Ch31P23-L3 Catagen-like 
Tricholemmoma

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G-6097IFKer021

F1Ch31 (G6097): This is a typical pattern of a follicular hamartoma of the butterfly area of the face. There is papillomatosis; the lesion has been cut across at its base. Columns of squamous cells extend vertically from the epidermis into the dermis. Germinative cells of basal unit-like type, and acidophilic squamous cells of superficial unit-like type (i.e., cells committed to terminal differentiation) are represented. There are scattered squamous eddies, some of which show central areas of keratinization. The papillary dermis (tumor stroma) is widened. By common criteria, this is an “inverted follicular keratosis.” By the criteria, as developed herein, it is a “catagen-like” tricholemmoma; it is a follicular tumor with representation of a component in which some of the histologic features can be characterized as catagen-like phenomena. These patterns are common as regional variations in classic tricholemmoma; the commonness of these patterns offers support for the interpretation that “inverted follicular keratosis” is a variant expression of “tricholemmoma.”

G-6097IFKer071

F2Ch31: Red arrows identify a population of cells of superficial unit-like type; blue arrows identify a neighboring population in which the cells are of basal unit-like type. One cluster of superficial unit-like cells has formed a lumen - a phenomena secondary to keratinization (of a type often characterized as epidermoid in type).

G-6097IFKer091

F3Ch31: Blue arrows identify squamous eddies. About the squamous eddy at the bottom of the field, there are small, empty defects among the squamous cells; dyskeratotic phenomena are also represented; the changes in the latter area can be characterized as catagen-like cytopathia. Dyskeratotic changes are also represented in the component of cells of superficial unit-like type to the left of the squamous eddies.

G-6097IFKer191

F4Ch31: Mild cytolytic and dyskeratotic changes are represented. The basement membrane is slightly coarsened. Focally, it is reduplicated.

G-6097IFKer131

F5Ch31; Some of the cells forming squamous eddies at the bottom of the field show peri-nuclear vacuoles. Cytolytic changes are present in the background population of cells about the squamous eddy to the left.

G-6097IFKer161

F6Ch31: The cells are of superficial unit-like type. Dyskeratosis and cytolysis are features. Centrally, one cell resembles a corps rond. There is mild to moderate nuclear atypia.

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