This chapter on cutaneous appendageal tumours covers the spectrum of lesions displaying eccrine, apocrine, sebaceous and follicular differentiation. It includes cysts, hamartomas and benign and malignant tumours. Traditionally, appendageal tumours have been classified according to rigid criteria separating lesions with eccrine, apocrine, sebaceous and follicular differentiation. This separation is clearly artificial and it is now acknowledged that lesions regarded as strictly eccrine may well have apocrine differentiation and lesions classified as purely follicular may exhibit apocrine differentiation reflecting the close embryological relationship between the pilosebaceous unit and the apocrine gland.


Keywords:

hamartoma;
appendageal tumours;
sweat gland tumours;
follicular tumours;
adnexal tumours;
sebaceous tumours;
adnexal neoplasms

Tumours of Skin Appendages

Lipomas are the most commonly encountered benign mesenchymal tumors, but their occurrence in the head and neck is rare, even more at the level of the parotid region where they can be found nearby the parotid capsule, inside the capsule, or within the gland. In addition, lipomas involving the deep parotid lobe are extremely unusual. That is why lipomas are not often considered for differential diagnosis of parotid lumps. Concerning diagnostic tools, magnetic resonance imaging (MRI) is nowadays considered as the main imaging examination for parotid lipomas due to a characteristic signal intensity on T1- and T2-weighted images. Furthermore, even if the cost of MRI is nearly three times that of computed tomography, MRI is accurate, safe, and has few biological costs for the patient. In this reported case, MRI provided all information for either diagnosis or preoperative planning being the best diagnostic tool regarding tumor margin characteristics and surrounding tissues' involvement. Concerning treatment, surgical excision of parotid masses is always mandatory for definitive diagnosis, but it is challenging because of the facial nerve. For this reason, a well-established surgical technique is mandatory for success. The authors present a rare case of parotid gland lipoma arising from the deep lobe and discuss diagnostic tools and surgical technique.

A rare case of parotid gland lipoma arising from the deep lobe of the parotid gland

An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.

/pdf/cross-sectional-imaging-and-cytologic-investigations-in-the-4wkn0mmbhj.pdf

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review.

Tracheal tumors are rarely diagnosed in veterinary medicine and the majority of tracheal neoplasia reported in adult dogs are malignant. Intratracheal lipoma has not been previously reported in the veterinary literature. A 7-year-old Briard dog was evaluated for inspiratory dyspnoea and an inspiratory wheeze. Cervical radiographs and tracheoscopic examination revealed an intratracheal mass that was surgically removed. The dog has been asymptomatic after the surgery. Based on histopathology, the mass was diagnosed as lipoma. To the authors‘ knowledge, this is the first published report of an intratracheal lipoma in the veterinary literature.

/pdf/intraluminal-tracheal-lipoma-as-a-rare-cause-of-dyspnoea-in-1xrzxsedi3.pdf

Intraluminal tracheal lipoma as a rare cause of dyspnoea in a dog

A rare development of basal cell carcinoma on trichoepithelioma in a chemical burn scar tissue: A case report

Lipomas are common soft tissue neoplasms; however, they are found rarely in the parotid gland region. The purpose of this study was to analyze the diagnostic challenges of this rare condition. We performed a retrospective analysis of 11 patients with parotid lipomas, treated from November 2009 to February 2014. The mean age at diagnosis was 46.6±2.9 years, and the study population included 8 males and 3 females. Computed tomography (CT) and/or magnetic resonance imaging (MRI) were performed in radiological diagnosis. Fine needle aspiration (FNA) was performed in all cases (including two times in five patients, for a total of 16 biopsies) and results were diagnostic in four instances. Specificities of the CT, MRI, and FNA cytology tests were 100%, 100%, and 25% respectively. CT and/or MRI scans were more reliable than FNA cytologies for accurate diagnosis of parotid lipomas.

/pdf/diagnostic-dilemma-of-parotid-lipomas-imaging-versus-fine-qdu5eigifu.pdf

Diagnostic dilemma of parotid lipomas: imaging versus fine needle aspiration cytology

Giant solitary trichoepitheliomas (GSTs), benign cutaneous adnexal tumors seen in advanced age particularly on the face, can rarely become large. The solitary types do not show hereditary transition. Hereditary trichoepitheliomas are seen in younger people with multiple millimetrical nodules. In this article, we describe a GST originating from the auricle and evaluate the approach to its management.

A giant solitary trichoepithelioma originating from the auricle.

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Diagnostic dilemma of parotid lipomas: imaging versus fine needle aspiration cytology

A giant solitary trichoepithelioma originating from the auricle.