Fibrosing Patterns
C4

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Follicular Hamartoma Syndrome Figures
Used as part of the presentation and discussion of
Case 5 of the Ochsner Clinicopathologic Skin Conference
Presented and discussed by R.J. Reed, M.D.



Fig. 11: Three follicles are represented in cross section. The red arrow points to a follicle showing the pattern of fibrofolliculoma with mantle-like patterns and perifollicular fibrosis. The green arrows identify follicles that are not significantly distorted in the plane of the section but there is perifollicular fibrosis (perifolliculoma pattern). A sebaceous gland is associated with the follicle on the right.


 

Fig. 12: The lesion is slightly polypoid. The pattern is mantle-like with perifollicular fibrosis and sebaceous gland lobules (fibrofolliculoma pattern)


 

Fig. 13: There is a plaque of fibrous tissue that presses upon the epidermis and is parallel to the surface of the skin. To the right there is nodular protrusion into the dermis that might prove to be a perifollicular component on additional section. A follicle is represented eccentrically to the left and shows perifollicular fibrosis. The combination of features in this lesion satisfy the criteria for the diagnosis of trichodiscoma. Sebaceous glands are associated with the follicle on the left.


 

Fig. 14: The plaque-like component is shown at higher magnification. The fibrous tissue is laminated and in areas the lamellae are perpendicular to the skin surface. Blue arrows outline a vessel showing incomplete concentric fibrous lamellae. Rete ridges are effaced


 

Fig. 15: The interface between the epidermis and the dermis is straight. There are vacuolar changes at the dermal-epidermal interface. Basal clear cells protrude into the dermis in this area. The pattern of the fibrous tissue in this area is characteristic but it would not be possible to exclude a fibrous papule on the basis of the pattern in this field


 

Fig. 16: Vessels are dilated, clustered, and outlined by concentrically arranged fibrous lamellae. These vascular alterations may also be seen in fibrous papules. Clearly, fibrous papule and trichodiscoma are hamartomas of the same order: they are hamartomas of the adventitial dermis.

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