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Giant Pilomatricoma: A Benign Tumor in an Uncommon Presentation
INSIGHTS
Giant Pilomatricoma: A Benign Tumor in an Uncommon Presentation
Figure 2. The cystic tumor consisting of small nests of dark matrical cells and large aggregations of pale cornified shadow cells.
subcutis. This lesion consisted of solid dark-staining aggregations of matrical and supramatrical cells and solid pale-staining cornified cells with ghost-like nuclei, the shadow cells (Figure 2). Von Kossa staining revealed calcium deposits around the shadow cells, leading to a diagnosis of pilomatricomas. Pilomatricomas, first described by Malherbe and Chénantais in 1880, are benign skin tumors of hair matrix origin that characteristically manifest with an average diameter of 1 cm in childhood or adolescence and in adults over age 60.1,2 Giant tumors, exceeding 3 cm in diameter, are reported only rarely.3 Because of the need to differentiate them from malignant processes, pilomatricomas should be excised completely.
Figure 1. Giant pilomatricoma A, on the left shoulder and B, in detail.
14-year-old girl was admitted to our clinic with a rapidgrowing, solitary tumor on her left shoulder. Several contacts with various physicans in the preceding months had not led to a diagnosis. The patient denied burning or pain sensations. Her medical history revealed no other relevant diseases. At presentation, the patient had a solitary, reddish-brown, firm but moveable tumor, measuring 4 ⫻ 2.5 cm in diameter and 2 cm in height, on her left cranial shoulder (Figure 1). Our clinical differential diagnosis included dermatofibrosarcoma protuberans, calcinosis cutis, and cutaneous metastasis. Histological analysis of the tumor disclosed a huge cystic, well-circumscribed, smooth-bordered lesion in the deeper reticular dermis and the
A
Sarah Piel, MD Natalia Denisjuk, MD Dirk Schadendorf, MD Joachim Dissemond, MD Department of Dermatology, Venerology and Allergology University of Essen Essen, Germany
REFERENCES 1. Julian CG, Bowers PW. A clinical review of pilomatricomas. J Am Acad Dermatol 1998;39: 191-5. 2. Malherbe A, Chénantais J. Note sur l’épithélioma calcifié des glandes sébacées. Bull Soc Anat Paris 1880;5:169-76. 3. Lozzi GP, Soyer HP, Fruehauf J, Massone C, Kerl H, Peris K. Giant pilomatricoma. Am J Dermatopathol 2007;29:286-9.
J Pediatr 2009;154:623 0022-3476/$ - see front matter Copyright © 2009 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2008.10.042
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Giant Pilomatricoma: A Benign Tumor in an Uncommon Presentation
Figure 2. The cystic tumor consisting of small nests of dark matrical cells and large aggregations of pale cornified shadow cells.
subcutis. This lesion consisted of solid dark-staining aggregations of matrical and supramatrical cells and solid pale-staining cornified cells with ghost-like nuclei, the shadow cells (Figure 2). Von Kossa staining revealed calcium deposits around the shadow cells, leading to a diagnosis of pilomatricomas. Pilomatricomas, first described by Malherbe and Chénantais in 1880, are benign skin tumors of hair matrix origin that characteristically manifest with an average diameter of 1 cm in childhood or adolescence and in adults over age 60.1,2 Giant tumors, exceeding 3 cm in diameter, are reported only rarely.3 Because of the need to differentiate them from malignant processes, pilomatricomas should be excised completely.
Figure 1. Giant pilomatricoma A, on the left shoulder and B, in detail.
14-year-old girl was admitted to our clinic with a rapidgrowing, solitary tumor on her left shoulder. Several contacts with various physicans in the preceding months had not led to a diagnosis. The patient denied burning or pain sensations. Her medical history revealed no other relevant diseases. At presentation, the patient had a solitary, reddish-brown, firm but moveable tumor, measuring 4 ⫻ 2.5 cm in diameter and 2 cm in height, on her left cranial shoulder (Figure 1). Our clinical differential diagnosis included dermatofibrosarcoma protuberans, calcinosis cutis, and cutaneous metastasis. Histological analysis of the tumor disclosed a huge cystic, well-circumscribed, smooth-bordered lesion in the deeper reticular dermis and the
A
Sarah Piel, MD Natalia Denisjuk, MD Dirk Schadendorf, MD Joachim Dissemond, MD Department of Dermatology, Venerology and Allergology University of Essen Essen, Germany
REFERENCES 1. Julian CG, Bowers PW. A clinical review of pilomatricomas. J Am Acad Dermatol 1998;39: 191-5. 2. Malherbe A, Chénantais J. Note sur l’épithélioma calcifié des glandes sébacées. Bull Soc Anat Paris 1880;5:169-76. 3. Lozzi GP, Soyer HP, Fruehauf J, Massone C, Kerl H, Peris K. Giant pilomatricoma. Am J Dermatopathol 2007;29:286-9.
J Pediatr 2009;154:623 0022-3476/$ - see front matter Copyright © 2009 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2008.10.042
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