Ch40cP32cL4 Atypical Tricholemmoma

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F1Ch40c (J4230): This pale lesion is expansile. It is in contact with the thin epidermis in at least one site near the right margin of the lesion. A short column of keratinocytes forms the column that connects tumor to the epidermis. Miniaturized follicles are present in the adjacent dermis. They appear to be increased in number (closely spaced).

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F2Ch40c: At this magnification, most of the tumor cells are somewhat spindle shaped; the cells have pale cytoplasm. There are scattered whorls of squamous cells.

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F3Ch40c: Blue arrows identify several of the whorls, some of which show central areas of keratinization. In this field, there is a second column of squamous cells that connects the tumor to the epidermis.

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F4Ch40c: The cells are spindle shaped and have pale or vacuolated cytoplasm. Nuclear characteristics are fairly uniform. In scattered areas, hyaline membranes separate neighboring collections of tumor cells. A whorl of cells is present to the left in the upper portion of the field.

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F5Ch40c: In this field, the cells are rounded or polygonal. There is some variation in nuclear size and outline. Clumped acidophilic deposits are present in the cytoplasm of many of the cells. Some of the clumps are somewhat suggestive of myelin figures, but are interpreted as evidence of dyskeratosis.

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F6Ch40c: The cells about the whorl have pale or clear cytoplasm. Nuclei are irregular in outline. Some of the cells of the whorl have clear cytoplasm. Some of the cytologic features may be evidence of degenerative changes.

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F7Ch40c: Two extensions of squamous cells blend with the clear cells of the tumor. Between the two columns, tumor extends close to the epidermis; in some areas, a well-defined basement membrane outlines the tumor.

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