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Zhu H, Wu S. Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation. Skin Res Technol 2024; 30:e13585. [PMID: 38279551 PMCID: PMC10818091 DOI: 10.1111/srt.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. MATERIALS AND METHODS Records of patients with pilomatricomas (n = 63), epidermoid cysts (n = 76), and dermatofibrosarcoma protuberans (n = 19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. RESULTS Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. CONCLUSION A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Huiling Zhu
- Department of UltrasoundThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
| | - Size Wu
- Department of UltrasoundThe First Affiliated Hospital of Hainan Medical UniversityHaikouChina
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2
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Wei X, Cheng D, Shao C, Pang K, Xiao J, Zhang Y, Wu M, Zhang L, Ni P, Zhang F. A comparative study of pilomatricoma and epidermoid cyst with ultrasound. Clin Radiol 2023; 78:e582-e589. [PMID: 37183139 DOI: 10.1016/j.crad.2023.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023]
Abstract
AIM To explore and compare the ultrasonic (US) features of pilomatricoma (PM) and epidermoid cyst (EC) in the differential diagnosis and improve the accuracy of US diagnosis of PM. MATERIALS AND METHODS Three hundred and nine patients who underwent US examination before surgery with a histopathological diagnosis of PM or EC after surgery were analysed retrospectively. The patients were categorised into the training and validation sets according to the inspection times. Univariate analysis was undertaken on the US and clinical features of PM and statistically significant variables (p<0.05) were included in the multivariate logistic regression model to establish a diagnostic model. RESULTS The results demonstrated that the multivariate logistic regression model for PM was statistically significant (p<0.001). The risk factors included posterior echo attenuation and hypoechoic halos (odds ratio [OR] = 9.277, 10.254) and the protective factors included age, diameter thickness, and posterior echo enhancement (OR=0.936, 0.302, 0.156). The performance of the diagnostic model was tested using the training set (area under the receiver operating characteristic curve [AUC] = 0.974, 95% confidence interval [CI] = 0.955-0.994) and the validation set (AUC = 0.967, 95% CI = 0.926-1.000), which demonstrated good discriminant ability. CONCLUSIONS The diagnostic accuracy for PM was higher than that for EC when the nodule is characterised by posterior echo attenuation, hypoechoic halos, smaller thickness, and younger age. The US diagnostic model developed may be used to guide the diagnosis of PM.
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Affiliation(s)
- X Wei
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - D Cheng
- Department of Radiology, Jinan Fourth People's Hospital, Jinan, Shandong, China
| | - C Shao
- Department of Evidence-Based Medicine, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - K Pang
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - J Xiao
- Department of Evidence-Based Medicine, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - Y Zhang
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - M Wu
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - L Zhang
- Department of Pathology, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - P Ni
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China
| | - F Zhang
- Department of Ultrasound, the Second Hospital of Shandong University, Jinan, Shandong, China.
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3
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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4
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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5
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila LF. Imaging palpable tumors in pediatrics: Part 2. RADIOLOGIA 2023; 65:43-54. [PMID: 36842785 DOI: 10.1016/j.rxeng.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 02/28/2023]
Abstract
Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.
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Affiliation(s)
- D Llanos
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I de la Pedraja
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L Campos
- Servicio de Dermatología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J Armijo
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L F Ávila
- Servicio de Cirugía Pediátrica, Hospital Universitario Clínico San Carlos, Madrid, Spain
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6
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila L. Radiología de las tumoraciones palpables en el paciente pediátrico. Parte 2. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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7
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Pediatric chest wall masses: spectrum of benign findings on ultrasound. Pediatr Radiol 2022; 52:429-444. [PMID: 34505950 DOI: 10.1007/s00247-021-05196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.
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8
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Abstract
Ultrasound has evolved in dermatology from an experimental phase to a daily practice imaging technique. Its several advantages include its safety, good balance between penetration and resolution, high definition, and the detection of blood flow in real time. Its applications are growing and include the support of the diagnosis and extent in all axes, including depth, vascularity patterns, staging, and follow up of multiple cutaneous diseases-benign cutaneous tumors, vascular anomalies, nail lesions, skin cancer, inflammatory cutaneous diseases, and aesthetics complications.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Departments of Dermatology, Universidad de Chile and Pontificia Universidad Catolica de Chile, Santiago, Chile.
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9
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Pelizzari M, Giovo ME, Innocente N, Pérez R. Ultrasound findings in 156 children with 169 pilomatricomas. Pediatr Radiol 2021; 51:2038-2046. [PMID: 34255110 DOI: 10.1007/s00247-021-05124-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous lesions present a diagnostic challenge to radiologists and clinicians alike. Pilomatricoma is the second most common skin neoplasm in childhood, yet there are limited reports in the literature focusing on imaging in pediatric patients. OBJECTIVE To characterize the typical and atypical US features of pilomatricoma in pediatric patients and to determine the performance of the adult-based Solivetti classification for assessing pilomatricomas in children. MATERIALS AND METHODS We retrospectively reviewed 169 US scans of pathologically proven pilomatricomas in 156 children performed over a period of 66 months. We evaluated images for the size of the lesion, borders, morphology, content, calcification, location on the skin and Doppler characteristics. RESULTS Most of the pilomatricomas presented as single dermohypodermic lesions with peripheral vascularity on color Doppler interrogation. The cheek was the most common location, followed by the arm. Solivetti type 2 US pattern was the most frequent, and peripheral hypoechoic halo was only observed in this type. One child had an anetodermic pilomatricoma, and 11 children had multiple lesions. CONCLUSION We showed that pilomatricomas exhibit variable sonographic patterns. In our cohort, less than 50% of the lesions showed the characteristic hypoechoic rim and less than 30% of the cases presented as diffusely hyperechoic masses with posterior acoustic shadowing. Our results show that the Solvetti classification for the US assessment of pilomatricomas can be of value in children.
