Como Tirar Tricoepitelioma?
O tricoepitelioma é um tumor benigno da pele derivado dos folículos pilosos, que leva ao surgimento de sintomas como pequenas bolinhas duras, nódulos ou caroços na pele que podem surgir como uma lesão única ou tumores múltiplos, sendo mais frequentes na pele do rosto, e aumentar em quantidade ao longo da vida.
Medical therapy with topical chemotherapeutic agents such as tretinoin and 5-fluorouracil were tried in the past, with minimal improvement. Since the tumor has a dermal location, topical remedies are generally unsuccessful.
Histopathology
Patients with desmoplastic trichoepitheliomas should be informed that, despite the benign nature of the tumor, these tumors can penetrate widely and have aggressive histologic features, subclinical growth, and occurrence in cosmetically important areas.
Complete surgical excision with histopathologic evaluation to rule out malignancy is the best option for definitive treatment of solitary trichoepitheliomas, if cosmetic outcomes allow. Deep shave of the lesion can be done, but dermal component may persist, increasing the chance of tumor recurrence. If the tumor is small, a punch excision around the visible tumor margins can be attempted.
Clínicamente, el tricoepitelioma se presenta como lesiones únicas o múltiples sobre el rostro, la variante múltiple inicia con neoformaciones papulares, rosadas o de color piel monomorfas que afectan la región centro-facial. Por lo general, son asintomáticas, habiéndose descrito prurito en muy pocos casos. Es un trastorno progresivo que evoluciona con incremento en el diámetro y la cantidad de lesiones, llegando a ser múltiples, confluentes y deformantes. En ocasiones desencadena trastornos ansiosos en los jóvenes afectados. El diagnóstico puede realizarse mediante una adecuada historia clínica y exploración física que incluya evaluación dermatoscópica. La histopatología, al igual que la inmunohistoquímica, confirma el diagnóstico4,5.
CONFLICT OF INTEREST
Frequent facial surgery may be disfiguring (i.e., scarring) and cause significant distress. Furthermore, multiple TEs/TBs associated with underlying genetic familial syndromes may recur after surgery, leaving numerous scars and invasive treatments throughout a patient’s lifetime.
Solitary trichoepitheliomas and trichoepitheliomas associated with multiple-familial trichoepitheliomas and Brooke-Spiegler syndrome all have similar features on histology. On histology, trichoepitheliomas consist of abortive hair papilla, keratinous microcysts, and islands of basaloid cells arranged in a lace-like network in a collagenous, hypocellular stroma (Figure 2, Figure 3).
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Since it is understood that the loss of wildtype allele of tumor suppressor genes is associated with tumor formation in multiple-familial trichoepitheliomas and Brooke-Spiegler syndrome, radiotherapy is not recommended, as it could result in further tumor induction. In addition, radiotherapy results in poikiloderma and increases the risk of basal cell and squamous cell carcinomas.
Rarely, TBs may arise in nevus sebaceus (of Jadassohn), which may appear as a translucent and verrucous plaque with central nodularity and pigmentation.[12] On the other hand, DTE often presents as white-to-yellow, firm skin-colored papules, plaques, or nodules with a central indentation on the face or cheeks.[9]
O tricoepitelioma é causado por mutações genéticas nos cromossomos 9p21 e 16q12-q13 durante a gestação, sendo comum os sintomas se desenvolverem na segunda década de vida, no caso do tricoepitelioma solitário.
Deterrence and Patient Education
A genetic workup may be necessary for patients with multiple or recurrent lesions, including an evaluation of chromosome 9q21 (for MFT) or the CYLD gene (for Brooke Spiegler syndrome).[15]
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Trichoepithelioma.
The tumours are small (usually less than one centimetre), firm, rounded and shiny. They may be yellow, pink, brown or bluish. They usually gradually increase in number with age, occurring on both cheeks, eyelids and around the nose.
Several surgical modalities have been successful in removing these dermal tumors. Most patients are agreeable to surgery, as resultant scarring is usually more acceptable than the appearance of the lesion itself. Since the tumors are benign, tumor bulk reduction for good cosmetic outcomes should be the aim, regardless of the surgical modality chosen.
Abstract
At present, there is no standardized classification system for trichogenic tumors, and several diagnostic terms have been proposed, but one should regard them as distinct entities until a universal classification system is established.
Multiple histologic variants of TB exist according to the updated 2018 World Health Organization (WHO) "Skin Tumors" classification, including nodular, retiform, cribriform, racemiform, and columnar. Less common variants of TB include clear cell, pigmented, and adamantinoid. Furthermore, dermatopathologists may recognize TE as a variant of TB with smaller tumor nodules and more superficial clusters of cells, and abundant fibrotic stroma. "Conventional" and "desmoplastic" TE may also be reported as "cribriform" and "columnar" TE, respectively. Another rare adamantine variant of TB has been described, referred to as cutaneous lymphadenoma, due to the prominent lymphocytic infiltrates within tumor nests.[10]
TE and TB are two common benign histologic mimickers of basal cell carcinoma. Histologically, TB appears as a sizeable dermal tumor without connection to the epidermis. It is well-circumscribed and composed of primitive basaloid cells that may arrange in multiple large or small nodules.