density of hair follicles, subcutaneous fat score and presence of connective tissue framework. Cartilaginous component was seen in 8 cases that were diagnosed as accessory tragi, while central cyst and radiating hair follicles were seen in 4 cases which were diagnosed as trichofolliculoma.CONCLUSION:The results of our study showed that diagnostic discrimination of these diseases could be made only with the clinicopathologic correlation because of their clinical and histopathological similarities.

[Evaluation of microvessel density in follicular cyst, keratocystic odontogenic tumor, and ameloblastoma]

Ameloblastoma is a benign epithelial odontogenic tumor that exhibits a more aggressive behavior than follicular cyst and keratocystic odontogenic tumor. The purpose of the current study was detection and evaluation of microvessel density [MVD] effect on growth and clinical behavior of above odontogenic lesions with immunohistochemistry. In this descriptive-analystic cross-sectional study, 45 paraffin blocks of mentioned lesions were selected and stained immunohistochemically with CD34. The mean MVD of each lesion in three microscopic fields was calculated separately and was evaluated in the two areas, adjacent and far from odontogenic epithelium and then were compared with one another. Mann-Whiteny and Kruskal Wallis tests were used for the statistical analysis. Mean microvessel density was 40.8 +/- 15.9, 25.4 +/- 5.3, and 9.4 +/- 5.3, and 9.4 +/- 3.52 in ameloblastoma, keratocystic odontogenic tumor, an dfollicular cyst, respectively. Mean microvessel density difference between the above mentioned lesions was statistically significant [P<0.001]. In all the odontogenic lesions, the microvessel density adjacent to odontogenic epithelium was higher than the areas far from the epithelium [P=0.001]. The increase in microvessel density in ameloblastoma compared to keratocystic odontogenic tumor and follicular cyst can be one of the main factors in ameloblastoma aggressive behavior. Angiogenesis adjacent to odontogenic epithelium has a more prominent role in growth of follicular cyst and progression and aggressive behavior of odontogenic tumors

Efficacy of fine needle aspiration [FNA] cytology in differentiating malignant and benign ovarian cysts

This study was carried out to determine the diagnostic efficacy of fine needle aspiration cytology between neoplastic and non neoplastic ovarian cysts and to verify the cytological diagnosis of aspirated fluid with histology of excised cyst. This was carried out at the Department of Obstetrics and Gynaecology, Ghurki Trust Teaching Hospital, Lahore from February 2003 to February 2005. It was an analytic study. A total number of 55 patients were included in the study. They were selected on the basis of ultrasonographic examination and having unilocular and non septate ovarian cysts. Ultrasound guided aspiration of cysts was done followed by excision. The cytology of fluid was correlated with histology of excised cyst. Follicular cysts were seen in the highest percentage followed by haemorrhagic luteal cysts, serous cyst adenomas and serous cyst adenocarcinomas. Ultrasound guided fine needle aspiration of ovarian cysts is a feasible alternative to surgery for benign cysts of the ovary

Unicystic granulosa cell tumor: a case report.

Granulosa Cell Tumors (GCT) constitutes 1.5% to 3.5% of all primary ovarian neoplasms. They may be solid, cystic or both. Unilocular cystic GCT are very rare. We report here a case of 32 years female with unicystic GCT in which the distinction from follicular cyst was difficult and was made by carefully examining the lining of the cyst,which showed occasional multiple layers of granulosa cells with a few Call-Exner bodies.