Two cases of multiple giant pilomatricoma

Syndromes associated with multiple pilomatricomas: When should clinicians be concerned?

BACKGROUND

Multiple pilomatricomas have been linked to various syndromes. However, these associations are poorly defined, leaving practitioners conflicted on management of these patients.

OBJECTIVE

To perform a comprehensive review to clarify the strength of these relationships and identify which patients may benefit from additional screening and/or genetic screening.

METHODS

A literature search was performed using the PubMed, Ovid, and Cochrane databases. Syndromic, familial, and sporadic cases of multiple pilomatricomas were stratified based on number of pilomatricomas. This information was graphed for visual comparison.

RESULTS

Sixty-six syndromic cases from 52 publications were identified, with the majority (54) of cases representing myotonic dystrophy, familial adenomatous polyposis-related syndromes (including Gardner syndrome), Turner syndrome, or Rubinstein-Taybi syndrome. Twenty-five of the 54 cases (46.3%) had six or more pilomatricomas. Of sporadic cases, 128 out of 134 (95.5%) had five or less pilomatricomas.

LIMITATIONS

Most articles were case reports and series, which are vulnerable to publication bias. Specific details were not explicitly noted in some original articles, and incomplete data could not always be included in analysis. Syndromes may have been missed in sporadic cases.

CONCLUSION

The presence of six or more pilomatricomas is highly suggestive of an underlying syndrome (>95% specificity). These patients should undergo additional screening. Patients with less than six pilomatricomas and family history of myotonic dystrophy, first-degree relative with colon cancer or FAP-related syndrome, or family history of pilomatricomas should also undergo further screening.

Giant pilomatricoma (pilomatrixoma) following an intramuscular injection

We describe a young Indian male patient who developed a large solitary tumor following an intramuscular injection at the same location. The tumor was histologically proven to be a pilomatricoma. It was treated by surgical excision and there was no recurrence until one year after the operation. An alarming phenomenon following intramuscular injection is presented here for its novelty.

Pilomatricomas in Turner syndrome

Pilomatricomas are benign, cutaneous tumors of the hair matrix cells, which present predominantly in childhood. Although usually an isolated finding, they have been described in association with several inherited conditions. We report a 10-year-old girl with Turner syndrome who has two pilomatricomas, including one giant tumor. In combination with a previous report of pilomatricoma in two patients with Turner syndrome, our observation indicates that it is likely a real, although uncommon, association of pilomatricomas with Turner syndrome exists. This apparent predisposition may be etiologically related to the abnormalities of hair-bearing skin observed in Turner syndrome. Doctors involved in the diagnosis and management of cutaneous masses in children should be aware of this association.

Multiple giant pilomatricoma in familial Sotos syndrome

Cerebral giantism or Sotos syndrome consists of a pre- and postnatal overgrowth whose genetic basis are mutations and deletions of the nuclear receptor-binding SET domain containing protein gene. These patients have an increased risk of developing neoplasms, especially in adulthood. We report a 9-year-old boy, diagnosed with familial Sotos syndrome, who had two pilomatrixoma, symmetrically located on both sides of the neck, measuring 4 cm in diameter. Genetic study of the tumor tissue showed deletion of exon 22 of the NSD1 gene, whereas beta-catenin gene mutations were not detected. To the best of our knowledge, presentation of multiple pilomatricomas with Sotos syndrome has never been reported. Therefore their association probably is incidental. Nevertheless, the unusual size of our patient's pilomatricomas could be due to deletion of the NSD1 gene, which characterizes Sotos syndrome.

Giant Pilomatricoma

A 52-year-old man was examined for an ulcerated, rapidly growing reddish nodule. It was 5.5 cm high with an 11 x 6-cm base and located on the left clavicle. The lesion had been present for approximately 7 years, and the patient complained occasional burning and pain. Clinical differential diagnoses included cutaneous lymphoma, sarcoma, squamous cell carcinoma, and cutaneous metastasis. Histopathologic examination revealed a well-circumscribed tumor involving the whole dermis and the subcutis and composed of partially confluent aggregates of matrical cells admixed with eosinophilic cornified material containing shadow cells. In addition, multinucleated giant cells, areas of calcification and metaplastic ossification, edema, and hemorrhage were also observed. On the basis of histopathologic features, the diagnosis of pilomatricoma was made. Our report highlights an unusual clinical appearance of pilomatricoma that made us consider a variety of primary or secondary cutaneous neoplasms in its differential diagnosis.

Large, Rapidly Growing Pilomatrixoma of the Upper Eyelid

A 41-year-old woman presented with a rapidly growing mass on her upper left eyelid that had first appeared 3 months earlier. The mass was dark red in color, alternating with whitish pseudocyst formations, and measured 3 cm long with a 1-cm base presenting. The rapid growth had caused a mechanical ptosis and bleeding as the result of erosion of the skin covering the tumor. The initial clinical diagnosis suggested a malignant lesion or vascular tumor; excisional biopsy was performed. The eyelid crease was approached for incision and resection as for a blepharoplasty. Pathologic examination yielded a diagnosis of giant pilomatrixoma. Pilomatrixomas are rare in adults and rarely attain such a large size. After 1 year of follow-up, no recurrence of the tumor has been observed.

The first case of exophytic pilomatricoma in an Asian male

Pilomatricomas are benign cutaneous neoplasms that occur frequently in children and usually present as slow-growing, firm, dermal nodules. They are the second most common skin lesion excised from children. A rare exophytic variety has been described, but to our knowledge this has not previously been reported in Asian children. We present this case to highlight the clinical features and to affirm that race may not play a role in the etiology of pilomatricomas. We also illustrate how these lesions can be effectively treated by shave excision.