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Affiliation(s)
- Mario Pelizzari
- Universidad Católica de Córdoba, Ciudad de Córdoba, República Argentina. .,Servicio de Radiología Pediátrica, Instituto Oulton, Avenida Vélez Sarsfield 562, Ciudad de Córdoba, República Argentina.
| | - María E Giovo
- Universidad Católica de Córdoba, Ciudad de Córdoba, República Argentina.,Servicio de Dermatología, Hospital de Niños de la Santísima Trinidad, Ciudad de Córdoba, República Argentina
| | - Natalia Innocente
- Servicio de Radiología Pediátrica, Instituto Oulton, Avenida Vélez Sarsfield 562, Ciudad de Córdoba, República Argentina.,Universidad Nacional de Córdoba, Ciudad de Córdoba, República Argentina
| | - Ricardo Pérez
- Universidad Católica de Córdoba, Ciudad de Córdoba, República Argentina.,Servicio de Radiología Pediátrica, Instituto Oulton, Avenida Vélez Sarsfield 562, Ciudad de Córdoba, República Argentina
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10
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Li L, Xu J, Wang S, Yang J. Ultra-High-Frequency Ultrasound in the Evaluation of Paediatric Pilomatricoma Based on the Histopathologic Classification. Front Med (Lausanne) 2021; 8:673861. [PMID: 33981718 PMCID: PMC8107216 DOI: 10.3389/fmed.2021.673861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pilomatricoma (PM) is one of the most common benign tumours in children. However, the inaccuracy of preoperative diagnosis and evaluation is high. Non-invasive examinations, including dermoscopy and ultrasound are helpful for diagnosing and evaluating PM. To date, ultra-high-frequency ultrasonographic features of PM have been rarely studied. Objective: We aimed to investigate the ultra-high frequency ultrasonographic features of PM in a large paediatric cohort and to determine the associations of these features with the clinical features of different histological subtypes of PM. Methods: This was a retrospective study. Patients who had both preoperative ultra-high-frequency ultrasonographic evaluation and pathological diagnosis of PM were enrolled. A series of infantile haemangiomas and cutaneous cysts during the same period were included as controls. Histological findings, including the stage, calcifying type, and ultrasonographic features of each lesion, were described. Results: A total of 133 patients with PM were included, and 147 PM lesions were analysed. The male-to-female ratio was 1:1.58, and the median age of onset was 91 (range: 10-188) months. On ultra-high-frequency ultrasonography, PM presented as heterogeneous (144/147, 98.0%), well-demarcated (143/147, 97.3%), and hypoechoic (126/147, 85.7%) tumours located between the deep dermis and subcutaneous tissue (139/147, 94.6%). The most common features were internal echogenic foci (135/147, 91.8%), hypoechoic rim (133/147, 90.5%), and posterior acoustic shadowing (94/147, 63.9%). Fourteen (9.5%) lesions were histologically categorized in the early stage, 58 (39.5%) in the fully developed stage, 65 (44.2%) in the early regressive stage and 10 (6.8%) in the late regressive stage. Three calcifying types, including scattered dots, clumps and arcs, were observed on histologic examination, which corresponded well with grey-scale imaging on ultra-high-frequency ultrasonography. Each calcifying type was significantly different in various histological stages (P = 0.001), among which scattered dots were mainly present in the early and fully developed stage and arc-shaped calcifying were present in the regressive stages. Calcification was observed in skin cysts, while there was more frequent posterior enhancement, less frequent posterior shadowing, and hypoechoic rim than PM. Haemangioma also presented as a hypoechoic tumour on grey-scale imaging. However, haemangioma was homogeneous and rarely calcifying. Conclusions: PM is a heterogeneous, well-demarcated, hypoechoic tumour located between the deep dermis and the subcutis on ultra-high-frequency ultrasonography. The most common features are internal echogenic foci (calcifying) and hypoechoic rim. Calcifying types can help in the staging of PM. Ultra-high-frequency ultrasound is a useful tool for the diagnosis and evaluation of PM.
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Affiliation(s)
- Li Li
- Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaosheng Xu
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Siwei Wang
- Department of Radiology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jun Yang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences, Tianjin, China
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11
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Almuhanna N, Wortsman X, Wohlmuth-Wieser I, Kinoshita-Ise M, Alhusayen R. Overview of Ultrasound Imaging Applications in Dermatology. J Cutan Med Surg 2021; 25:521-529. [PMID: 33682489 PMCID: PMC8474315 DOI: 10.1177/1203475421999326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Complete visualization of lesions is critical for the accurate diagnosis and
management of dermatological diseases. Currently, the most readily available
technologies used by dermatologists include dermoscopy and photography.
Nevertheless, ultrasound has emerged as a useful non-invasive modality in
dermatology, which can be added to the clinical examination supporting an early
and more accurate diagnosis. Moreover, there are significant technological
advances in recent years, such as the development of handheld devices and
ultra-high frequency probes that have expanded the integration of ultrasound
into daily dermatology practice. In this article, we reviewed the most common
applications of ultrasound in the field of dermatology.
