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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.
(Arch Pathol Lab Med. 2006;130:389-392)
In 1993, Ackerman and colleagues1 described a series of follicular neoplasms with infundibular, isthmus, stem, and bulbar differentiation. Because differentiation toward all parts of both upper and lower segments of a follicle was seen, the authors coined the term panfolliculoma. Subsequently, Schirren et al2 reported 4 additional cases with immunohistochemical findings in 1996. The ages of these patients ranged from 33 to 62 years, and both sexes were equally affected.3 These slow-growing lesions were thought clinically to be a cyst, trichoepithelioma, or basal cell carcinoma.3 We herein report an additional case of this rare neoplasm with a predominantly cystic architecture.
REPORT OF A CASE
A 33-year-old Hispanic woman presented with an 8-month history of a scalp mass. There was no associated tenderness. The clinical impression was a scalp cyst. The lesion was excised, and its content was evacuated.
MATERIALS AND METHODS
Four-micrometer-thick sections were cut from the paraffin blocks and stained with hematoxylin-eosin and periodic acid-Schiff with and without diastase. Additional paraffin sections of selected block were obtained for immunohistochemical studies, which were performed on an automated immunostainer (Ventana, Biotek System, Tucson, Ariz) using the standard avidin-biotin peroxidase complex technique, heat-induced epitope retrieval buffer (0.01 M citrate, pH 6), biotin blocking system, and the following primary antibodies: cytokeratin (CK) 5/6 (D5/16B4, Boehringer Mannheim, Indianapolis, Ind), CK8 (35BH11, DakoCytomation, Carpinteria, Calif), CK19 (RCK108, DakoCytomation), CK903 (3ABE12, DakoCytomation), Ber-EP4 (DakoCytomation), CD34 (Qbend/10, BioGenex, San Ramon, Calif), Ki-67 (MIB-1, Immunotech, Westbrook, Me), and CD117 (DakoCytomation).
PATHOLOGIC FINDINGS
A 3.0 × 2.0 × 2.0-cm cystic...