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Wydadi O, Bijou W, Laachoubi M, Oukessou Y, Roubal M, Mahtar M. Huge pilomatrixomas of the scalp: A case report. Int J Surg Case Rep 2021; 84:106048. [PMID: 34174742 PMCID: PMC8234360 DOI: 10.1016/j.ijscr.2021.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Pilomatrixoma is a rare benign skin tumor differentiating toward hair matrix cells usually encountered in the head and neck region. It is most frequently appearing in the first and second decades of life. Histopathological examination is essential to make definitive diagnosis. Herein, we present an atypical case of multiple pilomatrixomas. A 69-year-old man with multiple voluminous masses over the scalp. Among the three lesions, one was clinically suspicious for malignancy, it measured 17 cm and was ulcerated in places. Histopathology confirmed the diagnosis of pilomatrixoma. The tumors were removed surgically with free margins. Otolaryngologist should be familiar with this benign tumor when evaluating soft-tissue mass in the head and neck region. Pilomatrixoma, is a particular and uncommon type benign subcutaneous tumors arising from the cutaneous adnexa. Otolaryngologist should be familiar with this benign tumor when evaluating soft-tissue mass in the head and neck region. Clinical follow-up of these lesions is necessary to avoid recurrence and malignant transformation.
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Affiliation(s)
- Omar Wydadi
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Walid Bijou
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Mohammed Laachoubi
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco.
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
| | - Mohammed Roubal
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
| | - Mohammed Mahtar
- ENT Department, Face and Neck Surgery, Hospital August, 20, 1953, University Hospital Center IBN ROCHD, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
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Akhtar S, Rajabi-Estarabadi A, Zheng C, Zade J, Nouri K. Cells to Surgery Quiz: December 2020. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinheiro TN, Fayad FT, Arantes P, Benetti F, Guimarães G, Cintra LTA. A new case of the pilomatrixoma rare in the preauricular region and review of series of cases. Oral Maxillofac Surg 2018; 22:483-488. [PMID: 30284072 DOI: 10.1007/s10006-018-0724-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.
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Affiliation(s)
- Tiago Novaes Pinheiro
- Oral Pathology and Oral Medicine, Amazonas State University, Manaus, AM, 69050-010, Brazil
| | | | - Pedro Arantes
- Maxilofacial Surgery, Amazonas State University Maxilofacial Surgery Residency, Manaus, AM, 69050-010, Brazil
| | - Francine Benetti
- Endodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, 16015-050, Brazil
| | - Gustav Guimarães
- Periodontics, School of Dentistry, University Center São Lucas, Porto Velho, RO, 76804- 295, Brazil
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Yi KM, Chen K, Wang L, Deng XJ, Zeng Y, Wang Y. Pilomatricoma (calcifying epithelioma): MDCT and MR imaging findings in 31 patients with radiological-pathological correlation. Eur J Radiol 2018; 106:92-99. [DOI: 10.1016/j.ejrad.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/08/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
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Kato H, Kanematsu M, Watanabe H, Nagano A, Shu E, Seishima M, Miyazaki T. MR imaging findings of pilomatricomas: a radiological-pathological correlation. Acta Radiol 2016; 57:726-32. [PMID: 26253927 DOI: 10.1177/0284185115597717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings of pilomatricomas have yet to be determined. PURPOSE To assess the correlation between MRI and pathological findings of pilomatricomas. MATERIAL AND METHODS MR images were obtained on patients with histologically proven pilomatricomas using a 1.5-T MR scanner. The images were retrospectively reviewed for size, signal intensity compared with skeletal muscles, and enhancement patterns. Furthermore, we assessed the presence of a reticular appearance, a ring-like appearance, and peritumoral fat stranding. RESULTS We included 11 consecutive patients with 12 histologically proven pilomatricomas (3 boys/men, 8 girls/women; age range, 4-76 years; mean age, 20 years; median age, 14 years). The tumors were located in the head and neck (n = 6), upper extremities (n = 5), and lower extremities (n = 1). The maximum tumor diameter was in the range of 7-32 mm (mean, 16.5 mm). On T2-weighted (T2W) images, five tumors showed homogeneous hypointensity, whereas six showed reticular hyperintensity and one showed cystic hyperintensity. On fat-suppressed T2W images, nine tumors showed reticular hyperintensity, eight showed ring-like hyperintensity, and five showed peritumoral fat stranding. On fat-suppressed gadolinium-enhanced T1-weighted (T1W) images, one tumor showed no enhancement, whereas three showed reticular enhancement and five showed ring-like enhancement. Histologically, edematous and fibrous stroma was observed in 10 tumors, tumor capsules in 11, and inflammatory cell infiltration of the peritumoral fat tissue in nine. CONCLUSION MRI features of pilomatricomas included reticular and ring-like hyperintensities on fat-suppressed T2W images and reticular and ring-like enhancement on fat-suppressed gadolinium-enhanced T1W images.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
- High-level Imaging Diagnosis Center, Gifu University Hospital, Gifu, Japan
| | - Haruo Watanabe
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
| | - Akihito Nagano
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - En Shu
- Department of Dermatology, Gifu University School of Medicine, Gifu, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University School of Medicine, Gifu, Japan
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University School of Medicine, Gifu, Japan
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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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Pilomatricomas: the diagnostic value of ultrasound. Skeletal Radiol 2010; 39:243-50. [PMID: 19296101 DOI: 10.1007/s00256-009-0678-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/19/2009] [Accepted: 02/24/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze statistically significant diagnostic factors for pilomatricoma on the basis of ultrasonographic features. METHODS Sonographic images were retrospectively reviewed from 44 pilomatricomas, and from 43 control subjects with other subcutaneous tumors. Two radiologists determined the tumoral shape, margin, echotexture, echogenicity, posterior shadowing, posterior enhancement, hypoechoic rim, internal calcification, and vascularity. RESULTS The reliable diagnostic factors for pilomatricoma were hypoechogenicity (P < 0.001), heterogenicity (P < 0.05), internal calcification (P < 0.001), hypoechoic rim (P < 0.001), and posterior shadowing (P < 0.001). Scattered dots were the most common patterns of internal calcification. A combination of hypoechogenicity, heterogenicity, internal calcification of scattered-dot pattern, and a hypoechoic rim was a statistically significant difference between the two groups (P < 0.001; odds ratio, 21). CONCLUSIONS The features of heterogeneous echotexture, internal echogenic foci in scattered-dot pattern, and a hypoechoic rim or posterior shadowing itself could be discriminative ultrasonographic criteria for differentiating pilomatricomas from other subcutaneous tumors.
