Demant Mia, Saltvig Iselin, Trøstrup Hannah, Schmidt Volker J, Hesselfeldt Jørgen
Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark.
Case Rep Dermatol. 2020 Dec 2;12(3):266-274. doi: 10.1159/000509764. eCollection 2020 Sep-Dec.
Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.
毛发母细胞瘤（TBs）极为罕见，是一种可模仿基底细胞癌（BCC）的良性毛胚肿瘤。它们通常发生于头颈部，虽恶变可能性小，但仍有恶变可能。我们报告一例发生于一名75岁健康女性前额的巨大毛发母细胞瘤。自20岁起，她就发现前额有一肿物，现肿物表面出现一个看似表浅的伤口。最初，一名皮肤科医生对疑似基底细胞癌的肿瘤进行活检，组织学分析证实了该诊断。随后患者被转诊至整形外科，以便完整切除包括额部巨大肿物在内的癌灶。令人惊讶的是，最终的病理报告将诊断从基底细胞癌改为毛发母细胞瘤。目前大多数皮肤病变的处理依赖于单次穿刺活检的组织病理学亚型。许多良性和恶性皮肤疾病可能模仿基底细胞癌，因此误诊可能导致不必要的切除或转移性疾病的治疗延迟。模仿者可能包括各种非肿瘤性病变、良性附属器肿瘤（包括毛发母细胞瘤）或具有基底样特征的皮肤癌。单次穿刺活检并不总是足以做出正确诊断。虽然它被认为是金标准，但临床评估同样重要。由于其恶变可能性，建议切除切缘阴性的毛发母细胞瘤。
