Hunt S J, Abell E
Department of Dermatology, University of Pittsburgh, Pennsylvania.
Am J Dermatopathol. 1991 Jun;13(3):275-81. doi: 10.1097/00000372-199106000-00010.
An unusual adnexal tumor on the scalp of a 59-year-old woman with hereditary trichoepithelioma is reported. After the initial removal, the tumor recurred twice during a 4-year period. Mohs micrographic surgery resulted in full excision of the lesion. Two years later there was no evidence of recurrence. Histologic examination of the tumor showed it to merge with adjacent areas of classic trichoepithelioma. The tumor showed cytologic atypia, mitotic figures, necrosis, deep infiltration, and features of pilar differentiation including clear cells, reminiscent of cells of the follicular outer root sheath, and focal shadow-cell formation. The differential diagnosis of this malignant follicular neoplasm included pilomatrix carcinoma and basal-cell carcinoma with matrical differentiation. The unique clinicopathologic features, however, raised consideration of a "malignant trichoepithelioma."
报告了一名患有遗传性毛发上皮瘤的59岁女性头皮上的罕见附件肿瘤。初次切除后，肿瘤在4年期间复发了两次。莫氏显微外科手术完全切除了病变。两年后没有复发迹象。肿瘤的组织学检查显示它与经典毛发上皮瘤的相邻区域融合。肿瘤表现出细胞异型性、有丝分裂象、坏死、深层浸润以及毛囊分化特征，包括透明细胞，让人联想到毛囊外根鞘细胞，还有局灶性影细胞形成。这种恶性毛囊肿瘤的鉴别诊断包括毛母质癌和具有母质分化的基底细胞癌。然而，独特的临床病理特征引发了对“恶性毛发上皮瘤”的考虑。
