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Presented by Pedram Argani, M.D. and prepared by Todd Sheridan, M.D.
Case 2: Eighty-four year old female with an 8 centimeter slowly growing scalp mass.
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1. Question
Week 236: Case 2
Eighty-four year old female with an 8 centimeter slowly growing scalp mass.images/8.15.05.PAcase2a.jpg
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images/8.15.05.PAcase2e.jpgCorrect
Answer: Proliferating pilar tumor
Histology: This is a large, lobular, squamo-proliferative lesion. The lesion is well delineated, having a pushing border with the underlying stroma. The lesion shows trichilemmal differentiation, consisting of abrupt keratinization into large squamoid cells with pale, eosinophilic, homogenous (glassy) cytoplasm. Significant cytologic atypia is not present, though mitotic figures are found.
Discussion: Invasive squamous cell carcinoma would infiltrate the dermis irregularly, and tends to show greater cytologic atypia. Pilomatricoma would be composed of primitive small round blue cells undergoing abrupt keratinization, and ossification is also frequently seen. These lesions typically affect children. Sebaceous adenoma should show areas of true sebaceous differentiation, consisting of lipidized cells with scalloped nuclei.
Proliferating Pilar Tumor, while histologically alarming due to the extensive keratinization, frequent mitoses, and reactive atypia, is typically cured by local excision. Metastases are vanishingly rare.
Incorrect
Answer: Proliferating pilar tumor
Histology: This is a large, lobular, squamo-proliferative lesion. The lesion is well delineated, having a pushing border with the underlying stroma. The lesion shows trichilemmal differentiation, consisting of abrupt keratinization into large squamoid cells with pale, eosinophilic, homogenous (glassy) cytoplasm. Significant cytologic atypia is not present, though mitotic figures are found.
Discussion: Invasive squamous cell carcinoma would infiltrate the dermis irregularly, and tends to show greater cytologic atypia. Pilomatricoma would be composed of primitive small round blue cells undergoing abrupt keratinization, and ossification is also frequently seen. These lesions typically affect children. Sebaceous adenoma should show areas of true sebaceous differentiation, consisting of lipidized cells with scalloped nuclei.
Proliferating Pilar Tumor, while histologically alarming due to the extensive keratinization, frequent mitoses, and reactive atypia, is typically cured by local excision. Metastases are vanishingly rare.
