|Year : 2014 | Volume
| Issue : 4 | Page : 173-174
Perforating pilomatricoma in a 62-year-old female: A rare case report
Binod Kumar Thakur1, Shikha Verma1, Jaya Mishra2
1 Department of Dermatology and STD, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
2 Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
|Date of Web Publication||14-Oct-2014|
Binod Kumar Thakur
Department of Dermatology and STD, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong - 793 018, Meghalaya
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Pilomatricoma presents as a single, slow-growing, painless, superficial mass arising from the hair matrix cells, over the hair-bearing areas of the body, especially the head and neck. Perforating pilomatricoma is a rare variant of pilomatricoma presenting as crusted or ulcerated nodule. Here, we report a case of 62-year-old female presenting with rapidly growing noduloulcerative lesion on the left cheek, which on histopathology showed perforating pilomatricoma.
Keywords: Histopathology, noduloulcerative, perforating pilomatricoma
|How to cite this article:|
Thakur BK, Verma S, Mishra J. Perforating pilomatricoma in a 62-year-old female: A rare case report. Int J Trichol 2014;6:173-4
| Introduction|| |
Pilomatricomas are uncommon benign hamartomas of the hair matrix, first described as calcifying epithelioma by Malherbe and Chenantais in 1880.  The peak incidence of occurrence of pilomatricoma is in the first and sixth decades and predominantly involve the head and neck area.  Several variants of pilomatricoma have been described, including bullous-like, perforating, giant, familial, anetodermic, and multiple. We report here a rare case of perforating pilomatricoma.
| Case report|| |
A 62-year-old female patient presented with a noduloulcerative lesion on her left preauricular area for 1-month. The lesion started as a pea-sized papule, which enlarged rapidly and developed ulcer at the center. The lesion was mildly painful, and there was a history of recurrent bleeding from the lesion. There was no other significant medical history. The general and systemic examination revealed no abnormality. On cutaneous examination, there was an ulcerated erythematous nodule of size 2 cm × 3 cm over left preauricular area. The central ulcerated area showed fleshy tissue with hemorrhagic crusting [Figure 1]. On palpation, the nodule was soft to firm in consistency and not fixed to the underlying structures. A skin biopsy was taken from the periphery of the nodule. The histopathology showed well-circumscribed tumor located in superficial dermis with ulceration of the overlying epidermis. There were islands of basaloid cells and eosinophilic keratinized shadow cells in upper dermis [Figure 2]. The blood investigations were within the normal limits. With these findings, a diagnosis of perforating pilomatricoma was made. The lesion was removed with elliptical excision.
|Figure 2: Histopathology: Ulcerated tumor with left ×40 (a) and right ×40 (b) epidermal margins. Higher magnification ×100 (c), ×400 (d) showing islands of basaloid and shadow cells in dermis|
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| Discussion|| |
Perforating pilomatricoma is a rare variant of pilomatricoma.  There are some differences in presentation of perforating pilomatricomas. Clinically, the lesions appear as inflammatory papules,  cutaneous horn like nodules,  craters, ulcers, [3,6] or keratoacanthoma.  In our case, the tumor was of 1-month duration, had grown rapidly and presented as an ulcerated nodule. Perforating pilomatricomas were reported to be situated in the upper portion of the dermis, contrary to the deeper location of the tumor islands in classic pilomatricoma. ,, The tumor islands in our case were also located in the upper dermis, and eliminated through the ulceration of central part of the skin. Uchiyama et al.,  suggested this phenomenon resulting from transepithelial elimination. However, some authors proposed that in patients with perforating pilomatricoma, the elimination of tumor components from ulcers with damage to the epithelial structures, should not be described as transepithelial elimination. 
The different unusual morphological presentations of pilomatricoma make its clinical diagnosis difficult. The correct preoperative diagnosis is demonstrated to be as low as 0.01% by Lan et al. [2,9] In our case, malignant neoplasm was also considered because of elderly age and rapid progression of the lesion. The histopathological study remains only truly reliable mean of diagnosis of pilomatricoma. The classical histology shows the presence of ghost or shadow cells and basophilic cells. However calcification and foreign body giant cell reaction is also common. [2,9] As the tumor matures, the basaloid cells degrade centrally forming the enucleated ghost, or shadow cells.
Pilomatricoma should be considered in the differential diagnosis of solitary noduloulcerative lesion as in the present case. However, one should be careful to rule out pilomatrical carcinoma at an elderly age.
| References|| |
|1.||Malherbe A, Chenantais J. Note sur lepithelioma calcifie des glands sebacees. Bull Soc Anat 1880;5:169. |
|2.||Julian CG, Bowers PW. A clinical review of 209 pilomatricomas. J Am Acad Dermatol 1998;39:191-5. |
|3.||Alli N, Güngör E, Artüz F. Perforating pilomatricoma. J Am Acad Dermatol 1996;35:116-8. |
|4.||Tsoïtis G, Mandinaos C, Kanitakis JC. Perforating calcifying epithelioma of Malherbe with a rapid evolution. Dermatologica 1984;168:233-7. |
|5.||Uchiyama N, Shindo Y, Saida T. Perforating pilomatricoma. J Cutan Pathol 1986;13:312-8. |
|6.||Arnold M, McGuire LJ. Perforating pilomatricoma - Difficulty in diagnosis. J Am Acad Dermatol 1988;18:754-5. |
|7.||Kang HY, Kang WH. Guess what! Perforating pilomatricoma resembling keratoacanthoma. Eur J Dermatol 2000;10:63-4. |
|8.||Honda Y, Oh-i T, Koga M, Tokuda Y. Perforating pilomatricoma: Transepithelial elimination or not. J Dermatol 2002;29:100-3. |
|9.||Lan MY, Lan MC, Ho CY, Li WY, Lin CZ. Pilomatricoma of the head and neck: A retrospective review of 179 cases. Arch Otolaryngol Head Neck Surg 2003;129:1327-30. |
[Figure 1], [Figure 2]