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Affiliation(s)
- Nouf Almuhanna
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ximena Wortsman
- 14655 Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,38103 Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Iris Wohlmuth-Wieser
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Raed Alhusayen
- 793831507 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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12
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Hu JL, Yoo H, Kwon ST, Kim S, Chung JH, Kim H, Kim J, Yu NH, Kim BJ. Clinical analysis and review of literature on pilomatrixoma in pediatric patients. Arch Craniofac Surg 2020; 21:288-293. [PMID: 33143396 PMCID: PMC7644346 DOI: 10.7181/acfs.2020.00528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Pilomatrixoma is a benign tumor that originates from the hair follicle matrix. It usually presents as a hard, slow growing, solitary mass that can be easily misdiagnosed as other skin masses. The aim of this study was to clinically analyze a case series of pilomatrixoma in pediatric patients from Korea. Methods A total of 165 pediatric patients from 2011 to 2018 with a histological diagnosis of pilomatrixoma were included. A retrospective review was performed using the electronic medical records, including patient demographics, number and location of the mass, clinical and imaging presentation, and postoperative outcomes. Results There were 61 male and 104 female patients with 152 solitary and 13 multiple pilomatrixomas. Among solitary pilomatrixomas, the lesion commonly occurred in the head and neck (84.2%), followed by upper limbs (11.2%), lower limbs (3.3%), and trunk (1.3%). The pilomatrixoma lesion presented as the following types based on our clinical classification: mass (56.02%), pigmentation (25.31%), mixed (12.65%), ulceration (4.82%), and keloid-like (1.2%). Ultrasonography showed a high positive predictive value (95.56%). There were no specific complications observed except for two cases of recurrence. Conclusion Pilomatrixoma has various clinical feature presentations and commonly occurs in the head and neck. Ultrasonography is a helpful diagnostic tool. Surgical removal of the lesion is the main treatment method with a low recurrence rate.
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Affiliation(s)
- Ju Long Hu
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Tack Kwon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukwha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeonwoo Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jinhyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Na Hee Yu
- Biomedical Research Institute, Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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13
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Arceu M, Martinez G, Alfaro D, Wortsman X. Ultrasound Morphologic Features of Steatocystoma Multiplex With Clinical Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2255-2260. [PMID: 32356597 DOI: 10.1002/jum.15320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
The ultrasound features of 87 steatocytoma multiplex (SCM) lesions detected in 9 patients are reported. Steatocytoma multiplex is a hamartomatous condition derived from the pilosebaceous duct junction that generates multiple cutaneous cystic lesions. It appeared as clusters of well-defined hypoechoic nodules with mild posterior enhancement in 100% of cases, with both dermal and subcutaneous locations in 67%. No calcification foci were detected within or at the periphery of the lesions. Fifty-six percent of the cases showed signs of hypervascularity in the edge of the nodules, and 44% of the lesions were associated with another dermatologic condition, most frequent being hidradenitis suppurativa (75%), followed by vellus hair cysts (25%). Steatocytoma multiplex shows ultrasound features that allow discrimination from other common cutaneous entities.
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Affiliation(s)
- Montserrat Arceu
- Department of Dermatology, Universidad de Chile, Santiago, Chile
| | | | - Daniela Alfaro
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ximena Wortsman
- Department of Dermatology, Universidad de Chile, Santiago, Chile
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
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14
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Hosokawa T, Shibuki S, Tanami Y, Sato Y, Oguma E. Sonographic characteristics of pilomatricomas and their association with symptom duration. Medicine (Baltimore) 2020; 99:e22550. [PMID: 33019466 PMCID: PMC7535781 DOI: 10.1097/md.0000000000022550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the associations between the sonographic findings and duration of symptoms in children with pilomatricoma.This study included 86 children with 95 lesions confirmed to be pilomatricoma after pathological examination. The associations between symptom duration and sonographic observations, including the presence or absence of peritumoral hyperechogenicity, calcification, and vascularity were investigated. The internal echogenicity of each pilomatricoma was scored using a 5-point scale based on echogenic spots and calcification with posterior acoustic shadowing. The Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.We found that the absence of peritumoral hyperechogenicity and severity of calcification were associated with increased symptom duration. Calcification, (present, 19.19 ± 18.99 months vs absent, 4.31 ± 3.24 months; P < .01) and peritumoral hyperechogenicity (present, 5.02 ± 5.80 months vs absent, 16.17 ± 18.24 months; P < .01), and grade of internal echogenicity (grade 0/1/2/3/4 = 3 months [1 patient]/4.33 ± 3.26 months [range, 1-12]/4.57 ± 3.46 months [range, 2-12]/10.89 ± 9.17 months [range, 3-28]/35.27 ± 19.16 months [range, 9-60], respectively; P = .01 and <.01) were associated with significant differences in symptom duration. There were no significant between-group differences in vascularity (6.01 ± 7.24 months; range, 1-48 vs 15.50 ± 19.12 months; range, 1-60; P = .08).Pilomatricomas with a relatively short symptom duration were more likely to exhibit peritumoral hyperechogenicity and calcification with less severe posterior acoustic shadowing compared to lesions with a longer symptom duration. These sonographic findings provided useful information that facilitated the correct and rapid diagnosis of pilomatricoma.
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15
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He P, Chen W, Zhang Q, Cui LG, Zhang Q. Distinguishing a Trichilemmal Cyst From a Pilomatricoma With Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1939-1945. [PMID: 32333607 DOI: 10.1002/jum.15298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine whether ultrasound (US) could distinguish a trichilemmal cyst from a pilomatricoma preoperatively. METHODS Ultrasound images of 61 pathologically proven trichilemmal cysts and 90 pathologically proven pilomatricomas were analyzed retrospectively. Two radiologists evaluated several US features. The sensitivity, specificity, Youden index, and predictive values of statistically significant US features were assessed. Parallel combined tests, serial combined tests, or both were performed to identify US features with high statistical significance. RESULTS Results from individual US features were not satisfactory; however, serial combined tests that included absence of complete internal echogenic foci, absence of a hypoechoic rim, absence of peritumoral hyperechogenicity, and absence of vascularity showed higher diagnostic utility. The sensitivity, specificity, Youden index, positive predictive value, and negative predictive value for correctly identifying a trichilemmal cyst were 74%, 88%, 0.62, 80%, and 83%, respectively. If 1 of these 4 US features was not a match for a trichilemmal cyst, pilomatricoma was considered. CONCLUSIONS It may be possible to distinguish trichilemmal cysts from pilomatricomas preoperatively using US. A combined test is superior to using any individual US feature.
