PMC7499335_01
A 15-year-old patient presenting with multiple facial papules.
CRID2020-5648647.001.jpg
PMC7499335_01_CRID2020-5648647.001.jpg
fig1
A 15-year-old male patient presented with multiple asymptomatic nodules in relation to the nose, nasolabial folds, and temporal and frontal areas of the face (Figure 1).
PMC7499335_02
Patient's mother with multiple facial papules relatively larger in size and extensively distributed over the entire face.
CRID2020-5648647.002.jpg
PMC7499335_02_CRID2020-5648647.002.jpg
fig2
The patient's 38-year-old mother had been reported with multiple, similar lesions symmetrically and extensively distributed on the entire face (Figure 2).
Pedigree of the patient showing hereditary pattern of trichoepitheliomas.
CRID2020-5648647.003.jpg
PMC7499335_02_CRID2020-5648647.003.jpg
fig3
Her lesions had started appearing around puberty on the central parts of her face and gradually increased in size and number and were distributed over her entire face (Figure 3).
A single well-circumscribed and translucent papule.
CRID2020-5648647.004.jpg
PMC7499335_02_CRID2020-5648647.004.jpg
fig4
On examination, lesions were multiple, firm in consistency, and well circumscribed, with translucent papules and nodules ranging in size from 0.5 to 2 cm (Figure 4).
Pictomicrograph of the symmetrical adnexal tumour composed of lobules of basaloid cells and keratocytes (H&E, low power, *10).
CRID2020-5648647.005.jpg
PMC7499335_02_CRID2020-5648647.005.jpg
fig5
Histopathological analysis of the lesion revealed a symmetrical adnexal tumour predominantly composed of lobules of basaloid cells (Figure 5) with focal horn cysts and keratinization.
Prominent perilobular connective tissue sheath (H&E, high power, *40).
CRID2020-5648647.006.jpg
PMC7499335_02_CRID2020-5648647.006.jpg
fig6
In a few foci, prominent perilobular connective tissue sheaths were noted (Figure 6).
Peripheral stromal lining of the tumour positively stained with CD10 (H&E, high power, *40).
CRID2020-5648647.007.jpg
PMC7499335_02_CRID2020-5648647.007.jpg
fig7
The aforementioned histopathological features were consistent with those of trichoepithelioma (TE), and further immunohistochemical analysis with CD10 revealed positivity only in the stromal lining (Figure 7).
Timeline of the disease process.
CRID2020-5648647.008.jpg
PMC7499335_02_CRID2020-5648647.008.jpg
fig8
Upon confirmation of the diagnosis as MFT, the treatment plan was to excise relatively large papules surgically, and relatively smaller lesions were to be managed with 5% Imiquimod topical therapy for 32 weeks (Figure 8).