Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 2415  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-IJD CASE REPORT
Year : 2016  |  Volume : 61  |  Issue : 1  |  Page : 121
Multiple giant pilar cyst distributed over the body since childhood


1 Department of Dermatology, Al Zahra Hospital, Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran
2 Department of Pathology, Isfahan University of Medical Science Isfahan, Isfahan, Iran

Date of Web Publication15-Jan-2016

Correspondence Address:
Amir Hossein Siadat
Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.174097

Rights and Permissions

   Abstract 

Trichilemmal cyst or pilar cyst is defined as a cyst containing keratin and its breakdown products. It is usually situated on the scalp with a wall resembling external hair root sheath. In this case report we present a 55-year-old man with multiple giant pilar cysts that were distributed over the whole body since childhood. One of the cyst on the chest was transformed to squamous cell carcinoma (SCC).


Keywords: Body, pilar cyst, squamous cell carcinoma


How to cite this article:
Asilian A, Siadat AH, Shahmoradi Z, Shariat S, Moghadam NA, Soozangar H. Multiple giant pilar cyst distributed over the body since childhood. Indian J Dermatol 2016;61:121

How to cite this URL:
Asilian A, Siadat AH, Shahmoradi Z, Shariat S, Moghadam NA, Soozangar H. Multiple giant pilar cyst distributed over the body since childhood. Indian J Dermatol [serial online] 2016 [cited 2019 Sep 22];61:121. Available from: http://www.e-ijd.org/text.asp?2016/61/1/121/174097

What was known?
Pilar cysts are common, and benign lesions and malignant transformation in them is extremely rare.



   Background Top


Trichilemmal cyst or pilar cyst is defined as a cyst containing keratin and its breakdown products. It is usually situated on the scalp with a wall resembling external hair root sheath. This is quite a common condition and women are affected more frequently than men. It is seen mainly in the at middle age and is inherited in an autosomal dominant fashion. [1] In this case report, we present a 55-year-old man with multiple giant pilar cysts that were present since childhood. One of the cyst on the chest was transformed to squamous cell carcinoma (SCC).


   Case Report Top


A 55-year-old man was referred to us because of multiple cystic lesions located on the body, some of them measuring several centimeters [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]. Most of the lesions were located on the left side of the body. The family history of patient was negative for similar lesions. These lesions were present since childhood, and during this period the patient had no complaint except cosmetic concerns. Patient had ignored these lesions for many years until one of the lesions on the chest became ulcerated and then infected [Figure 5]. We excised five of the lesions on different parts of the body. We also performed biopsy from the lesion of the chest. Pathology of the lesion located on the chest showed neoplastic proliferation of the epithelial cells. These cells had vesicular nuclei with prominent nucleolus along with eosinophilic cytoplasm. Atypia along with mild pleomorphism and mitosis was also observed [Figure 7]. The squamous nests and keratin pearl was also observed in some sections. Pathology of the five other lesions showed a cystic lesion covered with stratified squamous epithelium without granular layer containing homogenous laminated keratin. This pathology confirmed the diagnosis of pilar or trichilemmal cyst [Figure 8]. Mohs surgery was performed to excise large SCC of the chest, and the site of operation was repaired by split-thickness skin graft technique. The patient visited every month for 1 year and during this period he showed no sign of recurrence in the operation site. Also, no change was observed in the remaining pilar cyst of the patient and he is now followed every 6 months.
Figure 1: Multiple pilar cysts were located on the body, extremities and head. One of the lesions on the chest was transformed to SCC

Click here to view
Figure 2: A closer view of the Figure 1

Click here to view
Figure 3: Close up of lesions on the trunk

Click here to view
Figure 4: Pilar lesions on the back of patient

Click here to view
Figure 5: A close view of the SCC showing large infected ulcer

Click here to view
Figure 6: Pilar cyst of the scalp

Click here to view
Figure 7: Pathology of the lesion on the chest showing squamous nests in well-differentiated SCC

Click here to view
Figure 8: Pathology of pilar cyst showing trichilemmal pattern of keratinization (×400)

Click here to view



   Discussion Top


Pilar cysts are common, occurring in 5-10% of population. They are the second most common keratinizing cyst on the scalp. They are benign lesions and malignant transformation in them is extremely rare. Inheritance may occur in an autosomal dominant pattern. Pilar or trichilemmal cysts contain keratin and its breakdown products, lined by a wall resembling the external (outer) hair root sheath. Most pilar cysts occur on the scalp. [2] Our presented case has several interesting features. The patient had these lesions since childhood, although most patients with this lesions are affected in middle age. [3] The patient had negative family history for the same lesions. Although pilar cyst are usually observed on the scalp, the giant cystic lesions of our lesions were scattered over the whole body. [4] One of these lesions on the chest was transformed to squamous cell carcinoma that was excised using Mohs surgery. According to our literature review, up to now, there is no report regarding malignant transformation of the pilar cyst.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

 
   References Top

1.
Burns T, Breathnach S, Cox N, Gripffiths C. Rook`s Textbook of Dermatology. 7 th ed. 2004. p. 36.48-36.49.  Back to cited text no. 1
    
2.
Mohsin A. Pilar cyst. Available from: http://www.emedicine.com/derm/topic328.htm. [Last Updated 2006 Feb 14].  Back to cited text no. 2
    
3.
Holmes EJ. Tumors of lower hair sheath. Common histogenesis of certain so-called "sebaceous cysts," acanthomas and "sebaceous carcinomas". Cancer 1968;21:234-48.  Back to cited text no. 3
[PUBMED]    
4.
McGavran MH, Binnington B. Keratinous cysts of the skin. Identification and differentiation of pilar cysts from epidermal cysts. Arch Dermatol 1966;94:499-508.  Back to cited text no. 4
[PUBMED]    

What is new?
Pilar cysts may rarely transform to SCC and also may occur on many parts of the body.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,110 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Background
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed3063    
    Printed10    
    Emailed0    
    PDF Downloaded39    
    Comments [Add]    

Recommend this journal