Indian Journal of Dermatology
E-IJD QUIZ
Year
: 2015  |  Volume : 60  |  Issue : 4  |  Page : 425-

A painless nodule on the face of 60 year old female


Avinash A Sajgane, Atul M Dongre 
 Department of Dermatology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India

Correspondence Address:
Dr. Avinash A Sajgane
87/204 A Wing Madhukunj CHS, Nehru Nagar, Kurla East, Mumbai - 24
India




How to cite this article:
Sajgane AA, Dongre AM. A painless nodule on the face of 60 year old female.Indian J Dermatol 2015;60:425-425


How to cite this URL:
Sajgane AA, Dongre AM. A painless nodule on the face of 60 year old female. Indian J Dermatol [serial online] 2015 [cited 2021 Aug 2 ];60:425-425
Available from: https://www.e-ijd.org/text.asp?2015/60/4/425/160555


Full Text

A 60 year old female presented with a mass on the right side of the face, since 20 years. The mass was painless and gradually increasing in size. There was no history of trauma prior to the appearance of lesions. There was no history of any discharge from the mass. On examination, there was a single soft sessile nodule of size 3 × 2 cm on the right cheek [Figure 1]. The nodule was mobile over the underlying bone. There was no evidence of discharge, ulceration or cervical lymphadenopathy. There were no other lesions on the scalp and other parts of the body.{Figure 1}

Punch biopsy and histopathological examination of the lesion was performed.

Microscopic examination revealed multiple basophilic tumour islands packed together in the dermis [Figure 2]. Higher magnification revealed masses of epithelial cells which are surrounded by the hyaline sheath. Island of cells showed dark nuclei at the periphery and pale nuclei at the centre [Figure 3].{Figure 2}{Figure 3}

 Question



What is the diagnosis?

 View Answer

 Answer



Cylindroma.

 Discussion



Cylindromas are rare, benign adnexal tumours that classically arise on the scalp, face and neck. They appear as smooth dome shaped nodules. Cylindromas can occur as multiple lesions or solitary lesions. Solitary cylindromas occur more commonly than multiple ones. Multiple cylindromas can occur as a part of a dominantly inherited condition, the Brooke-Spiegler syndrome and are associated with other adnexal tumours like trichoepithelioma and spiradenoma. Multiple tumours are more common on the scalp while solitary cylindroma is common on the face. Tumours on the scalp can be so large in number that they may cover the entire scalp like a turban, thus earning the name of turban tumour. [1] Cylindroma shows female preponderance and female to male ratios of 6:1 and 9:1 have been reported. Solitary cylindromas affect the face and scalp of older adults and usually are not inherited.

Histologically, a cylindroma shows multiple tumour islands of various size and shape lying closely to fit together, giving the appearance of a jigsaw puzzle. These tumour islands consist of two types of cells. Cells with dark nuclei are seen at the periphery while cells with lightly stained nuclei are seen in the centre. Often, thick hyaline eosinophilic, periodic acid-Schiff stain (PAS) positive membrane can be seen around the tumor islands. This hyaline membrane is diastase resistance and immunoreactive to collagen IV. Eosinophilic hyaline material can be seen in the form of globules within the tumor islands. A variable number of tubules can also be seen within the tumor islands. Cylindromas may show apocrine or eccrine differentiation, of which apocrine is commonly seen. [2] Cylindromas need to be surgically excised. Cylindromas rarely undergo malignant degeneration. [3],[4]

References

1Mackie RM. Tumours of the skin appendages. In: Champion RH, Burton JL, editors. Textbook of Dermatology. 5 th ed, vol 2, London: Blackwell Science; 1998. p. 1713-4.
2Walter K, Edward C, Seykora J. Tumours of the epidermal appendages. In: Elder D, editor. Lever′s Histopathology of the Skin, 8 th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 897-8.
3Gerretsen AL, van der Putte SC, Deenstra W, Van Vloten WA. Cutaneous cylindroma with malignant transformation. Cancer 1993;72:1618-23.
4Hammond DC, Grant KF, Simpson WD. Malignant degeneration of dermal cylindroma. Ann Plast Surg 1990;24;176-8.