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Affiliation(s)
- Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Qian Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Qian Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
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16
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Sirakaya M, Vydianath S. Pilomatrixoma of the head and neck: Typical presentation of a rare lesion. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:51-53. [PMID: 32063995 PMCID: PMC6987501 DOI: 10.1177/1742271x19867113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
Pilomatrixomas are benign tumours of primitive hair follicles, usually presenting as painless lumps in the head and neck region in children. As they are uncommon, they are often misdiagnosed clinically. We discuss a case of a five-year-old boy presenting with a five-month history of a pre-auricular lump. The initial clinical differential diagnosis was of a dermoid or a branchial cleft cyst. However, on ultrasonography the lesion was typical of a pilomatrixoma. The imaging literature is reviewed to illustrate the sonographic appearances of pilomatrixomas.
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Affiliation(s)
- Mert Sirakaya
- Mert Sirakaya, Royal Wolverhampton Hospitals
NHS Trust, Wolverhampton WV10 0QP, UK.
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17
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in pediatric dermatology. Part I: Lumps, bumps, and inflammatory conditions. Pediatr Dermatol 2020; 37:29-39. [PMID: 31743485 DOI: 10.1111/pde.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a non-invasive diagnostic technique that is particularly appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and can enhance our understanding of cutaneous diseases. Patient cooperation and limited training and experience are the main challenges for cutaneous ultrasonography in pediatric dermatology. This review describes cutaneous ultrasonography and the nuances of its use in the pediatric setting, followed by the ultrasonographic findings of cutaneous lumps, bumps, and inflammatory dermatoses commonly encountered in pediatric patients.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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18
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Marino MA, Ascenti G, Cardia R, Ieni A, Colonna MR. Pilomatrixoma of the right thigh: Sonographic-pathologic correlation in a young man. Radiol Case Rep 2019; 15:230-233. [PMID: 32071653 PMCID: PMC7010961 DOI: 10.1016/j.radcr.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/01/2022] Open
Abstract
Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a histological type of benign subcutaneous tumor arising from the cutaneous adnexa. We present our experience and the characteristic findings of a pilomatrixoma of the right thigh in a young healthy man. The lesion had grown slowly in size over the past year and this was the reason for referral to the Department of Plastic Surgery. Ultrasound imaging was performed and, through the use of B-mode, color-Doppler, and elastosonography, the lesion was depicted. The patient was therefore scheduled for surgery. Pilomatrixomas at times can pose a diagnostic challenge, especially when the location is unusual. Ultrasound and its tools, that is, color-Doppler and elastography, can assist the clinician arising the suspicion of pilomatrixoma.
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Affiliation(s)
- Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Pathology, University of Messina, 98123 Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Pathology, University of Messina, 98123 Messina, Italy
| | - Michele R Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, Section of Plastic Surgery, University of Messina, Messina, Italy
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An Unusual Tumor of the Ear: Pilomatricoma in a Middle-Aged Woman. Case Rep Otolaryngol 2019; 2019:4975216. [PMID: 31915560 PMCID: PMC6931023 DOI: 10.1155/2019/4975216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022] Open
Abstract
Pilomatricoma is a benign tumor arising from hair follicle matrix cells, presenting as an asymptomatic, firm, slow growing, mobile, superficial skin nodule typically in children. This lesion with an atypical clinical presentation is frequently misdiagnosed as other skin lesions and even as malignant entities regardless of detailed cytological, imaging examinations; the site of occurrence is one of the keys to accurate diagnosis. Here, we present a case of pilomatrixoma involving the ear, the cymba conchae of the auricle, which is an extremely rare site for the lesion in a 52-year-old woman. The present case suggests that this benign tumor needs to be included in the differential diagnosis in patients who present with an atypical auricular lesion.
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20
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Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci 2019; 9:15. [PMID: 31448166 PMCID: PMC6702939 DOI: 10.25259/jcis-6-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | | | - Darshan Gandhi
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Neeta Ghimire
- Department of Pediatric Dentistry, Kathmandu University, Nepal
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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21
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He P, Cui LG, Wang JR, Zhao B, Chen W, Xu Y. Trichilemmal Cyst: Clinical and Sonographic Features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:91-96. [PMID: 29708283 DOI: 10.1002/jum.14666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In this study, we retrospectively reviewed the clinical and sonographic features of patients with trichilemmal cysts. METHODS Sonographic findings of 54 cases of trichilemmal cysts were retrospectively analyzed from 50 patients, including 4 cases of proliferating trichilemmal cysts. Associated factors of internal calcification-positive cases were also evaluated. RESULTS The mean age of the 50 patients was 43.4 years (range, 15-80 years) and the female-to-male ratio was 1.3. Overall, 68% of the trichilemmal cysts in the 54 lesions were located in the scalp, and 15% were located in the extremities. All 54 lesions were preoperatively examined by sonography and showed well-defined, oval-shaped structures located in subcutaneous soft tissues close to the dermis. Of the 54 lesions, 72% were hypoechoic masses, 89% were heterogeneous, and 65% had internal calcification. Among the internal calcification-positive cases, the mean age of the patients was 43.4 years, and the female-to-male ratio was 0.6. Of these lesions, 83% were located in the scalp. We did not find any significant association between calcification, age, or sex (P = .993 and P = .99); however, lesions present in the scalp were significantly associated with internal calcification (P = .005). 81% of the 54 lesions displayed posterior enhancement. but the color Doppler sonography of all lesions revealed no vascularization. CONCLUSIONS Trichilemmal cysts should be considered to diagnose of well-defined, hypoechoic lesions with internal calcification and posterior sound enhancement in the subcutaneous soft tissues of the scalp or extremities upon sonography.
