BHD (introduction)

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Note: the Ochsner Clinicopathologic Skin Conference has been on-going since 1975. It was begun by Dr. William Perret. Currently Dr. Marilyn Ray is the Director. The cases for each conference are selected by Dr. Ray. Many of the cases have been contributed by residents on the Dermatology Service at either LSU School of Medicine or Tulane School of Medicine. This case was contributed by Dr. Trent Massengale, resident, Dermatology Service, LSU School of Medicine and Charity Hospital of New Orleans.

This young Black lady presented with a solitary pedunculated lesion on the rim of her right nasal ala. It was uniform in diameter and dome-shaped at its free extremity. Small hairs projected from the tip of the lesion. On the basis of the latter finding the clinical diagnosis was trichofolliculoma.

Fig 1: The polypoid lesion is strikingly follicular. A distorted, hyperplastic follicle is supported by a widened perifollicular sheath. From the central epidermal attachment, the follicle extends in branching patterns into the perifollicular connective tissue. Each column that projects from the central, vertically oriented follicle is invested with its own sheath of connective tissue. The entire lesion is separated from the adjacent dermis by a loose, delicate condensation of fibrous tissue. The lesion is biphasic; it has both epithelial and stromal components and these combinations qualify the lesion as a hamartoma. The green arrows identify branching follicles in anagen-like patterns. The red arrows identify catagen-like patterns. The rust-colored arrows outline a mantle-like pattern.


Fig 2: On some of the sections, the parent follicle is not only attached to the epidermis but also has a dilated lumen. The oval defects in the keratin layer of the follicle are defects where hair shafts have been lost during preparation of the specimen.


Fig 3: At some levels, the patterns have a lobulated quality. The lobule outlined by green arrows shows thin radiating cords of follicular epithelial cells. These mantle-like patterns also resemble patterns of fibrofolliculomas. The red arrows point to immature hair bulbs in pro-anagen-like patterns. The rust colored arrow points to an epithelial component with catagen-like patterns.


Fig 4: Some of the branching components show hair bulb differentiation (anagen patterns). The perifollicular component is prominent. At the extremity of the hair bulb, the "capsule" is represented.

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