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Lee K, Lee OJ, Lee SY, Choi MY. Upper Lid Pilomatricoma: A Report of Four Cases. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.5.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyoungsook Lee
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ok Jun Lee
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung Young Lee
- Department of Radiology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
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Lim HW, Im SA, Lim GY, Park HJ, Lee H, Sung MS, Kang BJ, Kim JY. Pilomatricomas in children: imaging characteristics with pathologic correlation. Pediatr Radiol 2007; 37:549-55. [PMID: 17437094 DOI: 10.1007/s00247-007-0461-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 02/26/2007] [Accepted: 03/14/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although pilomatricoma commonly occurs in children, there is still a poor understanding of the imaging characteristics of pilomatricoma and lack of agreement regarding its imaging findings and histopathologic features. OBJECTIVES To characterize the radiologic appearance of pilomatricomas on US, CT, and MR and to correlate the imaging findings with histopathologic features. MATERIALS AND METHODS The imaging findings of 47 pilomatricomas on US (n = 17), CT (n = 31), and MR (n = 5) were retrospectively evaluated. Pathologic specimens of all cases were reviewed and compared with imaging findings. RESULTS All lesions were well-circumscribed, subcutaneous nodules with partial attachment to the overlying skin. On US, the lesions were mostly hyperechoic with posterior acoustic shadowing and hypoechoic rim. On CT, they appeared as enhancing soft-tissue masses with varying amounts of calcification. MR findings were internal reticulations and patchy areas on T2-weighted images and contrast-enhanced T1-weighted images, corresponding to edematous stroma on pathology. Peritumoral inflammatory changes and connective capsule on pathology were well correlated with imaging findings. CONCLUSION Pilomatricoma should be considered when US or CT shows a well-defined hyperechoic or calcific nodule in subcutaneous fat attached to the skin in children. MR images may be helpful in diagnosis. Pathologic findings are well correlated with imaging findings.
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Affiliation(s)
- Hyun Wook Lim
- Department of Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
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Hwang JY, Lee SW, Lee SM. The common ultrasonographic features of pilomatricoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1397-402. [PMID: 16179624 DOI: 10.7863/jum.2005.24.10.1397] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The purpose of this series was to describe typical ultrasonographic features of 20 cases of pilomatricoma and to improve its diagnostic rate with the use of an ultrasonographic approach. METHODS For 20 pilomatricomas in 19 patients with preoperative ultrasonography from 1995 to 2004, we reviewed age, sex, symptoms, duration, referring clinician, and tumor sites. The ultrasonographic findings were retrospectively analyzed for tumor location, shape, size, margin, echo texture, echogenicity, presence, amount, and shape of calcification, presence of a hypoechoic rim, and Doppler flow pattern. RESULTS The mean age of the 19 patients was 6.9 years (range, 1-21 years), and the female-male ratio was 1.1:1. Patients had a painful palpable mass in 10 cases (50%). Nine lesions occurred in the neck, 5 in the cheek, 2 in the preauricular region, and 4 in the extremity. All tumors were located in the subcutaneous layer. The mean size of the tumors was 13.4 mm. Fourteen pilomatricomas (70%) appeared as well-defined oval masses. Tumors were heterogeneously hyperechoic in 80% of cases. All tumors had internal echogenic foci. A hypoechoic rim was seen in 17 cases (85%). Doppler flow signals were observed in the peripheral region in 14 cases (70%). A correct preoperative diagnosis was made in 33% on the basis of clinical findings and in 76% by ultrasonography. CONCLUSIONS Diagnosis of pilomatricoma should be considered when a well-defined mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing in the subcutaneous layer of the head, neck, or extremity is found on ultrasonography.
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Affiliation(s)
- Ji Young Hwang
- Department of Radiology and Medical Research Institute, Ewha Womans University College of Medicine, 911-1 Mokdong, Yangcheongu, 158-710 Seoul, Korea
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Bobić Radovanović A, Latkovic Z. [Pilomatrixoma as a problem in ophthalmic surgery]. ACTA CHIRURGICA IUGOSLAVICA 2004; 50:135-7. [PMID: 15307510 DOI: 10.2298/aci0304134r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pilomatricoma, relatively rare benign tumour of the hair matrix cells, is usually misdiagnosed preoperatively. This result in unnecessary extensive surgery. In order to improve diagnosis and treatment of pilomatricoma, authors discuss their ten years experience (28 cases) with this tumour.
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