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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 112-113

Trichoblastic carcinoma of retroauricular region with intracranial and lung metastasis


Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication14-Jun-2017

Correspondence Address:
Deepti Sharma
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrcr.jrcr_17_17

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  Abstract 


Trichoblastic carcinoma is a rare skin malignancy which arises from the differentiation of primitive hair follicles. As trichoblastic carcinoma is very rare, the standard treatment protocol is yet to be established. Here, we present a rare case report of trichoblastic carcinoma of retroauricular region with intracranial extension and lung metastasis.

Keywords: Extensive, retroauricular metastasis, trichoblastic carcinoma


How to cite this article:
Sharma D, Singh G. Trichoblastic carcinoma of retroauricular region with intracranial and lung metastasis. J Radiat Cancer Res 2017;8:112-3

How to cite this URL:
Sharma D, Singh G. Trichoblastic carcinoma of retroauricular region with intracranial and lung metastasis. J Radiat Cancer Res [serial online] 2017 [cited 2019 Dec 15];8:112-3. Available from: http://www.journalrcr.org/text.asp?2017/8/2/112/208020


  Introduction Top


Trichobalstic carcinoma is a rare skin malignancy which arises from the differentiation of primitive hair follicles.[1] It is locally aggressive and develops dermal or subcutaneous fat invasion but sometimes also presents with lymphatic and hematogenous dissemination.[2] Here, we present a rare case report of trichoblastic carcinoma of retroauricular region with intracranial extension and lung metastasis.


  Case Report Top


A 40-year-old female presented to the general surgery outpatient department (OPD) of our hospital with complaints of painless, progressive swelling associated with itching in the retroauricular region for 1 year. Excision biopsy of the swelling was suggestive of trichoblastic carcinoma. The patient was discussed in a multidisciplinary clinic and was planned for adjuvant radiotherapy, to which she defaulted. She again presented in the surgery OPD with recurrent swelling at the same site. Magnetic resonance imaging was suggestive of recurrent mass in the temporoparietal region causing bone destruction with extradural intracranial component; the patient underwent re-excision of tumor with involved bones along with covering of defect over posterior auricular and temporal scalp with facial flap. However, the swelling reappeared within a month. On local examination, the swelling was about 2 cm × 3 cm in size, hard, fixed to underlying structures, tender along the stitch line in temporoparietal region with a proliferative growth of 1 cm × 1 cm protruding out of external auditory canal. The swelling was progressively increasing in size. The general physical examination was unremarkable. Contrast-enhanced computerized tomography scan was suggestive of lytic heterogeneous enhancing mass lesion involving the right side of occipital bone, right mastoid, right squamous temporal bone with extradural extension, right transverse sinus, and sigmoid sinus thrombosis with posterior auricular mass involving right parotid gland, right hypoglossal canal, and right jugular bulb [Figure 1] with cavitating bilateral lung metastasis [Figure 2]. The patient was treated with palliative radiotherapy of 30 Gy in 10 fractions to the local area and was planned for palliative chemotherapy with taxane and platinum, but the patient defaulted again and was lost to follow-up.
Figure 1: Contrast-enhanced computed tomography head suggestive of lytic heterogeneous enhancing mass lesion involving the right side of occipital bone, right mastoid, and right squamous temporal bone

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Figure 2: Contrast enhanced computed tomography thorax cavitating lung metastasi

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  Discussion Top


Trichoblastic carcinoma is a very uncommon tumor with differentiation toward follicular germinative cells reminiscent of trichoblastoma and usually presents in a younger age group.[3] It usually presents as a solitary, poorly circumscribed, large, asymmetric, dermal, or subcutaneous mass. Histopathologically, these are usually poorly differentiated carcinomas with high mitotic activity, infiltrating growth, and necrosis.[4],[5] Several studies based on clinical and histopathological features, further classified trichoblastic carcinoma into low-grade and high-grade lesions.[6],[7] High-grade lesion is usually characterized by larger lesion (>3 cm), necrosis with potential for systemic spread.[2]

As trichoblasic carcinoma is very rare, the standard treatment protocol is not established yet, wide excision of the lesion being the recommended treatment.[3] However, the role of adjuvant treatment in the form of radiotherapy or chemotherapy is not defined. In few studies, adjuvant radiation therapy is used in case of high-grade tumors, younger age group, infiltrative tumors or with close or positive margins, so as to reduce the chances of recurrence.[3],[8] When surgery is not possible, radiotherapy can be used as an alternative. In the present case also, radiation was used for palliation of pain.

The present case is unique because it is both locally aggressive leading to intracranial extension and also has distant metastasis to bilateral lungs.


  Conclusion Top


Trichoblastic carcinoma is a rare tumor with no standard treatment protocol. However, it should be treated aggressively with complete surgical excision with the use of adjuvant radiation therapy in selected cases.

Financial support and sponsorship

Nil.

Conflicts off interest

There are no conflicts of interest.

 
  References Top

1.
Rofagha R, Usmani AS, Vadmal M, Hessel AB, Pellegrini AE. Trichoblastic carcinoma: A report of two cases of a deeply infiltrative trichoblastic neoplasm. Dermatol Surg 2001;27:663-6.  Back to cited text no. 1
[PUBMED]    
2.
Regauer S, Beham-Schmid C, Okcu M, Hartner E, Mannweiler S. Trichoblastic carcinoma (“malignant trichoblastoma”) with lymphatic and hematogenous metastases. Mod Pathol 2000;13:673-8.  Back to cited text no. 2
[PUBMED]    
3.
Laffay L, Depaepe L, d'Hombres A, Balme B, Thomas L, De Bari B. Histological features and treatment approach of trichoblastic carcinomas: From a case report to a review of the literature. Tumori 2012;98:46e-9e.  Back to cited text no. 3
    
4.
Helm KF, Cowen EW, Billingsley EM, Ackerman AB. Trichoblastoma or trichoblastic carcinoma? J Am Acad Dermatol 2001;44:547.  Back to cited text no. 4
    
5.
Ackerman AB, Gottlieb GJ. Fibroepithelial tumor of pinkus is trichoblastic (Basal-cell) carcinoma. Am J Dermatopathol 2005;27:155-9.  Back to cited text no. 5
    
6.
Schulz T, Proske S, Hartschuh W, Kurzen H, Paul E, Wünsch PH. High-grade trichoblastic carcinoma arising in trichoblastoma: A rare adnexal neoplasm often showing metastatic spread. Am J Dermatopathol 2005;27:9-16.  Back to cited text no. 6
    
7.
Sau P, Lupton GP, Graham JH. Trichogerminoma. Report of 14 cases. J Cutan Pathol 1992;19:357-65.  Back to cited text no. 7
    
8.
Oufkir AA, Znati K, Kamal D, El Alami MN. Trichoblastic carcinoma. Rev Stomatol Chir Maxillofac Chir Orale 2013;114:102-5.  Back to cited text no. 8
    


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