Spindle Cell–Predominant Trichodiscoma With a Palisaded Arrangement of Stromal Cells
Notice bibliographique
Résumé
To the Editor: Spindle cell–predominant trichodiscoma is one of the histologic variants along the fibrofolliculoma–trichodiscoma hamartomatous spectrum.1 It features a central cellular stroma of spindled cells arranged in interweaving fascicles associated with prominent peripheral mitt-like sebaceous lobules.2 A variant of spindle cell–predominant trichodiscoma that demonstrated a focal palisaded arrangement of stromal cells reminiscent of schwannoma has been described.3 This variant is particularly interesting, given the historic classification of these lesions as neurofollicular hamartomas4–6 and its ability to resemble neural neoplasms. To the best of our knowledge, only one spindle cell–predominant trichodiscoma with a palisaded pattern has been presented in the English-language literature to date. Here, we present a second case, which featured a diffuse palisaded pattern. The lesion was excised from the nose of a 49-year-old woman. It was a solitary papule measuring 3 mm in diameter and was reported to have been present for 5 years, with an increase in size in the previous year. Clinically, it was thought to be either an intradermal nevus or a nodular basal cell carcinoma. Histologically, the lesion was a small circumscribed protuberant nodule located in the upper dermis and was composed primarily of haphazard fascicles of spindled stromal cells showing a prominent palisading pattern (Fig. 1). This striking palisaded pattern gave the lesion a neural-like appearance, quite reminiscent of schwannoma. There were some small vessels in the background and occasional lipocytes were also seen focally. Sebaceous lobules were present at the periphery of the central mesenchymal component, in a pattern that is in keeping with trichodiscoma.FIGURE 1.: Spindle cell–predominant trichodiscoma showing a prominent palisaded arrangement of stromal cells (A and B). Note the peripherally situated sebaceous lobules typical of trichodiscoma (A).Immunohistochemical stains revealed the stromal cells to be strongly and diffusely positive for CD34 and completely negative for S100 (Fig. 2). CD31 mainly highlighted background small vessels, with only quite minimal granular staining in stromal cells. There was also minimal patchy staining with CD10. Factor XIIIa highlighted scattered dendritic cells. Neurofilament, epithelial membrane antigen , smooth muscle actin, muscle-specific actin, desmin, h-caldesmon, collagen type IV, and MART-1 were negative. A Ki67 stain demonstrated a very low proliferative index.FIGURE 2.: The stromal cells are strongly and diffusely positive for CD34 (A) and are negative for S100 (B).This second reported case of a spindle cell–predominant trichodiscoma with a palisaded arrangement of stromal cells further demonstrates the degree of palisading that may be present within these lesions. As mentioned by Kacerovska et al,3 despite the resemblance the stromal component may have to schwannoma, the characteristic epithelial component is helpful in recognizing these lesions as trichodiscomas. Immunohistochemistry confirms the diagnosis.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
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| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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