FOLLICULAR TUMORS

Question 1

Identify the pointed structures

Answer 1

Question 2

Answer 2

STEM / SUPRABULBAR AREA

Question 3

Identify the pointed structures

Answer 3

Question 4

Answer 4

Isthmus

Trichilemmal keratinization - without granular layer

Question 5

Answer 5

Infundibulum - lined by epithelium identical to the epidermis; (+) granular layer

Question 6

follicular tumors with infundibulum differentiation

Answer 6

• Trichoadenoma
• Dilated pore of winer
• Folliculo-sebaceous cystic hamartoma (FSCH)

Question 7

Follicular tumors with Outer root sheath/ trichilemmomal differentiation

Answer 7

• Inverted follicular keratosis
• Pilar sheath acanthoma
• Trichilemmoma
• Trichilemmal/ pilar cyst
• Proliferating trichilemmal/ pilar cyst

Question 8

Follicular tumor with hair matrix differentiation

Answer 8

Pilomatricoma

Question 9

Question 10

Answer 10

Question 11

Answer 11

• central crater keratinizes through a granular layer
• smaller bluish projecting epithelial buds

Question 12

Answer 12

• central crater keratinizes through a granular layer
• Bigger buds than that of dilated pore; w/ isthmic character;
• (+/-) duct.

Question 13

Answer 13

• Central cystic structure that opens to the skin; with infundibular differentiation .
• Smaller secondary mature or immature/abortive follicles radiate out into the dermis. (Inferior segment differentiation)
• Interfollicular bridges connect radiating follicular structures
• Surrounding Stroma: fibrotic & “encapsulates” the neoplasm

Question 14

Answer 14

DILATED PORE (of WINER)

Question 15

Answer 15

PILAR SHEATH ACANTHOMA

Question 16

Answer 16

TRICHOFOLLICULOMA

Question 17

Answer 17

Question 18

Answer 18

• CATEGORY: CYSTS
• Dermal-based cyst
• Lined by stratified squamous epithelium WITHOUT a granular layer
• Central abrupt compact keratinization (trichilemmal differentiation)
• Epithelial lining resembles isthmus follicular outer root sheath

Question 19

Answer 19

Question 20

Answer 20

Question 21

Answer 21

• no koilocytes

Question 22

Answer 22

TRICHILEMMOMA

• Multiple trichilemmoma – a major criterion for Cowden’s syndrome.
• a wart-like silhouette; hyperkeratosis, hypergranulosis, even epidermal colarette,
• thickened epithelium w/ bulbous lobular contour
• pale or clear cells;
• peripheral palisading at the outer margin
• thick basement membrane.
• (+/-) squamous eddies and microcysts

Question 23

Multiple trichilemmoma is seen in what syndrome

Answer 23

Cowden’s Syndrome

Question 24

Answer 24

Question 25

Answer 25

Question 26

Answer 26

Trichoblastoma

Question 27

Answer 27

Question 28

Answer 28

Question 29

How can you differentiate TRICHOBLASTOMA (TB) / TRICHOEPITHELIOMA (TEP) VS BCC

Answer 29

Question 30

SYNDROMES WITH TRICHOBLASTOMAS/ TRICHOEPITHELIOMAS

Answer 30

• Brooke Fordyce syndrome: multiple trichoblastomas
• Brooke Spiegler Syndrome: Spiradenomas, cylindromas, and trichoepitheliomas (cribriform trichoblastomas)
• Rombo syndrome: Atrophoderma vermiculata, milia, hypotrichosis, BCC, trichoepitheliomas, peripheral cyanosis
• Bazex syndrome: : Atrophoderma vermiculata, hypotrichosis, hypohidrosis, trichoepitheliomas, BCC.
• Gardner’s Syndrome: Epidermoid cysts, desmoid tumors, multiple trichoepitheliomas, fibromas, lipomas, leiomyomas, osteomas
• Rassmusen’s syndrome: Trichoepitheliomas, milia and cylindromas
• Multiple Familial Trichoepithelioma*

Question 31

Answer 31

Question 32

most frequent benign secondary lesion arising from Nevus sebaceus

Answer 32

Syringocystadenoma papilliferum followed by trichoblastoma

Question 33

Most common malignant lesion arising from nevus sebaceus

Answer 33

BCC