Proliferating Trichilemmal Tumor: A Case on the Nose of a 70-Year-Old Man
A 70-year-old white man, born in Buenos Aires, Argentina, visited for a consultation about a localized swelling on the tip of his nose and an external orifice with serosanguineous discharge (fig. , fig. ). Our initial hypothesis was a furuncular myiasis, since the patient had been to a rural area and had lived in a heavily wooded area with a plantation. The patient was treated with a single dose of 18 mg ivermectin, which was repeated 1 week later.\nWhen he returned 2 months later, his clinical status was unchanged. Although it did not look like a sebaceous cyst, the orifice produced a sebaceous secretion. At this point, an excisional biopsy was performed, removing a large part of the lesion followed by curettage. Histopathology showed follicular hyperkeratosis and, in the dermis, prominent sebaceous glands, telangiectasic capillaries, and a diffuse mononuclear inflammatory reaction. Also, a ‘cystically’ dilated infundibular structure was observed, whose wall showed squamous cell proliferation with wide eosinophilic cytoplasm, pleomorphic nuclei, and prominent nucleoli as well as extensive dyskeratosis-forming masses of cells with areas of necrosis. This histopathological picture was interpreted as suggestive of adnexal neoplasia with pilar differentiation and a possible proliferating epidermoid cyst (fig. , fig. , fig. ).\nThe lesion had already relapsed 45 days later, and another surgery was performed (fig. ). This time, part of the alar cartilage was removed and the reconstruction was done with a dorsal nasal flap. Histopathology showed a complete excision of the lesion. The patient has been monitored since then without a recurrence of the lesion (fig. ).\nAfter the last surgery, prostate cancer was diagnosed, and the patient was submitted to radical prostatectomy and radiotherapy. After this surgery, he suffered from deep vein thrombosis and needed to take anticoagulants. He also had intestinal cancer, making the removal of 25 cm of the large bowel necessary. One year before the appearance of these 2 malignant tumors, the patient had developed a severe mental depression due to his mother's ill health and eventual death.