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Affiliation(s)
- Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Jin-Rui Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Bo Zhao
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, 100191, China
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Abstract
INTRODUCTION Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a superficial benign skin tumor that arises from hair follicle matrix cells. Although pilomatrixomas are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. By reviewing all the literature over the past 10 years, the aims of this article are to analyze the cause, clinical presentation, management, and outcome of pilomatrixoma among children and adults to gain a more complete understanding of this lesion in today's clinical context. METHODS A MEDLINE and EMBASE search was conducted from January 2005 to February 2015 using a combination of the terms: "child," "childhood," "adult," and keywords: "pilomatrixoma," "pilomatricoma," and "calcifying epithelioma of Malherbe." A total of 150 articles were reviewed. RESULTS The lesions occurred most commonly in the first and second decades (mean age 16 years and 7 months). The commonest presentation was of an asymptomatic, firm, slowly growing, mobile nodule. Only 16% were accurately diagnosed on clinical examination. Imaging in the form of ultrasound, computed tomography, and magnetic resonance imaging has been reported. Pathological diagnosis was achieved through incision, punch, and shave biopsies. Pathological findings are discussed and summarized in this review. CONCLUSION Pilomatrixomas are thought to arise from mutation in the Wnt pathway and has been linked to several genetic conditions. It is commonly misdiagnosed preoperatively; however, with better awareness of the lesion, it can be appropriately treated while avoiding unnecessary diagnostic tests. Complete surgical excision with clear margins is almost always curative.
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Idiopathic Facial Aseptic Granuloma: Clinical and Ultrasound Findings in 3 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Stember JN, Liu M, Poliak D, Hecht E, Laifer-Narin S. The Distal Acoustic Spotlight: a novel method to visualize the distal acoustic space on ultrasound. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kapoor A, Narayanan R, Tandon A, Santosh AK. Pilomatricoma: An unusual cause of lump in a male breast. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:209-211. [PMID: 28555882 DOI: 10.1002/jcu.22503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/25/2017] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Abstract
We present the case of a 48-year-old man who presented with a painless, progressively increasing lump in the left breast. The mammographic and sonographic appearance of the lesion was suspicious for malignancy. Fine needle aspiration cytology and histopathologic examination confirmed the diagnosis of pilomatricoma. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:209-211, 2018.
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Affiliation(s)
- Anu Kapoor
- Department of Radiology, Nizams Institute of Medical Sciences, Panjagutta Hyderabad, Telangana, India, 500082
| | - Ramakrishna Narayanan
- Department of Radiology, Nizams Institute of Medical Sciences, Panjagutta Hyderabad, Telangana, India, 500082
| | - Ashwani Tandon
- Department of Pathology, Nizams Institute of Medical Sciences, Panjagutta Hyderabad, Telangana, India, 500082
| | - Arun Kumar Santosh
- Department of Radiology, Nizams Institute of Medical Sciences, Panjagutta Hyderabad, Telangana, India, 500082
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26
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Lin S, Xu S, Xie Z. Calcifying epithelioma of malherbe (Pilomatrixoma): Clinical and sonographic features. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:3-7. [PMID: 28677820 PMCID: PMC5763411 DOI: 10.1002/jcu.22517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/19/2017] [Accepted: 06/03/2017] [Indexed: 05/28/2023]
Abstract
PURPOSE The purpose of this study was to describe the clinical and sonographic features of calcifying epitheliomas (pilomatrixomas). METHODS We retrospectively reviewed the clinical data and sonographic appearances of 59 cases of calcifying epitheliomas in 58 patients that were confirmed pathologically. RESULTS The mean age of the patients was 26 years (range, 5-69 years) and the female-to-male ratio was 1.2. All masses were located in subcutaneous soft tissues. Overall, 76.3% of the cases were located in the head and neck; the mean tumor size was 13 mm, and 72.9% of the cases were between 10 and 20 mm in size. Of the lesions, 62.7% were hypoechoic masses with internal calcifications, and 74.6% of them showed low or moderate internal vascularity on Doppler imaging. CONCLUSIONS The diagnosis of calcifying epithelioma should be considered in a patient with a painless, circumscribed, oval-shaped hypoechoic mass with internal calcifications and internal vascularity in the subcutaneous soft tissues of the head or neck. The mass may be small and have well-defined margins, with hypoechogenicity. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:3-7, 2018.
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Affiliation(s)
- Sai‐Feng Lin
- Department of UltrasoundThe first affiliated hospital of Wenzhou Medical UniversityWenZhou325000Zhejiang ProvinceChina
| | - Shi‐Hao Xu
- Department of UltrasoundThe first affiliated hospital of Wenzhou Medical UniversityWenZhou325000Zhejiang ProvinceChina
| | - Zuo‐Liu Xie
- Department of UltrasoundThe first affiliated hospital of Wenzhou Medical UniversityWenZhou325000Zhejiang ProvinceChina
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27
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Rodríguez-Bandera AI, Feito-Rodríguez M, Maseda-Pedrero R, de Lucas-Laguna R. Idiopathic Facial Aseptic Granuloma: Clinical and Ultrasound Findings in 3 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:e1-e5. [PMID: 29217229 DOI: 10.1016/j.ad.2017.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/30/2017] [Accepted: 08/12/2017] [Indexed: 11/28/2022] Open
Abstract
Idiopathic facial aseptic granuloma is a typical childhood disease characterized by the presence of one or more asymptomatic nodules on the cheek. Although pathogenesis remains unclear, the disease is thought to be a type of childhood rosacea. It resolves spontaneously, yet it could be confused with other lesions that require treatment. We present clinical and ultrasound findings and outcome from 3 new cases. In 2 cases, the lesion presented as childhood rosacea. Ultrasound revealed a characteristic pattern, with variations depending on the stage of development. High-frequency ultrasound can facilitate the differential diagnosis and thus obviate unnecessary biopsy or excision.
