Proliferating Trichilemmal Cyst with Lymphadenopathy: A Discussion of Cutaneous Neoplasms Involving the Scalp - Abstract
This paper introduces a unique case example of a trichilemmal scalp cyst that was
initially erroneously diagnosed as a cancerous lesion because of its proliferating cellular
morphology. The evaluation and treatment histories of this patient are augmented by
a detailed review of the literature on this condition, especially with respect to cases
of rare malignant transformation to squamous cell carcinoma. Whereas proliferating
pilar or trichilemmal cysts are uncommon tumors that rarely undergo malignant
transformation [1]. Squamous cell carcinomas with metastasis to regional head
and neck lymph nodes rarely develop from proliferating pilar cysts. However, such
degeneration has been reported in the literature [2]. These lesions are fraught with
significant morbidity and mortality, and their treatment usually consists of substantial
surgical excision. Histopathologic evidence of malignancy often demands adjuvant
regimens of radiation therapy (+/-chemotherapy) [3]. The purpose of this case report
is to present a patient with an ulcerative, necrotic scalp mass and lymphadenopathy
whose initial biopsy demonstrated squamous cell carcinoma. Surgical excision and
posterior unilateral posterior neck dissection was performed with final pathology of
proliferating trichilemmal cyst. At the close of the case history a detailed review of the
literature is presented, particularly with respect to head and neck lesions that have the
potential for malignant transformation.