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Pathology of Folliculosebaceous

Cystic Hamartoma

Dr Sampurna Roy MD           




Folliculosebaceous cystic hamartoma (FSCH), first described by Kimura et al in 1991, is a rare cutaneous hamartoma composed of dilated folliculosebaceous units associated with mesenchymal elements.

Some authors have presented evidence suggesting that this lesion is very closely related to trichofolliculoma.

Clinical presentation:  

Majority of lesions present as 0.5-1.5 cm papules or exophytic nodules. 

Lesions are usually rubbery to firm in consistency.

Typically arise in adulthood but the giant variant appears to be congenital and enlarges during puberty.

Site:  Face or scalp, ear and upper back. 

Microscopic features:

- Lobular neoplasm ;

- Large cystic structure lined by squamous epithelium similar to the infundibular epithelium ; 

- Surrounded by multiple mature sebaceous lobules ; 

- Rudimentary hair follicules may be present in the middle of the dermis ;

- The folliculosebaceous cystic structures are set in a fibrovascular stroma containing fat cells and neural tissue ; 

- Marked increase in reticular dermal collagen bundles and between sebaceous follicles ; 

- Some areas resemble angiofibroma ;

- Moderate perifollicular lymphocytic infiltrate.


Differential diagnosis:   

- Sebaceous gland hyperplasia

- Steatocystoma ;

- Nevus sebaceus of Jadassohn  ; - Small aberrant sebaceous glands, - Budding in close association with a hyperplastic papillomatous epidermis.

- Sebaceous trichofolliculoma - Histopathologically , FSCH shares several similar features to sebaceous trichofolliculoma, but it is usually possible to differentiate these two tumours  ;

- Dermoid cyst of skin.


Further reading:

Folliculosebaceous cystic hamartoma presenting as a subcutaneous nodule on the thigh.

Nasal folliculosebaceous hamartoma with vascular-mesenchymal overgrowth in an infant.

Distinctive genital folliculosebaceous cystic hamartomas in a patient with fibrous dysplasia.

Folliculosebaceous cystic hamartoma of the external auditory canal in an adult.

Folliculosebaceous cystic hamartoma in a patient with neurofibromatosis type I.

Giant folliculosebaceous cystic hamartoma on the right forearm.

Nevus lipomatosus superficialis with a folliculosebaceous component: report of 2 cases.

Folliculosebaceous cystic hamartoma associated with melanocytic nevus.

Folliculosebaceous cystic hamartoma of the upper lip and labial mucosa.

Folliculosebaceous cystic hamartoma on the nipple.

A clinicopathologic study of folliculosebaceous cystic hamartoma.

Folliculosebaceous cystic hamartoma of the right cheek and inner canthus.

A revaluation of folliculosebaceous cystic hamartoma: the histopathological and immunohistochemical features.

Folliculosebaceous cystic hamartoma of the nipple: a case report.

A case of giant folliculosebaceous cystic hamartoma.

Giant, congenital folliculosebaceous cystic hamartoma: a case against a pathogenetic relationship with trichofolliculoma.

Clinicopathological and immnuohistochemical findings in a series of folliculosebaceous cystic hamartoma.

Folliculosebaceous cystic hamartoma or trichofolliculoma? A spectrum of hamartomatous changes inducted by perifollicular stroma in the follicular epithelium.

Giant folliculosebaceous cystic hamartoma of the upper extremity.  

Genital variant of folliculosebaceous cystic hamartoma.  




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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