Ch32aP24aTricholemmoma-like
Mixed Tumor

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F1Ch32a: The lesion is polypoid. Columns of squamous cells connect it to the epidermis. To the right, a column of germinative cells is isolated in the stroma; the cells have clear cytoplasm; the basal layer shows prominent nuclear palisades. The main portion of the tumor, nearest the isolated column, shows similar cytologic features.

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F2Ch32a: The clear cell patterns, and the prominent perpheral row of basal cells are features in keeping with tricholemmal differentiation. There is mild to moderate nuclear atypia with variations in nuclear size and outlines. Nuclear membranes are somewhat “heavy.” Focally, the tumor cells of the isolated nest (the nest on the right) are spindle shaped.

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F3Ch32a: At the perphery of some of the nests, a hyaline membrane is a prominent feature; it is lightly stained. There is microcyst near the bottom of the field. In the upper 1/2 of the field, Membranous zones, that are brightly acidophilic, define the periphery of many of the cells.

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F4Ch32a: In addition to the accentuation of acidophilia in the cell membrane area, many of the cells are partitioned internally by delicate, acidophilic fibers. There is moderate nuclear atypia.

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F5Ch32a: At the top of the field, thin cords of squamous cells are interconnected to form a complex latticework. One prominent whorl of squamous cells shows a central area of keratinization. A hyaline matrix is present among the cords. At the bottom and the sides of the epithelial component, ill-defined aggregates of tumor cells are entrapped in the hyaline matrix. The entrapped cells have acidophilic cytoplasm.

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F6Ch32a: Cords of tumor cells are entrapped in a hyaline matrix. There is moderate cytologic atypia. The tumor cells are spindle shaped. Individual cells, that are interpreted as tumor cells, are entrapped in the matrix; blue arrows identify some of these cells.

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F7Ch32a: Individual tumor cells and small clusters of tumor cells are isolated in a chondroid or hyaline matrix. The cells are associated with distinctive, acidophilic fibers; the fibers outline some of the cells. Perhaps, the fibers are myofibrils or reticulum fibers. An interpretation that the fibers are an expression of a peculiar form of keratinization is favored. In the small cluster, near the bottom of the field on the right, the cytologic features, the arrangement of the cells, and the prominent fibers produce a pattern that is somewhat suggestive of a pattern of keratinization, as seen in a developing hair shaft near the bulb (F2&3Ch10).

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F8Ch32a: Individual cells, that are associated with distinctive acidophilic fibers, are isolated in a chondroid or hyaline matrix. If the comparison with the patterns of keratinization in a hair root near the bulb is valid, this type of keratinization may serve as a structural support for the enclosed cells. The spindle cell qualities, the isolation of individual cells, and the chondroid or hyaline matrix are features seen in “mixed” tumors. Many of the features can be offered in support of the interpretation that this is a mixed tricholemmal tumor. Perhaps, it is a tumor showing patterns of divergent differentiation.

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