A Case of Folliculosebaceous Cystic Hamartoma: DISCUSSION
Clinically, FSCH is an asymptomatic, slow-grow- ing, small papule or nodule usually occurring on the head or neck areas, but other uncommon locations such as the upper back, forearm, labia majora, and the scalp have been reported. The tumor size is usually 0.5-1.5 cm in diameter, but 2 cases of a giant variant have been reported. One was a 7.5 cm in diameter, exophytic, lobulated mass on the back and the other one was a 15 cm-sized multinodular plaque on the arm.
Originally, the term hamartoma meant a benign tumor-like nodule composed of an overgrowth of mature cells and tissues which normally occur in the affected area. It usually presents at the time of birth, and does not show active growth after birth. Hence, hamartoma used in FSCH is actually a misnomer. However, the term “hamartoma”, Kimura used in his original article, is intended to convey the fact that a jumble of tissue elements is normally present at the site of the lesion. Thus, FSCH is thought to be just merely one of the epidermal appendage tumors appearing in postnatal life and also having a potential for size enlargement. The tendency of tumor enlargement might be stronger in unusual areas such as the back, the labia, and the extremities and can result in morphologic changes including polypoid, plaque- like, or multinodular growth.
Although it was not a giant lesion and had none of the above morphologic changes, the tumor in our patient had continuously grown to 3 cm in diameter by the time of diagnosis. Because of its rarity, the importance of a large or giant variant is still unknown except for the cosmetic or therapeutic aspects.
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Since FSCH carries no specific clinical characteristics, various tumors may be suspected prior to histopathologic examination. While intradermal nevus, neurofibroma, pilomatricoma and other adnexal tumors are clinical differential diagnoses for a typical FSCH lesion, pilar cyst, epidermal cyst or lipoma were suspected for our scalp lesion. Whatever the clinical impressions may be, the correct final diagnosis of FSCH can be made without difficulty from the well-known histopathologic features.
We report an unusual case of FSCH showing a relatively large, 3 X 2.5 cm sized, smooth, subcutaneous nodule on the occipital area of the scalp, an uncommon location for FSCH.