Multiple Tumors of the Follicular Infundibulum: A Cutaneous Reaction Pattern?

Cutis. 2014 December;94(6):301-303

December 11, 2014|Cutis

Jian-Wei Zhu, MD, PhD;Min Zheng, MD, PhD;Zhong-Fa Lu, MD, PhD

The etiology of tumor of the follicular infundibulum (TFI) is unknown. Eruptive forms of TFI are rare. We present the case of a 49-year-old woman with multiple lesions on the arms, shoulders, trunk, buttocks, and legs of more than 3 years’ duration. On clinical and histologic examination, a diagnosis of multiple TFI was made. Additionally, the patient presented with other rare remarkable features including severe pruritus, the Köbner phenomenon, and underlying inflammatory cell infiltration of the tumors. These findings strongly suggest that eruptive TFI may represent a kind of cutaneous reaction.

Practice Points

Multiple tumors of the follicular infundibulum (TFIs) sometimes may have the potential for malignant transformation; therefore, long-term supervision of TFI is strongly recommended.
Eruptive forms of TFI are rare. In our patient, severe pruritus, the Köbner phenomenon, and the underlying inflammatory cell infiltration of the tumors strongly suggested that eruptive TFI may represent a kind of cutaneous reaction.

A remarkable feature in our case was the patient’s severe pruritus, as most reported cases have been asymptomatic. The increased association with other cutaneous lesions,² the Köbner phenomenon, and the underlying inflammatory cell infiltration of the tumors in our case strongly suggested that eruptive TFI may represent a kind of cutaneous reaction.

^{Figure 3. Histopathologically, a benign platelike proliferation of pale-staining keratinocytes and follicular structures could be observed in the papillary dermis connected to the overlying epidermis with a moderate lymphatic cell infiltration (A)(H&E, original magnification ×40). Weigert staining showed a network of black-blue elastic fi-bers at the base of the tumor (B) (original magnification ×200). The pale kerat- inocytes were positive on periodic acid–Schiff staining (C)(original magnification ×100). Immunohis-tochemically, the proliferation of keratinocytes was positive for keratin 17 (D)(diaminobenzidine, original magnification ×100).}

Conclusion

The clinical findings of severe pruritus and the Köbner phenomenon in our patient further expand the constellation of the clinical presentation of the eruptive variant of TFI.

References

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