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There are a number of different hair follicle tumors, each with its own distinguishing features. In the Digital Dermatopathology Digest series, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, discusses these different variants in greater detail.

Trichilemmal cells come from the outer root sheath of the hair follicle. The cells show abrupt keratinization and pink to clear cytoplasm with a lack of keratohyalin granules.

Trichilemmoma cells have a lobular proliferation of cells that can push into the dermis. They can also present as pink to clear due to glycogen, and there can be peripheral palisading at the periphery of the islands as well as a thick pink basement membrane deposition. Multiple trichilemmomas are associated with Cowden syndrome.

Trichoadenoma cells can have multiple epithelial islands of keratin-filled cysts in the dermis. These cysts can frequently rupture, shoring a foreign body giant cell reaction to keratin fibers. Cyst islands are lined by epithelium, and the majority of the squamous epithelium lacks keratohyalin granules.

Trichoblastoma cells typically have multiple blue islands with fibrotic stroma and are associated with nevus sebaceous.

Cells on the trichofolliculoma, fibrofolliculoma, and trichodiscoma spectrum are all different stages of the same tumor. They can present with branches of anastomosing epithelium originating out of the hair follicle and often occur in small antigen hair follicles.

• In a fibrofolliculoma, there can be a proliferation of fibrous cells or fibrous stroma, which can have a concentric pattern around the tumor.
• Fibrous proliferations are most prominent in a trichodiscoma.
• Cells can show peripheral palisading, but there is no retraction artifact or myxoid stroma surrounding them, which would be seen in basal cell carcinoma.
• Multiple fibrofolliculomas and trichodiscomas are commonly associated with Birt-Hogg-Dubé syndrome.

The Digital Dermatopathology Digest series provides educational information for both students and professionals on a number of topics. To view the complete series, click here.

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

If you happen across a small cluster of brown, yellow, or pink bumps (or papules), around the eyes or on the neck, it may be a case of syringomas. In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, clinical research associate in dermatopathology for PathologyWatch, briefly discusses the distinct characteristics of this benign growth of the sweat gland. 

According to Rajni, syringomas are common in the periorbital and genital regions. Growths can be associated with Down’s syndrome, and disseminated, solitary, or eruptive types sometimes indicate Nicolau-Balus syndrome. 

“Note that the eccrine ducts have an eccentric lumen and can have a tadpole shape,” says Rajni, referring to a common variant of syringomas. “And a clear cell syringoma is often associated with diabetes.” 

Another type of syringomas, a mixed tumor called chondroid syringoma, is common in elderly males and appears on the head and neck. It’s characterized by a circumscribed dermal tumor, and it also appears as an apocrine/eccrine proliferation in fibrous, myxoid, or chondroid stroma. 

“Women, especially of Japanese heritage, are affected more than men,” explains the American Osteopathic College of Dermatology. “Syringomas tend to first erupt in adolescence, but could start at any age.” The AOCD adds that young people may be predisposed to “eruptive syringomas,” wherein the growths occur suddenly.  

Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.

PathologyWatch was recently ranked by MedTech Innovator as one of the top 50 most transformative device, diagnostic, and digital health technologies from around the globe. PathologyWatch will participate in a flagship, four-month Showcase and Accelerator program that offers unparalleled visibility and access to some of the medtech industry’s leading manufacturers, providers, investors, and other industry stakeholders. 

“Our goal at MedTech Innovator is to find the most promising medical innovations and make sure they actually reach the patients who need them,” said Paul Grand, CEO of MedTech Innovator. “We are thrilled with the caliber of the startups participating in this year’s cohort and we look forward to providing them with the resources and mentorship they need to succeed.”

Since 2017, PathologyWatch has been an innovative leader in intuitive, easy-to-implement digital dermatopathology solutions that aim to streamline the diagnostic process while improving patient care models. 

Compared to its competitors, PathologyWatch focuses on enhancing services available in outpatient clinics by offering a fully interfaced EMR reporting process, access to top dermatopathologists with the option to interpret and bill for their cases, and provide their clients 24/7 access to digital slides. 

“I believe PathologyWatch is the future of dermatopathology for dermatologists. The group combines academic expertise with the efficiency of a private lab. It is a huge timesaver for me and my staff,” said April Larson, a certified dermatologist, and VP of client experience and advisory board at PathologyWatch. “By reviewing my own cases, I am able to make better clinical decisions for my patients. It’s a win-win for everybody.”

With PathologyWatch, clinics can significantly reduce the time it takes from completing the patient examination to diagnosis with high-quality reads that lead to improved patient-provider relationships in shared medical decisions. What typically takes two weeks to receive a diagnosis can now potentially take two days through the efficient workflow that PathologyWatch has developed.

The 50 companies selected by MedTech Innovator will compete in the final competition at The MedTech Conference in September 2021. 

To read the full list of the medtech companies honored, click here. 

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

In this episode of Digital Dermatology Digest, things are starting to heat up as dermatopathologist Rajni Mandal, MD, at PathologyWatch discusses sweat gland tumors.

What is a sweat gland tumor?

These skin tumors are often benign and derive from cells related to sweat glands. “Normal sweat glands have ducts and secretory components,” explains Dr. Mandal, noting the different appearance, which shows clear apocrine and eccrine cells.

Here are highlights of the four common types of sweat gland tumors.

1. Hidradenoma papilliferum, which is common in the vulvar area. The distinct appearance of this dermal tumor includes papillary folds and the apocrine gland’s decapitation secretion.
2. Papillary adenoma often appears in the axilla, the patient’s scalp, and other sites. This is a tumor of the skin, also known as eccrine papillary adenoma, where the tumor forms tubular and tubulopapillary structures.
3. Apocrine hidrocystoma is common in the patient’s head and neck as well as the Moll’s gland in the eyelid. It’s a multiloculated cyst with apocrine cells and is often associated with Schöpf–Schulz–Passarge syndrome.
4. Poroma is common on the patient’s palms, soles of their feet, and scalp. This benign adnexal neoplasm is composed of epithelial cells that show tubular (usually distal ductal) differentiation.

What is the treatment for sweat gland tumors?

Sweat gland tumors are often benign. However, some patients may prefer to have them removed surgically.

To learn more about this skin condition and other common diseases, join us for each episode of Digital Dermpath Digest right here on pathologywatch.com.