CASE REPORT


Pilomatrixoma Mimicking a Pyogenic Granuloma Clinically: A Rare Case Report from Syria



Lina Al-Soufi1, Moatasem Hussein Al-janabi2, *, Boshra Wannous3, Rana Issa4, Zuheir Al-shehabi5
1 Department of Dermatology, National Hospital, Lattakia, Syria
2 Department of Pathology, Cancer Research Center, Tishreen University Hospital, Lattakia, Syria
3 Department of Dermatology, Tishreen University Hospital, Lattakia, Syria
4 Department of Pathology, Tishreen University Hospital, Lattakia, Syria
5 Department of Pathology, Director of Cancer Research Center, Tishreen University Hospital, Lattakia, Syria


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Creative Commons License
© 2022 Al-Soufi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pathology, Cancer Research Center, Tishreen University Hospital, Lattakia, Syria; Email: dr.3esami2022@gmail.com


Abstract

Background:

Pilomatrixoma is a benign skin tumor arising from the hair matrix cells. It is typically found in the head and neck region. However, few cases of pilomatrixoma that mimic a pyogenic granuloma have been reported. Clinicians should be aware of it because it may recurrence and transform into a malignant tumor.

Case Presentation:

We report a rare case of a 9-year-old boy who presented with an asymptomatic mass on the left cheek for 2 months. Clinically, it was diagnosed as a pyogenic granuloma. An excisional biopsy was performed and sent to the pathology department for histopathological study. Histological examination showed that it was a pilomatrixoma. The patient was discharged on the same day, without any complications.

Conclusion:

Pilomatrixoma is often misdiagnosed clinically; therefore, the definitive diagnosis of skin tumors should be made after a histologic examination of the excisional mass. Surgical resection with wide margins was the optimal treatment for pilomatrixoma because local recurrence may occur.

Keywords: Pilomatrixoma, Calcifying epithelioma of Malherbe, Pyogenic granuloma, Hair matrix cells, Skin tumors, Neoplasm.



1. INTRODUCTION

Pilomatrixoma, also referred to as pilomatricoma, or calcifying epithelioma of Malherbe is a rare neoplasm arising from the hair matrix [1]. It is usually a solitary lesion and is most commonly found on the head, neck region, and upper extremities [2, 3]. It presents as a slow-growing, subcutaneous nodule smaller than 3 cm [3]. Pilomatrixomas are often confused clinically with other benign masses [4]. Here, we report a rare case of pilomatrixoma mimicking pyogenic granuloma on the left cheek in a 9-year-old boy.

2. CASE REPORT

A 9-year-old boy first visited the dermatology clinic due to an asymptomatic nodular mass on the left cheek, which had been presented for 2 months (Fig. 1).

Clinical examination revealed that the mass was red, fixed, well-defined and it was smaller than 1 cm in diameter. Routine blood investigations (CBC) revealed no abnormality. The clinical diagnosis was made as pyogenic granuloma. The patient did not use any specific drugs and had no history of allergy. There was no tumor history in her family; particularly no history of skin tumors. An excisional biopsy was performed and sent to the pathology department for histopathological study. A pathologic review of the excised mass demonstrated a relatively well-circumscribed, whitish solid lesion, measuring 2.5 cm in maximum diameter. The cut surface was gray-white with chalky deposits. Microscopically, the tumor is composed of a lobular proliferation of small basaloid cells (Fig. 2A). Ghost cells, enlarged epithelial cells with eosinophilic cytoplasm, but without a nucleus, are seen (Fig. 2B). The tumor cells are surrounded by fibroblastic stroma (Fig. 2C). with foreign body giant cells (Fig. 2D). The final diagnosis was pilomatrixoma. The patient was discharged on the same day, without any complications.

Fig. (1). Firm, red, nodular nodule on the left cheek.