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Affiliation(s)
| | - M Feito-Rodríguez
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - R Maseda-Pedrero
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - R de Lucas-Laguna
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
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28
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Beattie G, Tai C, Pinar Karakas S, Cham E, Idowu O, Kim S. Colossal pilomatrixoma. Ann R Coll Surg Engl 2017; 100:e38-e40. [PMID: 29182000 DOI: 10.1308/rcsann.2017.0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We describe the largest reported case of pilomatrixoma in the literature. While pilomatrixomas typically present as small soft-tissue nodules of the head, neck and upper extremities, they can also present as much larger masses in atypical locations. When they present in their usual size, pilomatrixomas have typical imaging features and can be correctly diagnosed with imaging studies before histological confirmation. Their clinical and imaging diagnosis become challenging when they are very large, as in our case. A giant pilomatrixoma should also be considered for paediatric patients presenting with a large subcutaneous soft-tissue mass.
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Affiliation(s)
- G Beattie
- Department of Surgery, University of California San Francisco-East Bay Oakland, CA United States
| | - C Tai
- Division of Plastic Surgery, UCSF Benioff Children's Hospital Oakland, CA United States
| | - S Pinar Karakas
- Department of Radiology, UCSF Benioff Children's Hospital Oakland, CA United States
| | - E Cham
- Department of Pathology, UCSF Benioff Children's Hospital Oakland, CA United States
| | - O Idowu
- Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, CA United States
| | - S Kim
- Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, CA United States
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Jones C, Twoon M, Ho W, Portelli M, Robertson BF, Anderson W. Pilomatrix carcinoma: 12-year experience and review of the literature. J Cutan Pathol 2017; 45:33-38. [DOI: 10.1111/cup.13046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 09/03/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher Jones
- Plastic and Reconstructive Surgery Department; St John's Hospital; Livingston UK
| | - Mark Twoon
- Plastic and Reconstructive Surgery Department; St John's Hospital; Livingston UK
| | - Weiguang Ho
- Department of Plastic Surgery; Ulster Hospital; Belfast UK
| | - Mark Portelli
- Canniesburn Unit, Plastic and Reconstructive Surgery Department; Glasgow UK
| | | | - William Anderson
- Plastic and Reconstructive Surgery Department; St John's Hospital; Livingston UK
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30
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Martínez-Morán C, Echeverría-García B, Tardío J, Borbujo J. Ultrasound Appearance of Juvenile Xanthogranuloma. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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31
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Martínez-Morán C, Echeverría-García B, Tardío JC, Borbujo J. Ultrasound Appearance of Juvenile Xanthogranuloma. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:683-685. [PMID: 28372783 DOI: 10.1016/j.ad.2016.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 10/19/2022] Open
Affiliation(s)
- C Martínez-Morán
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, España.
| | - B Echeverría-García
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, España
| | - J C Tardío
- Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, España
| | - J Borbujo
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, España
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Chiriac A, Chiriac AE, Podoleanu C, Stolnicu S. The Diagnostic Value of Ultrasonography in a Case of Unusual Pilomatrixoma. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroduction:Pilomatrixoma or pilomatricoma is a benign appendageal growth, originating from hair cortex cells.Case presentation:We present an unusual case of a 65-year-old female patient who has been diagnosed and treated for a presumed recurrent furunculosis localized on the abdominal area. Ultrasonography raised the suspicion of pilomatrixoma. A large excision was performed and histopathology confirmed the diagnosis.Conclusions:Ultrasonography could be a simple and reliable diagnostic tool in daily practice.
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Utility of Ultrasound in a Rapidly Growing Cutaneous Nodule in an Infant. J Pediatr 2017; 180:290-290.e1. [PMID: 27751521 DOI: 10.1016/j.jpeds.2016.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
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34
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Rodríguez Bandera AI, de Lucas Laguna R. Utilidad de la ecografía en la consulta de dermatología infantil. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.piel.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Pilomatricoma of Childhood: A Common Pathologic Diagnosis Yet a Rare Radiologic One. AJR Am J Roentgenol 2016; 206:182-8. [DOI: 10.2214/ajr.15.14842] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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36
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Niklitschek S, Niklitschek I, González S, Wortsman X. Color Doppler Sonography of Cutaneous Juvenile Xanthogranuloma With Clinical and Histologic Correlations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:212-213. [PMID: 26635254 DOI: 10.7863/ultra.15.04007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sergio Niklitschek
- Department of Dermatology (S.N.), School of Medicine (I.N.), Department of Pathology (S.G.), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile, Departments of Radiology and Dermatology (X.W.), Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ian Niklitschek
- Department of Dermatology (S.N.), School of Medicine (I.N.), Department of Pathology (S.G.), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile, Departments of Radiology and Dermatology (X.W.), Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sergio González
- Department of Dermatology (S.N.), School of Medicine (I.N.), Department of Pathology (S.G.), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile, Departments of Radiology and Dermatology (X.W.), Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ximena Wortsman
- Department of Dermatology (S.N.), School of Medicine (I.N.), Department of Pathology (S.G.), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile, Departments of Radiology and Dermatology (X.W.), Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
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37
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Scotto di Santolo M, Sagnelli M, Mancini M, Scalvenzi M, Delfino M, Schonauer F, Molea G, Ayala F, Salvatore M. High-resolution color-Doppler ultrasound for the study of skin growths. Arch Dermatol Res 2015; 307:559-66. [PMID: 25604691 DOI: 10.1007/s00403-015-1538-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED High-resolution (17 MHz) color-Doppler ultrasound (US) is used in the evaluation of normal and pathological skin. To analyze retrospectively the sonographic pattern of healthy skin and of some skin lesions using Doppler US and to compare the results with dermoscopy examination and histology to identify specific patterns of ultrasound for differentiating benign from malignant lesions. To select among them the Melanomas to describe their US pattern, the presence and morphology of vascular signal and to compare their thickness at US with the Breslow index. After signing informed consent in accordance with the ethical standards laid down in the Declaration of Helsinki in 1964 and its subsequent amendments, 104 patients with skin lesions were retrospectively studied. Patients were evaluated with clinical dermatological examination and Doppler US, and underwent surgical excision with subsequent histological analysis. STATISTICAL ANALYSIS the difference between variables was analyzed with statistical Chi square test or Fisher's when appropriate. The strength of the relationship between variables was analyzed with Pearson's r coefficient. The sensitivity and specificity of US tests were also calculated. Sixty-five malignant lesions and 39 benign lesions were identified at Doppler US. In the 34 melanomas, typical US and vascular patterns were identified depending on the thickness of the lesion and a strong correlation between the latter and Breslow index was confirmed. Doppler US is a valuable diagnostic tool for the study of skin and for pre-excision characterization of skin lesions.
