Cystic panfolliculoma

Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9073, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 04/2006; 130(3):389-92. DOI: 10.1043/1543-2165(2006)130[389:CP]2.0.CO;2
Source: PubMed


Panfolliculoma is a rare follicular neoplasm with differentiation toward both upper (infundibulum and isthmus) and lower (stem, hair matrix, and bulb) segments of a hair follicle. We present an unusual case of cystic panfolliculoma. A 33-year-old Hispanic woman presented with an 8-month history of a 3.0-cm cystic scalp mass. The lesion was excised, and the histologic sections showed a cystic follicular neoplasm that contained corneocytes in basket-woven and laminated array, trichohyalin granules of the inner root sheath, germinative cells, papillae, matrical cells, and "shadow" cells. Cytokeratin 903 and cytokeratin 5/6 immunostains uniformly highlight the tumor cells. Ber-EP4 strongly labels the germinative cells but not the follicular papillae. CD34 labels the surrounding fibrotic stroma and focally the epithelial component.

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    ABSTRACT: Panfolliculoma is a distinctive and unusual benign follicular neoplasm. It shows differ-entiation towards all components of the hair follicle, including the upper and the lower segments. We report two cases of this rare disease. The first patient presented with a painful nodule on the scalp and the second patient had an asymptomatic skin-colored nodule on his left eyebrow. Histopathologic examination of both cases revealed lobular proliferation of solid-cystic follicular structures. The cystic structures contain laminated keratin, indicating infundibular differentiation. The solid tumor part was composed of basaloid germinative cells, matricial cells, and cells with trichohyalin granules, repre-senting inner root sheath differentiation. The range of differentiations was highlighted using immunohistochemical stains, including labeling of cytokeratin 1, 5, 10, 14 (using 34βE12), cytokeratin 5/6, CD34 (outer root sheath), and Ber-EP4 (lower segment of hair follicle). Panfolliculoma should not be confused with trichofolliculoma or trichoblastoma.
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