User:Hmz0903/sandbox

Description
Trichilemmoma is a recurrent benign skin tumor, and it is derived from basal cells of hair follicle. Usually, the disease was manifested as 1-5cm granular erythema or papules on the neck, face, and in the central part of lips. As the patient ages, the symptom becomes more obvious and severe. Diagnosis depends on careful histopathological examination of the skin biopsy. Generally, cutaneous trichoadenoma occur in conjunction with other skin lesions, such as trichoblastoma. Sometimes, rash sebaceous gland lesions may come with new Tricholemmomas. HPV damage may cause trichilemmoma. HPV is human papillomavirus, a highly infectious virus. Trichilemmoma is divided into solitary trichilemmoma and multiple trichilemmoma basically. The complications of the patients with single trichilemmoma are manifested in one site / organ, and the complications of the patients with multiple trichilemmoma are manifested in two or more sites / organs. Trichilemmoma with mild symptoms is not required to be treated, but it needs to be surgically resected when it is severe.

Table of Contents
●Symptoms

●Diagnosis

●Solitary Trichilemmoma

●Multiple Trichilemmoma

●proliferative Trichilemmoma

●Causes, treatment and prevention

Characteristics
Trichilemmoma is derived from the basal cells of hair follicles, mainly marked by differentiation of cells towards the outer root sheath. It consists of the dilatation and proliferation of the capillary network. It is manifested as an isolated 1-5cm small erythema/papule. these lesions grow slowly over time and tend to form small plaques similar to warts or skin horns. The onset of the disease is manifested as formation of small plaques, which usually appears on the upper lip, forehead, upper trunk, scalp, and nose. Most commonly, the disease occur on cheeks and nose. It is divided into solitary symptom and multiple symptom basically. Solitary Trichilemmoma presents a single small papule that occurs in one organ of the patient, and Multiple Trichilemmoma refers to the presence of small papule in multiple organs. Histologically, trichophyton tumor is manifested as lobular epidermis growing downward into the dermis. The lesion surface is characterized by hyperkeratosis and somewhat papillary. Due to the high level of glycogen in the cells, the cells facing the center of the lobule showed light staining, and the amylase was unstable. The cells facing the periphery of the lobule are usually basophilic, and the surrounding cells are arranged. The entire lobule is enclosed in an eosinophilic basement membrane. Differentiation of tumor towards outer root sheath of hair capsule is consistent, and tumor around hair follicle can locally express CD34. CD34 is derived from the differentiation protocol cluster that recognizes cell surface antigens. It is a transmembrane phosphate glycoprotein encoded by CD34 genes in humans and other species. It is clinically used to quantify the number of hematopoietic stem cells used in hematopoietic stem cell transplantation. 80% of solitary-trichilemmoma patients are converted to multiple-trichilemmoma patients, and the trichilemmoma spread from one site to more than seven sites. Half of the 80% of patients suffered from symptoms of Vibrio follicles, that is CS. Trichilemmoma is chronic and benign tumors, and it usually occurs in young people with an average age of 22 years. The tumor consists of one or more lobules, small and distinct in shape, dark red and bright red in color. As the patient grows older, the tumor area increases and the color deepens. It affects the appearance, and in serious cases, the tumor invades deep into the human body tissue and seriously damages the function of organs and people.

Diagnosis
● Judgement of patient types

Most of the patients are adults, and the incidence of the disease in female patients is higher. The onset age is 0-68 years, with a very small proportion for children patients. The average age of Tricholemmoma patients is 22 years.

Diagnosis types
Diagnosis method: Small-sized biopsy is the only method to diagnose Tricholemmoma. Biopsy is the abbreviation of "in vivo tissue examination ". Biopsy refers to a technique of taking pathological tissue out of the patient's body by means of cutting, forceps or puncture for pathological examination. Histology of Tricholemmomas will differentiate them from other skin tumors with similar clinical manifestations, such as capillary epithelioma and basal cell carcinoma. Different biopsy results represent different symptoms, including skin disease and cancer. Skin disease is divided into keratosis. The test evidence is that no glycogen cell was found in the biopsy. Benign cancer is classified into capillary follicular tumor, tripod, proliferative papillary tumor, and basal cell carcinoma. Biopsy results of horny cystic cyst include follicular tumor and capillary epithelioma. Biopsy result of proliferative capillary tumors is CD34 positive cells.

Clinical manifestation
The results of routine examination: Vital sign is stable. No enlarged superficial lymph is found, systemic nodules are found. heart and external single hair root neurilemmoma is found in heart and outside. Tumor tissue is transparent, peripheral cells are arranged in a grid shape, and there is a glassy membrane outside the cell. Tumor epithelium may come with cystic cavity. Transparent cellular sweat adenoma with large cystic or tubular lumen is found. A large number of amorphous keratin is contained. Tumor cells have varying degrees of atypia and may have squamous eddy currents. Red papules appear on the patient's skin, the papules gradually grow into nodules, with slight bulge in the vicinity of the nodules. Average diameter of individual papules is 3~8 mm.



Microscopically diseased cells
Trichilemmoma have three types: solitary, multiple, and proliferative. The cell belongs to cuboid. The nuclei is circular and centered. The cytoplasm is light or translucent and may be keratinized.

Solitary Trichilemmoma
Trichilemmoma is a common verrucous tumor, and it is associated with the role of human papillomavirus. It is a hereditary skin disease, suggesting the possibility of some benign and malignant visceral tumors. The disease often occurs in 20-80-year-old adult men, prone to occur on face, especially on nose and upper lip, as well as on the scalp, neck and other parts. Skin surface is keratinized or smooth, slightly shiny, therefore it is easily misdiagnosed as verruca vulgaris.Clinical manifestations: single papule with the diameter of 3~8 mm, with keratinized or smooth surface, slightly shiny, is easily misdiagnosed as verruca vulgaris.