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Affiliation(s)
- Maria Scotto di Santolo
- Dipartimento di Scienze Biomorfologiche e Funzionali sezione Radiodiagnostica, Università degli Studi di Napoli "Federico II", Via Pansini 5, Naples, Italy,
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AlSharif S, Meguerditchian A, Omeroglu A, Lamarre P, Altinel G, Mesurolle B. Pilomatricoma of the male breast: sonographic mammographic MRI features with pathologic correlation. Clin Imaging 2014; 39:308-10. [PMID: 25123419 DOI: 10.1016/j.clinimag.2014.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/12/2014] [Indexed: 11/17/2022]
Abstract
We report a case of 43-year-old man who presented with an enlarging, painless, palpable mass in the left breast for one year associated with surface blue discoloration of the skin. Mammogram showed a well-defined 2.3-cm mass with microcalcifications. Ultrasound revealed a well-defined, subcutaneous hypoechoic mass adherent to the skin with multiple bright foci. Ultrasound-guided needle biopsy produced a dark-colored sample corresponding to pilomatricoma on final pathology. Bilateral breast magnetic resonance imaging showed heterogeneously hyperintense in T1- and T2-weighted images with heterogeneous enhancement toward the delayed phase. Surgical resection was carried out with wide margins.
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Affiliation(s)
- Shaza AlSharif
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada
| | - Ari Meguerditchian
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada
| | - Atilla Omeroglu
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada
| | - Pascal Lamarre
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada
| | - Gulbeyaz Altinel
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada
| | - Benoît Mesurolle
- McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, H3H 1A1, Canada.
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Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 2014; 202:W532-40. [PMID: 24848846 DOI: 10.2214/ajr.13.11457] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. MATERIALS AND METHODS Seven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without pathologic confirmation were followed up clinically. RESULTS Overall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively. CONCLUSION The diagnostic accuracy of ultrasound in the assessment of superficial musculoskeletal soft-tissue tumors is high and can be improved through increased radiologist awareness of less frequently encountered tumors. Ultrasound is accurate for differentiating benign from malignant superficial soft-tissue tumors.
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Toprak H, Kiliç E, Serter A, Kocakoç E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci 2014. [PMID: 24744969 DOI: 10.4103/2156-7514.127965.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation. In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.
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Affiliation(s)
- Huseyin Toprak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kiliç
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
| | - Asli Serter
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Kocakoç
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Salih Ozgocmen
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
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Toprak H, Kiliç E, Serter A, Kocakoç E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci 2014; 4:12. [PMID: 24744969 PMCID: PMC3988607 DOI: 10.4103/2156-7514.127965] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/06/2014] [Indexed: 12/01/2022] Open
Abstract
Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation. In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.
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Affiliation(s)
- Huseyin Toprak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kiliç
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
| | - Asli Serter
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Kocakoç
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Salih Ozgocmen
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Erciyes University Kayseri, Turkey
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Hassan SF, Stephens E, Fallon SC, Schady D, Hicks MJ, Lopez ME, Lazar DA, Rodriguez MA, Brandt ML. Characterizing pilomatricomas in children: a single institution experience. J Pediatr Surg 2013; 48:1551-6. [PMID: 23895971 DOI: 10.1016/j.jpedsurg.2012.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/10/2012] [Accepted: 08/10/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND/PURPOSE Pilomatricomas, or calcifying epitheliomas of Malherbe, are among the most common superficial cutaneous soft tissue lesions in children. Familiarity with the presenting signs and symptoms allows for the diagnosis to be made on physical examination alone in most patients, avoiding expensive and unnecessary diagnostic imaging. METHODS A retrospective IRB-approved review of surgical pathology archives and medical records of all patients undergoing excision of pilomatricomas between 1982 and 2010 was performed to determine the characteristics of the pilomatricoma tumors. Data regarding gender, age, location, size of tumor, and histopathology were collected. RESULTS There were 916 pilomatricomas resected in 802 patients. Fifty-five percent of the patients were girls (441 patients). The median age at the time of resection was 6 years (range 5 months to 18 years). Multiple lesions were found in 43 patients (5%). The most common location was head and neck (n = 529, 58%), followed by upper limbs (n = 214, 23%), trunk (n = 130, 14%), and lower limbs (n = 43, 5%). Information on size was available for 674 lesions; mean lesion diameter was 14.0 ± 7.4 mm. Twenty-eight patients (3%) had either recurrent (n = 11) or metachronous (n = 17) lesions resected at our institution, with a median interval of 12 months after initial resection (range 5 weeks to 5 years). No cases of pilomatrix carcinoma were observed. CONCLUSION The majority of pilomatricomas occur in the head and neck, although they can present in any location. Approximately 5% of children have multiple lesions. Pilomatricomas occur slightly more commonly in girls, and 66% of lesions occur in children < 10 years of age. Complete surgical excision is necessary to prevent recurrence. Recurrences and pilomatrix carcinoma are very rare if complete excision is achieved.
