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Pilar sheath acanthoma
Other Resources UpToDate PubMed

Pilar sheath acanthoma

Contributors: Haya Raef MS, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Pilar sheath acanthoma is a benign adnexal tumor that is derived from follicular epithelium.

It presents as an asymptomatic, small, skin-colored papule or nodule with a central opening (comedo), most often on the head / neck, and especially the upper lip, of middle-aged to elderly people. Pilar sheath acanthomas may occur at other sites as well.

Codes

ICD10CM:
L73.9 – Follicular disorder, unspecified

SNOMEDCT:
254693008 – Pilar sheath acanthoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Dilated pore of Winer – Consists of a larger central cystic cavity with thinner and radiating strands of epithelium, as opposed to a lobular arrangement.
  • Tumor of follicular infundibulum – Composed of pale pink cells and sometimes clear cells forming anastomosing narrow strands that run parallel to the epidermis in a shallow fashion.
  • Trichofolliculoma – Secondary and tertiary small hair follicles radiate from the wall of cystic cavity, often with a central "tuft" of multiple convalescing hairs.
  • Trichilemmoma – An endophytic proliferation of basaloid and slightly squamous appearing cells derived from follicular epithelium, with rudimentary palisading, but without marked atypia or retraction artifact.
  • Inverted follicular keratosis – An endophytic variant of a seborrheic keratosis with lesser trichilemmal differentiation, lesser palisading than a trichilemmoma, and often, with squamous eddies.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/02/2021
Last Updated:02/02/2021
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Pilar sheath acanthoma
Pilar sheath acanthoma : Smooth nodule, Smooth papule, Upper lip
Clinical image of Pilar sheath acanthoma
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