• 15
    Jan
  • A Case of Folliculosebaceous Cystic Hamartoma

INTRODUCTION

FSCH is a rare, distinct, cutaneous hamartoma of follicular, sebaceous and mesenchymal com­ponents. It usually presents as a small, exophytic papule or nodule on the central part of the face. Histopathologically, it is characterized by infundi- bulo-sebaceous cystic proliferation with specific mesenchymal changes including packed fibrillary bundles of collagen, cleft formation between fibroe- pithelial units and surrounding stroma, sparsely distributed adipocytes, and increased numbers of small venules.

fig 1. a smooth

Fig. 1. A smooth, 3 X 2.5 cm sized, subcutaneous nodule on the scalp.

Since FSCH was first described in 1991, there have been approximately 30 reported cases including 2 cases of a giant variant in the English literature and 6 cases of FSCH in the Korean literature (Table  1).
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Table 1. Summary of FSCH in the Literature

Cases

Age/sex

Location

Size

Duration

Kimura et al.

Case 1

42/F

Scalp

1.0 X 1.0 cm

3 years


Case 2


50/M


Nose


1.3 X 1.3 cm


6 years

Case 3

58/M

Forehead

0.6 X 0.6 cm

6 years

Case 4

48/F

Cheek

1.0 X 1.0 cm

15 years

Case 5

85/F

Nose

0.9 X 0.8 cm

Unclear

Donati et al.

32/F

Ear

1.0 cm in diameter

3 years

Yamamoto et al.

24/F

Back

7.0 X 4.5 cm

24 years

Aloi et al.

8/M

Auditory canal

1.0 X 0.7 cm

Since birth

Bolognia et al.

34/F

Labia major

4 cm


Sturtz et al.

32/F

Arm

15 cm at greatest dimension

Several years

Lee et al.

Case 1

23/M

Scalp

Pea-sized

1 year

Case 2

46/M

Face

Pea-sized

Several years

Ahn et al.

34/F

Face

0.5 X 0.6 cm

2 years

Choe et al.

39/F

Back

0.8 cm

8 years

Kwon et al.

37/M

Face

0.5 X 0.5 cm

1 year

Jang et al.

36/F

Scalp


3 months

Our case

61/M

Scalp

3 X 2.5 cm

2 years

We describe a clinically interesting case of FSCH in a 61-year-old male, whose lesion was relatively large, reaching to 3 cm in diameter, and developed on the occiput.

CASE REPORT

A 61-year-old man presented with a 2-year history of a large, subcutaneous nodule on the scalp. Physical examination revealed an asymptomatic, 3 X 2.5 cm sized, firm, subcutaneous nodule on the occipital area of the scalp (Fig. 1). Under the clinical impression of a “pilar cyst”, “epidermal cyst” or “lipoma”, the lesion was removed surgically. On histopathologic examination, there was found to be a cystically-dilated follicular infundibulum with numerous sebaceous lobules around it (Fig. 2). Mature sebaceous lobules were attached, through sebaceous ducts, to the dilated infundibulum. The stroma was composed of compactly-laminated Folliculosebaceous Cystic Hamartoma fibrotic tissue, adipocytes, and small vessels (Fig. 3). The tumor was separated by a cleft from the sur­rounding, compressed normal tissues in the dermis. buy viagra jelly

fig 2. showing

Fig. 2. Showing a cystically-dilated folliculosebaceous unit in the center (H&E, X 20). The tumor was sepa­rated by a cleft from the surrounding normal tissue (arrow).

On the basis of the above findings, a diagnosis of folliculosebaceous cystic hamartoma was made. There was no evidence of recurrence 5 months after removal of the tumor.
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fig 3. mesenchymal

Fig. 3. Mesenchymal stromal components demonstrate dense fibrous tissue with increased blood vessels (arrow) and foci of adipocytes (arrow heads) (H&E, X 100).

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