Biopsy results: clear cell sweat adenoma with large cystic or tubular lumen was found. It includes basal cell tumor, hair follicle funnel tumor, sebaceous gland tumor and metastatic renal cancer, so it should be distinguished. Outer root sheath cutaneous horn refers to the significant keratosis occurs based on outer root sheath, which is mostly seen on the face and scalp.

Multiple Trichilemmoma
Multiple trichilemmoma is also known as Cowden disease. It belongs to autosomal dominant inheritance, mostly occurred in 20~40-year-old adults. It is characterized by facial multiple nodules, oral mucosal fibroma and distal limb punctate keratosis. It is diagnosed by depending on clinical manifestations and histopathological examination. As for facial lesions, it should be differentiated from the inverted hair follicle keratosis, etc. pathologically. As for skin lesions excluding facial lesions, it should be differentiated from verruca vulgaris. It is not important to treat multiple trichilemmoma itself, the key is to detect visceral tumors, especially breast cancer, which should be early treated.

Symptoms: The disease mostly occurs around the mouth, nose and ear. It is characterized by flesh color, pink or tan. Oral lesion is manifested as keratinized or smooth cobblestone-like papules, lip papilloma and sulcus tongue. Limb lesion is manifested as multiple, small hyperkeratosis papillomas. In addition, the disease comes with a variety of systemic diseases and tumors, including fibrocystic disease, thyroid tumor, gastric polyps, uterine leiomyoma and skeletal system abnormalities, etc.. 50% of women can suffer from breast cancer many years after skin lesions occur.

Proliferative Trichilemmoma
Proliferative trichilemmoma, also called proliferative hair tumor is derived from benign tumor of outer hair follicle root sheath. 90% of such kind of the patients are attacked in scalp. It mostly occurs in the elderly group, and the incidence of this disease is higher for the female patients. Common symptoms include red rash with the diameter of more than 6cm, multi-node, soft, and breakable. It can be complicated with one or several sheath cysts in scalp and grows slowly.

Clinical manifestations: A large number of patients are attacked by proliferative trichilemmoma on the cyst wall of the original hair cyst, with the symptom of skin lesions. It mostly come with solitary nature, while multiple nature for a few patients. Generally, the erythema is more than 6cm in diameter, multi-node, soft, and breakable. 90% of such kind of the patients are attacked in scalp or on back. Sometimes it is involved with subcutaneous tissue or even bone. It may recur in case of incomplete resection. A few of proliferative trichilemmoma may metastasize to local lymph nodes. Hyperplastic bronchiolar tumor is manifested as mild inflammatory mononuclear dermal infiltration. It mainly occurs on the scalp and also on the back. At first the lesion occurs subcutaneously and gradually enlarged. Its diameter is of 0.4-1 cm. Possibly, it forms plaques that are higher than the skin surface or becomes lobules. If the lesions increase rapidly, it will indicate deterioration of the condition, which can cause regional metastases called malignant proliferative trichilemmoma..

Biopsy results: pathological examination of skin lesions showed that the tumor tissue was located in the dermis, with a clear boundary with the peripheral tissue. Lobules of different sizes was composed of squamous epithelial cell mass which is like squamous cell carcinoma. The interlobular boundary of tumor mass was clear, and there were regular non-immersion zones. The peripheral cells of the tumor mass were arranged in the manner of palisade and surrounded by basement membrane. Extensive hair sheath keratosis and necrosis areas were found in the center of the lesion, without granular layer. A large number of transparent cells were found in tumor mass, with formation of keratosis of individual cells and scaly vortex.

Causes, treatment and precautions
Causes

Trichilemmoma is associated with HPV, from which several viral subtypes were isolated PCR the damage caused. The epithelial tissue of the outer root sheath is affected by trauma, infection and inflammation of the outer skin contents. Human papillomavirus (HPV) causes morphological changes in this tumor. No autosomal dominant PTEN gene was not found on chromosome 10 in 80% of patients.

Treatments

Treatments include curettage and electrodeposition, surgical resection, Morse microscopy, and carbon dioxide laser therapy. Trichilemmoma does not require particular treatment. It can be removed if it occur in functionally sensitive areas. It's a benign follicular tumor, and there may be some granular erythemas on the skin. If these granular erythemas appear inexplicably and exist for more than a week, which may be a precursor for major diseases, the patient should be vigilant about the lesions. Most importantly, visceral tumors, especially breast cancer and Caden's disease should be examined and detected, so as to be medically treated early.

Postoperative care：

1. After the operation, pay attention to washing face, or do not moisten the wound when taking a bath.

2. In case that the wound is broken, apply anti-inflammatory drugs on the wound in time.

3. Spicy and other irritant foods is forbidden.

4. The patients who suffer from hemangioma treated with laser should pay attention to preventing from sunshine.

5. Let the scar of the wound fall off by itself.

Complications
Trichilemmoma is associated with a variety of systemic diseases and tumors, including fibrocystic diseases, thyroid tumors and cancers, goiter, colonic adenoma, uterine leiomyoma, and skeletal system abnormalities. Fifty percent of women suffer from breast cancer several years after being attacked by breast cance.

Prevention methods
Children:                        it is recommended that each child should receive annual ultrasound examination (Ng, 2016),  skin examination, as well as the examination of neurodevelopmental and thyroid glands

Adult male patients:     18-year-old patients: annual thyroid US assessment, once a year

35-year-old patients:    colonoscopy examination assessment, once every five years

40-years-old patients:  renal color ultrasound assessment once or twice a year

Adult Female patients: 18-year-old patients: breast self-examination for a year

30-35-year-old patients: mammogram and breast MRI, once a year, and screening for endometrial cancer, once a year