Annals of Case Reports (ISSN: 2574-7754)

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Proliferinting Trichilemal Tumor: Case Report

Authors: Isabela Bercovici Soares Pereira1, Júlia Guimarães Pereira1, Renata de Oliveira Belo Custódio dos Santos1, Danilo Queiroz Dantas¹, Fernanda Moreira Boaventura1, Ana Carla De Oliveira Johnen1, Eduardo Achar² and João Kleber de Almeida Gentile3*

*Corresponding Author: João Kleber de Almeida Gentile, General Surgeon and Digestive Surgeon. Titular Member of the Brazilian College of Surgeons TCBCD. Preceptor of the Surgical Skills Discipline of FM-UNICID. Fellow of American College of Surgeons (FACS), Brazil.

1Graduates in Medical Sciences at the Faculty of Medicine of the Universidade Cidade de São Paulo. Member of the League of General Surgery and Trauma of FM-UNICID. São Paulo-SP, Brazil

2Assistant Professor, Experimental Surgery, UNICID, São Paulo - SP, Brazil

3General Surgeon and Digestive Surgeon. Titular Member of the Brazilian College of Surgeons TCBCD. Preceptor of the Surgical Skills Discipline of FM-UNICID. Fellow of American College of Surgeons (FACS), Brazil

Received Date: 16 February, 2022

Accepted Date: 22 February, 2022

Published Date: 25 February, 2022

Citation: Pereira IBS, Pereira JG, Santos Renata OBC, Dantas DQ, Boaventura FM, et al. (2022) Proliferinting Trichilemal Tumor: Case Report. Ann Case Report 7: 783. DOI:


The proliferinting trichilemmal tumor is a unusual condition that develops from follicular cystic lesions with rare reports of metastases. We report a case of a male, 48 years old, who had multiples tumors up to 2 centimeters in the scalp and neck first noticed 1 year ago, with recent demand for complete surgical exeresis.

Case Report

A 48-year-old male patient, with controlled schizophrenia, referred to the hospital reporting the appearance of three nodular lesions on the posterior left side of the neck, right side of the scalp in the temporal region and left occiptal region of the scalp, noticed 1 year ago.

The tumors showed areas of tessiu with acantholysis and queritinized center, which is representative of trichilemmal differentiation. The histological findings were consistent with proliferinting trichilemmal tumor.

The complete cirugical exeresis was performed in hospital. The histopatologic exam revealed an intradermic proliferation with lobular architecture and irregularities, formed by epithelial eosinophilic cluster, with pleomorphism and nuclear atypias forming a fibrous pseudocapsule.


The proliferating trichilemmal tumor is a rare and pseudomalignant lesion as can be seen in literature reviews (Table 1), described in 1966 by Wilson Jones.

Pseudomalignity is due to histological presentation, which may be similar to squamous cell carcinoma. The occurrence mainly affect female patients (more than 90% of cases) and elderly women. The most affected

regions of the body involve areas with greater exposure to the sun's rays and which have a higher density of hair follicles since it evolves from the hair follicle isthmus such as the scalp, for example, but can also develop in other areas like the trunk and neck. Its pathogenesis is unknown; however, in some cases there is the presence of Human Papilloma Virus (HPV), raising the hypothesis that there is some relationship between the presence of the virus and the development of the tumor. Clinically, it manifests as a solitary, well-circumscribed, nodular tumor, of variable size and slow growth, which may present inflammatory signs. The lesion area commonly presents alopecia, as well as atrophy or ulceration of the edges. Diagnostic confirmation is done by anatomopathological examination. Macroscopically, the lesions are multinodular and in the superficial section, the cysts are filled with keratin and calcifications. Microscopically, it is presented as a well-defined solid-cystic mass that affects the dermis and can extend to the subcutaneous tissue. The characteristic histological marker is the presence of trichilemmal keratinization, in which there is an abrupt transition from epithelial nucleated cells to keratinized anucleated cells and, also, there is absence of the granular layer. Other exams, such as magnetic resonance and ultrasonography, are important for differential diagnosis, prognosis and adequate treatment. The differential diagnosis includes several entities, among then malignant proliferation and squamous cell carcinoma. Treatment consists of resection with safety margins. The prognosis in most cases is optimistic but there are caveats for cysts that present cell atypia as a histopathological finding due to the possibility of malignant evolution.



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(Proliferating trichilemmal tumour) OR (Proliferating trichilemmal tumours)




(Proliferating trichilemmal tumour) OR (Proliferating trichilemmal tumours)

OR (Tumor triquilemal proliferante)



Table 1: Results of systematic search in databases with the descriptors in health (DeCS) and Medical Subheadings (MeSH) carried out on October 3, 2020.


  1. Oluyori Kutulola Adegun, Simon Morley, Nicholas Kalavrezos, Amrita Jay (2019) Proliferating trichilemmal tumour: diagnostic challenge on core biopsy. BMJ Case Rep. 12: e226567
  2. Ediel Valerio, Fernando Henrique Sgarbi Parro, Mariana Petaccia de Macedo, Clovis Antonio Lopes Pinto (2019) Proliferating trichilemmal cyst with clinical, radiological, macroscopic, and microscopic correlation. An Bras Dermatol. 94: 1806-4841.
  3. Oscar Tellechea, José Carlos Cardoso, José Pedro Reis, Leonor Ramos, Ana Rita Gameiro, et al (2015) Benign follicular tumors. An Bras Dermatol. 90: 1806-4841.
  4. Luíza Helena dos Santos Cavaleiro, Fernanda de Oliveira Viana, Clivia Maria Moraes de Oliveira Carneiro, Mario Fernando Ribeiro de Miranda (2011) Tumor triquilemal proliferante: relato de caso. An. Bras. Dermatol. 86.
  5. D’AVILA Denise Graffitti, Et Al. (2017) Cisto Triquilemal Proliferante Localizado Na Região Perianal: Um Achado Excepcional. Journal Of Coloproctology.
  6. Ocanha, Juliana Polizel et al. (2013) Tumor triquilemal proliferante. Diagnóstico & Tratamento.
  7. Theresinha C. Fonseca, Camila L. Bandeira, Bruno A. Sousa, Terence P. Farias, Ana Lúcia A. Eisenberg (2016) Proliferating trichilemmal tumor: case report. Jornal Brasileiro de Patologia e Medicina Laboratorial. 52: 120-123.
  8. Thiago Souza, Fabio Francesconi, Daniel Auade, Marcos Ricci (2011) Giant proliferating trichilemmal cyst with latissimus dorsi bilateral myocutaneous flap closure. Surgical And Cosmetic Dermatology. 3: 355-357

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