Imaging findings of trichilemmal cyst and proliferating trichilemmal tumour

Abstract

Purpose: The purpose of this study was to evaluate computed tomography and magnetic resonance imaging of benign trichilemmal cysts and proliferating trichilemmal tumours.

Methods: Nineteen histologically confirmed cutaneous lesions with trichilemmal keratinisation (12 trichilemmal cysts and seven proliferating trichilemmal tumours) were enrolled. Among them, 10 lesions (six trichilemmal cysts and four proliferating trichilemmal tumours) were examined by computed tomography, while 13 lesions (eight trichilemmal cysts and five proliferating trichilemmal tumours) were examined by magnetic resonance imaging. Computed tomography and magnetic resonance imaging characteristics were retrospectively reviewed.

Results: Sixteen lesions (84%, 10 trichilemmal cysts and six proliferating trichilemmal tumours) occurred on the scalp. Lobulated margins were observed in five lesions (26%, three trichilemmal cysts and two proliferating trichilemmal tumours). With respect to computed tomography attenuation, calcification (>200 Hounsfield units) was observed in seven lesions (70%, five trichilemmal cysts and two proliferating trichilemmal tumours), hyperdense areas (≥80 and ≤200 Hounsfield units) in six (60%, three trichilemmal cysts and three proliferating trichilemmal tumours), and soft tissue density areas (<80 Hounsfield units) in nine (90%, five trichilemmal cysts and four proliferating trichilemmal tumours). On T1-weighted images, intratumoral hyperintensity was only observed in eight trichilemmal cysts but no proliferating trichilemmal tumours (100% vs. 0%, P<0.01). On T2-weighted images, hypointense rim and intratumoral hypointensity was observed in all 13 lesions (100%, eight trichilemmal cysts and five proliferating trichilemmal tumours), and linear or reticular hypointensity was observed in 10 (77%, six trichilemmal cysts and four proliferating trichilemmal tumours).

Conclusion: Trichilemmal cysts and proliferating trichilemmal tumours predominantly occurred on the scalp with calcification, and usually exhibited linear or reticular T2 hypointensity. Intratumoral T1 hyperintensity may be a useful imaging feature for differentiating trichilemmal cysts from proliferating trichilemmal tumours.

Keywords: CT; MRI; Trichilemmal cyst; proliferating trichilemmal tumour; scalp.

Figure 1.

36-Year-old man with trichilemmal cyst on the scalp. Unenhanced computed tomography image shows a well-defined, oval, subcutaneous lesion with calcifications (arrows) and hyperdense areas (arrowheads).

Figure 2.

76-Year-old man with proliferating trichilemmal tumour on the scalp. Unenhanced computed tomography shows a well-defined, lobulated, cutaneous lesion with calcifications (arrows) and hyperdense areas (arrowheads).

Figure 3.

56-Year-old man with trichilemmal cyst on the scalp. (a) T1-weighted image (TR/TE, 542/15 ms) shows a well-defined, oval, subcutaneous lesion (arrow) with diffuse hyperintensity. (b) T2-weighted image (TR/TE, 3,500/90 ms) shows a heterogeneous subcutaneous lesion (arrow) with linear or reticular hypointensity (arrowheads).

Figure 4.

57-Year-old woman with proliferating trichilemmal tumour on the scalp. (a) T1-weighted image (TR/TE, 778/15 ms) shows a well-defined, oval, subcutaneous lesion (arrow), which is hypointense to gray matter. (b) T2-weighted image (TR/TE, 3,170/90 ms) shows a heterogeneous subcutaneous lesion (arrow) with linear or reticular hypointensity (arrowheads).