Trikofoliküloma
Özet
Trikofoliküloma, kıl folikülünden kaynaklanan, nadir görülen benign (iyi huylu) bir deri eki tümörüdür. Genellikle orta yaşlı erkeklerin baş ve boyun bölgesinde, özellikle yüz ve skalpte deri renginde, kubbe şekilli, asemptomatik soliter bir nodül veya papül olarak izlenir. Etyolojisi tam olarak bilinmemekle birlikte, pluripotent deri hücrelerinden kaynaklandığı düşünülmektedir. Histopatolojik olarak merkezde, yüzeye ostiumlarla açılan ve keratinöz debris ile kıl fragmanları içeren genişlemiş primer infundibulokistik bir yapı barındırır; bu yapıdan çevreye doğru prolifere olan çok sayıda vellus kıl folikülü (sekonder ve tersiyer foliküller) ışınsal olarak uzanır. Sekonder foliküllerde sebase farklılaşma eşlik ettiğinde "sebase trikofoliküloma" olarak adlandırılır. İmmünhistokimyasal incelemede sekonder foliküller CK14 ve bazal tabaka CK15 pozitifliği gösterirken, CK1 ve CK10 ile boyanma izlenmez. Ayırıcı tanısında bazal hücreli karsinom, trikoepitelyoma, pilar kılıf akantomu ve folikülosebase kistik hamartom gibi lezyonlar yer alır. Çok nadir olarak malign transformasyon bildirilmiş olsa da prognozu oldukça iyidir. Tedavisi cerrahi eksizyon ile gerçekleştirilir ve operasyon sonrasında nüks (tekrarlama) olasılığı oldukça düşüktür.
Trichofolliculoma is a rare, benign cutaneous adnexal tumor originating from the hair follicle hamartoma. It typically presents as an asymptomatic, dome-shaped, flesh-colored solitary nodule or papule on the head and neck area, particularly the face and scalp of middle-aged men. Although its etiology remains unclear, it is thought to arise from pluripotent stem cells differentiating toward the hair follicle. Histopathologically, it is characterized by a dilated central primary infundibulocystic follicle opening to the skin surface via ostia, containing keratinous debris and hair fragments. Numerous secondary and tertiary vellus hair follicles radiate from this central cavity into the surrounding dermis. The presence of sebaceous differentiation within these secondary follicles defines the "sebaceous trichofolliculoma" variant. Immunohistochemically, secondary follicles express CK14 and the basal layer shows CK15 positivity, whereas CK1 and CK10 are negative. The differential diagnosis includes basal cell carcinoma, trichoepithelioma, pilar sheath acanthoma, and folliculosebaceous cystic hamartoma. Despite an extremely rare case reporting malignant transformation with perineural invasion, the overall prognosis is excellent. The definitive treatment is complete surgical excision, and recurrence is rarely observed.
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