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Three patients with desmoplastic tricholemmoma with an incidental histological surprise impacting on management
  1. Tsiang Ung1,
  2. Jennifer H Tan1,
  3. Hardeep Mudhar1,2
  1. 1Eye Department, Royal Hallamshire Hospital, Sheffield, UK
  2. 2Department of Pathology, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Tsiang Ung, Eye Department, Level A, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; ctu195{at}yahoo.co.uk

http://dx.doi.org/10.1136/bjo.2010.187856

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    Case 1

    A patient was referred for removal of a persistent ‘benign’ lower lid lesion. She previously had two shave excision biopsies for ‘papilloma’ of the right lower lid by the nurse practitioner. Her recurring symptoms included redness, and crusting at the lid margin. An excision biopsy showed an incompletely excised desmoplastic tricholemmoma (DT-figure 1A–D; see legend). A year later, a rapidly expanding, recurrent lesion was seen at the same site. An excision revealed an unexpected nodular basaloid tumour (figure 1E–G).

    Figure 1

    (A) H&E-stained section containing the desmoplastic tricholemmoma (DT) from case 1. The white arrow points to the desmoplastic component, and the black arrow points to the non-desmoplastic component. Note how the desmoplastic component is composed of irregular cords of cells. (B) Higher-power-magnification H&E-stained section of the black arrowed area from (A). The cells of the nodular tricholemmoma component exhibit clear cytoplasm with bland nuclei. (C) H&E, showing a higher-power magnification of the desmoplastic component. The black arrow points to the stromal desmoplasia, and the white arrow points to the basement membrane. The sections are from case 1. (D) CD34 immunohistochemistry stain with the desmoplastic component and the non-desmoplastic component from case 1 (bottom-left inset) expressing CD34 strongly, confirming the diagnosis of desmoplastic tricholemmoma. The lesion was negative for BerEP4 (not shown). The sections are from case 1. (E) H&E. The black arrow points to the basal cell carcinoma that developed in case 1 after incomplete excision of the DT. (F) Higher-power-magnification H&E-stained section of (E) showing the basaloid cells, mitotic figures (black arrow), palisade of cells and lack of a distinct basement membrane (white arrow) around the tumour cells. These are typical features of a basal cell carcinoma. The sections are from case 1. (G) Immunohistochemistry with BerEP4 showing a positive signal on the nodular basal-cell carcinoma (BCC) …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.