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Proliferating trichilemmal tumor (PTT), also referred to as proliferating trichilemmal cyst or pilar tumor, is an uncommon neoplasm that originates from the outer root sheath of a hair follicle. It occurs commonly on the scalp in elderly women (1). PTT is usually considered as a benign skin appendageal tumor, biologically; however, malignant PTT with recurrence/metastasis has been reported recently (2-5). The principle of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) scan is based on the modified glucose metabolism of the tumor cell. The proliferative tumor cell has enhanced activity of glycolytic enzyme (e.g., hexokinase) and increased glucose transporter on cell membrane; thus, the glucose utilization of proliferative tumor cell is higher than that of normal cell. FDG, glucose analogue, is rapidly transported into the tumor cell and phosphorylated into FDG-6-phosphate by hexokinase. In contrast to normal glucose, metabolism of FDG is terminated in the production of FDG-6-phosphate that remains trapped within the cell (6, 7). To date, the diagnostic usefulness of F-18 FDG PET in PTT has not been assessed due to its rarity. Herein, we reported our experience of a rare case of recurrent malignant PTT with increased FDG uptake on PET/computed tomography (CT).

Recurrent Proliferating Trichilemmal Tumor with Malignant Change on the F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography