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Brooke-Spiegler Syndrome
Quyn Sherrod, MD; Miguel Gutierrez, MD; Keith Carlson, MD
UCLA/WLA VA Division of Dermatology David Geffen School of Medicine
Los Angeles, California
HistoryHistory
39 year-old, healthy, Caucasian maleMultiple lesions on face and scalp
beginning at 10 years oldNonpainful, nonpruriticPrevious paranasal biopsy consistent
with trichoepitheliomaMother with similar presentation
Physical ExamPhysical Exam
Physical ExamPhysical Exam
Physical ExamPhysical Exam
Physical ExamPhysical Exam
HistopathologyHistopathology
HistopathologyHistopathologyScalp cylindroma-spiradenoma Scalp cylindroma-spiradenoma
HistopathologyHistopathologyScalp cylindromaScalp cylindroma
HistopathologyHistopathologyScalp spiradeomaScalp spiradeoma
HistopathologyHistopathologyFace trichoepitheliomaFace trichoepithelioma
Brooke-Spiegler SyndromeBrooke-Spiegler Syndrome
Brooke-Spiegler SyndromeBrooke-Spiegler Syndrome
Uncommon syndrome with autosomal dominant inheritance pattern
Variable expression and penetranceMore severe phenotype in womenMutiple cutaneous adnexal neoplasmsCylindromas, spiradenomas,
trichepitheliomas on head and neck
Clinical PresentationClinical PresentationBegins during second or third decadeCylindromas, spiradenomas on scalp ‘Turban tumors’ when numerousTrichoepitheliomas more
common on faceProgressive increase in size and
number
GeneticsGenetics
Autosomal dominant mutation affecting epidermal appendages
CYLD gene on chromosome 16q12-q13CYLD functions as a tumor suppresorCYLD inhibits NF-κB transcription factor
in the TNF-α signaling pathway, regulating cell growth
Differential DiagnosisDifferential Diagnosis
Familial cylindromatosis Multiple familial trichoepithelioma Rombo syndrome
– Vermicular atrophoderma - Milia– Basal cell carcinomas - Hypotrichosis– Peripheral vasodilation/cyanosis - Trichoepitheliomas
Bazex syndrome– Follicular atrophoderma - Hypotrichosis– Basal cell carcinomas - Trichoepitheliomas– Hypohidrosis
PrognosisPrognosis
Psychologic impact due to physical disfigurement
Rare malignant transformation of trichoepitheliomas into basal cell carcinomas– -Low metastatic potential
Rare malignant transformation of cylindromas and spiradenomas– -Local infiltration and distant metastases reported
Increased risk for salivary and parotid gland adenomas and adenocarcinomas
TreatmentTreatment
Excision Dermabrasion Electrodessication Cryotherapy Radiotherapy Laser- Argon, erbium:Yag, CO2 Medical therapy with sodium salicylate and
prostaglandin A1 is under investigation– -Inhibit NF-κB activiation
Monitor for clinical signs of malignant transformation
ReferencesReferences Kakagia D, Lambropoulou M, Alexiadis G. Brooke-Spiegler syndrome with
parotid gland enlargement. Eur J Dermatol. 2004 May-Jun;14(3):139-41. Kim C, Kovich OI, Dosik J. Brooke-Spiegler syndrome. Dermatol Online J.
2007 Jan 27;13(1):10. Zhang GL, Huang YJ, Yan KL et al. Diverse phenotype of Brooke-Spiegler
syndrome associated with a nonsense mutation in the CYLD tumor suppressor gene. Exp Dermatol. 2006 Dec;15(12):966-70.
Ly H, Black MM, Robson A. Case of the Brooke-Spiegler syndrome. Australas J Dermatol. 2004 Nov;45(4):220-2.
Szepietowski JC, Wasik F, Szybejko-Machaj G et al. Brooke-Spiegler syndrome. J Eur Acad Dermatol Venereol. 2001 Jul;15(4):346-9.
Ralla D, Harland CC. Brooke-Spiegler syndrome: treatment with laser ablation. Clin Exp Dermatol. 2005 Jul;30(4):355-7.
Lee DA, Grossman ME, Schneiderman P et al. Genetics of skin appendage neoplasms and related syndromes. J Med Genet. 2005 Nov;42(11):811-9.