An unusual presentation of giant pilomatrixoma in an adult patient

A Case Report of a Rapidly Growing Giant Pilomatrixoma on the Posterior Shoulder in a 12-Year-Old Male Patient

Introduction

Giant pilomatrixomas are quite rare and can be clinically challenging to diagnose.

Case Presentation

Here, we report a case of a rapidly growing mass on the shoulder of a 12-year-old previously healthy boy. The lesion on his right shoulder appeared as a painless, pink-blue-colored solitary mass that started 6 months ago and rapidly enlarged to 4.5 × 6 cm in size. Previous biopsy results were inconclusive, showing only hypercellular spindle cell proliferation in a collagenous stroma. There was concern for malignancy versus mixed lymphatic venous malformation or benign soft tissue tumor. An excisional biopsy was done and demonstrated features of a pilomatrixoma. Complete surgical removal with clear margins was curative.

Conclusion

Diagnosis and management of rapidly enlarging skin lesions in children can be difficult for clinicians and dermatopathologists. Excisional biopsy can be both diagnostic and therapeutic. A timely exclusion of malignancy is of utmost importance.

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases

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.

Pilomatrixoma: A Comprehensive Review of the Literature

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.

Giant pilomatrixoma presenting in the posterior thorax, a rare location and the largest described

Pilomatrixoma is a common benign soft tissue neoplasm arising from hair follicle cells, typically not exceeding 3 cm and located mainly within the head and neck regions. Lesions greater than 3 cm or those located elsewhere are rare and are often not thought of or high on a differential diagnosis. Moreover, the radiographic features of pilomatrixoma are very nonspecific making the diagnosis even more difficult and rarely described in the radiology literature. We present the largest reported case of pilomatrixoma measuring 24 cm arising from the posterior thorax. Our hope is to increase awareness of this diagnosis for slow-growing soft tissue masses not located in the classically described locations of head and neck, explore the radiographic features on various imaging modalities, and review the current radiology literature.

Characteristics of pilomatrixoma in children: a review of 137 patients

OBJECTIVE

To describe our institutional experience with pilomatrixoma in the pediatric population, specifically examining its clinical presentation, associated conditions, surgical treatment and future implications.

METHODS

This is a retrospective review of a single tertiary care center. Subjects included 137 patients with diagnosis of pilomatrixoma between the years of 2000 and 2013 up to the age of 19. Patient gender, age at excision, number of tumors, tumor size, tumor location, preoperative diagnosis, recurrence, patient race and zip code, along with associated medical conditions were assessed.

RESULTS

There were a total of 174 tumors in 137 patients. The median age at excision was 7.1 years old, with the youngest patient at 6 months and the oldest at 19 years. Head and neck tumors predominated with 70% (n=122) of all pilomatrixomas, followed by the upper extremity with 22% (38). Other locations included the hair-bearing back, chest and lower extremities. A male to female ration of 1:1.2 was observed. Tumor diameter size ranged from 0.2 to 5.2 cm with an average diameter of 1.4 cm. There were no cases of recurrence. Associated diagnoses included Turner syndrome and Sticker syndrome.

CONCLUSIONS

Pilomatrixoma, previously thought to be a rare lesion, is one of the most common causes of superficial head and neck masses in children. This study demonstrates clinical presentations that should help guide differential diagnoses. We demonstrate associations that are consistent with the proposed pathophysiology of pilomatrixoma. Surgical excision is curative.