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Affiliation(s)
- Saif F Hassan
- Division of Pediatric Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Song EH, Lee SY, Park HJ, Jin Lee Y, Wan Chae S, Pyo JS, Lee MH. Cystic pilomatrixoma of the wrist mimicking a ganglion cyst in a child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:313-315. [PMID: 22531962 DOI: 10.1002/jcu.21931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/19/2012] [Indexed: 05/31/2023]
Abstract
We describe a patient with a cystic pilomatrixoma mimicking a ganglion cyst on ultrasound. A 9-year-old boy had a subcutaneous mass on his left wrist. Ultrasound displayed a well-defined, multilobulated anechoic mass containing a few internal septa between the extensor pollicis longus and the extensor carpi radialis longus tendons. Sonographic findings suggested that the mass was a ganglion cyst. After excisional biopsy, histopathologic examination confirmed the diagnosis of pilomatrixoma.
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Affiliation(s)
- Eun-Hee Song
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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45
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Abstract
Pilomatrixoma is a rare benign neoplasm that presents as a solitary, hard, mobile, subcutaneous mass. Pilomatrixomas can be found on any hair-bearing region of the body, with the upper extremity being the second most common location. Pilomatrixomas are common in children, and have a higher frequency in girls. We present a case of left-arm pilomatrixoma in a 5-year-old girl. Surgical excision was curative. Pediatric orthopedic surgeons should be familiar with this benign tumor when evaluating a calcified soft-tissue mass in the extremities of a child.
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Wortsman X. Common applications of dermatologic sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:97-111. [PMID: 22215775 DOI: 10.7863/jum.2012.31.1.97] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In recent years, there has been growing use of sonography in the dermatologic field. Thus, this review analyzes the most common dermatologic applications of sonography with some technical considerations for performing this type of examination. Moreover, the sonographic findings in common benign and malignant skin tumors, inflammatory dermatologic diseases, and ungual and cosmetic conditions, among others, are considered. Thus, this noninvasive technique may be a potent adjunctive tool in the diagnosis and management of dermatologic conditions in daily practice, delivering critical information otherwise unavailable to the clinical naked eye.
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Affiliation(s)
- Ximena Wortsman
- Department of Radiology, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
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Wortsman X, Wortsman J, Arellano J, Oroz J, Giugliano C, Benavides MI, Bordon C. Pilomatrixomas presenting as vascular tumors on color Doppler ultrasound. J Pediatr Surg 2010; 45:2094-8. [PMID: 20920738 DOI: 10.1016/j.jpedsurg.2010.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 12/24/2022]
Abstract
Diagnosis of pilomatrixomas may be difficult because they can mimic other clinical conditions. Color Doppler ultrasound had been proven useful in the study of localized lesions of the skin and can both define lesion morphology and determine blood flow changes in real time, and may thus help differentiate primary from secondary vascular skin lesions. We present 3 cases of pilomatrixomas that mimic vascular lesions of the skin on physical examination. Clinical, sonographic, intraoperative, and histologic images are provided to highlight the nature of these challenging cases.
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Affiliation(s)
- Ximena Wortsman
- Department of Radiology, Clinica Servet, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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The Spectrum of Vascularized Superficial Soft-Tissue Tumors on Sonography With a Histopathologic Correlation: Part 1, Benign Tumors. AJR Am J Roentgenol 2010; 195:439-45. [DOI: 10.2214/ajr.09.3832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Epithelioma of Malherbe: new ultrasound patterns. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2010; 29:42. [PMID: 20444298 PMCID: PMC2883973 DOI: 10.1186/1756-9966-29-42] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/06/2010] [Indexed: 11/19/2022]
Abstract
Backround Calcifying epithelioma of Malherbe, or Pilomatricoma, is considered an uncommon cutaneous neoplasia, normally occurring in children as a solitary, firm, asymptomatic, hard, subcutaneous, slowly growing nodule on the face, neck, or proximal upper extremity. In literature, two Pilomatricoma ultrasound patterns are described: the totally calcified nodule and the hypoechoic nodule with internal calcific foci. High frequency ultrasound has not yet been applied for routine diagnosis of Pilomatricoma. The aim of the study was to retrospectively identify specific ultrasound features. Methods We retrieved 124 histologically Pilomatricoma cases: 28 patients with 32 lesions were preoperatively evaluated with ultrasound. Results 22/32 have shown a solid formation, hypoechoic, with a sharp outline. Of these 22, 10 lesions were completely calcifying and 12 partially calcified. In 3/32 lesions with uncertain diagnosis, ultrasounds showed a complex/mixed pattern with pseudo-fluid areas and microspots. 7/32 lesions with US different diagnosis included 3 complex lesions, 2 cystic lesions and 2 solid nodular lesions. Conclusion In addition to well-known ultrasound patterns (completely calcified and partially calcified) we identified three new, not yet described, patterns that constitute the 31% of the cases: complex, pseudocistyc and pseudotumoral.
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