Fig. (2). H & E stain (A-D) Microscopic images of pilomatrixoma. (A) Lobular proliferation of small basaloid cells (x40). (B) Ghost cells, an enlarged epithelial cell with eosinophilic cytoplasm and calcifications (blue arrow) (x100). (C) The tumor cells are surrounded by fibroblastic stroma (x40). (D) Foreign body giant cells are seen (black arrow) (x40).

3. DISCUSSION

Pilomatrixoma, first described as a “calcified epithelioma of Malherbe” in 1880, is a nodular, benign tumor arising from the hair matrix. It occurs predominantly in children and young adults, and most of the cases are located on the head, neck, and upper extremities [5-7]. It presents as a slow-growing, firm nodule less than 3 cm [1, 3]. Microscopically, it is composed of solid nests of small basaloid cells and shadow cells (ghost cells) that are eosinophilic-stained with nuclear concentration and disappearance [2]. Local recurrence may occur if excision is incomplete; therefore, wide local excision with confirmed negative margins represents the treatment of choice for pilomatrixoma [1, 2]. Malignant transformation of pilomatrixoma into a pilomatrix carcinoma should be suspected in cases with repeated local recurrences [3, 4]. The differential diagnoses of pilomatrixoma include basal cell carcinoma, pyogenic granuloma, and epidermal cyst [4, 8]. However, pyogenic granuloma of the skin appears as rapidly growing, smooth or lobulated, reddish exophytic vascular nodules, in any size from a few millimeters to several centimeters, and it usually occurs in teenagers, young adults, and during pregnancy [9, 10].

CONCLUSION

Pilomatrixoma is often misdiagnosed clinically; therefore, the definitive diagnosis of skin tumors should be made after a histologic examination of the excisional mass. Surgical resection with wide margins was the optimal treatment for pilomatrixoma because local recurrence may occur.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

Written consent was obtained.

STANDARDS OF REPORTING

CARE guidelines were followed.

AVAILABILITY OF DATA AND MATERIALS

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Saniasiaya J, Mohamad I, Kamaludin Z. Pilomatrixoma of the neck: A forgotten entity. Egyptian Journal of Ear, Nose, Throat and Allied Sciences 2017; 18(3): 311-2. ISSN 2090-0740
[2] Birman MV, McHugh JB, Hayden RJ, Jebson PJ. Pilomatrixoma of the forearm: a case report. Iowa Orthop J 2009; 29: 121-3.
[3] Multiple pilomatrixomas: Case report and literature review Shashidhar Sadda Reddy, MD, MPH; Swarupa A. Gadre, MD; Patrick Adegboyega, MD; Arun K. Gadre, MD. 2021.
[4] Hind MAlkatan, Wajda Alhothali, Ola Alnuhayer, Dalal Alessa. Pilomatrixoma in a child mimicking a ruptured epidermal cyst clinically and histopathologically: Case report Int J Surg Case Rep 2021; 84 106068, ISSN 2210-2612
[5] Julian CG, Bowers PW. A clinical review of 209 pilomatricomas. J Am Acad Dermatol 1998; 39(2): 191-5.
[6] Moehlenbeck FW. Pilomatrixoma (calcifying epithelioma). A statistical study. Arch Dermatol 1973; 108(4): 532-4.
[7] Forbis R Jr, Helwig EB. Pilomatrixoma (calcifying epithelioma). Arch Dermatol 1961; 83(4): 606-18.
[8] Missak M, Haig A, Gabril M. Pilomatrixoma with atypical features: A case report. Case Rep Dermatol 2021; 13(1): 98-102.
[9] Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G. Pyogenic granuloma – a common benign vascular tumor with variable clinical presentation: New findings and treatment options. Open Access Maced J Med Sci 2017; 5(4): 423-6.
[10] Amirchaghmaghi M, Falaki F, Mohtasham N, Mozafari PM. Extragingival pyogenic granuloma: A case report. Cases J 2008; 1(1): 371.