International Journal of Trichology

: 2014  |  Volume : 6  |  Issue : 4  |  Page : 175--176

Seemingly insignificant, but crucial cytomorphological leads in diagnosis of pilomatricoma of parotid region

Chakshu Bansal, Jyoti Mishra 
 Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India

Correspondence Address:
Jyoti Mishra
Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh - 201 306


Pilomatricoma is a benign cutaneous appendegeal neoplasm which occurs as dermal nodule on head and neck region of children and young adults. Tumors pose a potential difficulty when diagnosed on fine-needle aspiration cytology. In this communication, we illustrate the cytomorphological features of pilomatricoma in a 38-year-female who presented with a nodule over the parotid region. Repeated aspirations of this nodule revealed low cellularity and cytology was hence inconclusive. The final diagnosis was made on histological examination and then retrospectively when those paucicellular cytological smears were analyzed again; showed features that could have driven the pathologist toward pilomatricoma. Familiarization and careful cytological examination under appropriate clinical conditions is warranted.

How to cite this article:
Bansal C, Mishra J. Seemingly insignificant, but crucial cytomorphological leads in diagnosis of pilomatricoma of parotid region.Int J Trichol 2014;6:175-176

How to cite this URL:
Bansal C, Mishra J. Seemingly insignificant, but crucial cytomorphological leads in diagnosis of pilomatricoma of parotid region. Int J Trichol [serial online] 2014 [cited 2023 Mar 23 ];6:175-176
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Pilomatricoma, also called calcifying epithelioma of Malherbe, is a benign skin adnexal tumour of hair matrix origin. The lesions are typically found in head and neck of young adults and children. [1,2] Histopathological features of this lesion are characteristic and well recognized, but diagnosis is difficult on cytology and usually misdiagnosed as an epidermal inclusion cyst, squamous cell carcinoma, or metastatic neoplasm. [3],[4],[5],[6],[7],[8] Low cellularity of cytological smears can further escalate the difficulty in diagnosis.

We present a case of pilomatricoma of parotid region diagnosed after histopathological examination when no conclusive diagnosis was made on cytology due to paucicellularity.


The 38-year-old female presented with 1-month history of nodule over the right parotid region. This nodule was painless and slow growing. There was no history of trauma, fever, and fatigue or weight loss. On local examination, a firm hard nodule measuring 1.5 × 1.2 cm was seen. Fine-needle aspiration cytology (FNAC) was performed using 23G needle and smears were stained and examined. On microscopic examination, the smears showed low cellularity and a single cluster of cells having round to oval nuclei with mild pleomorphism and scanty to moderate amount of cytoplasm. A repeat FNAC was advised, which showed again 1-2 clusters of similar looking cells with background showing debris [Figure 1]a and b. With these cytomorphological features and the site of lesion no conclusive diagnosis was given, however possibility of pleomorphic adenoma was rendered.{Figure 1}

On general physical examination, all the systems were normal. All investigations including haematological and radiographic were normal. The nodule was excised and sent for histopathology examination. Grossly, the cut surface is grey-white and chalky. Microscopically, showed typical histology of pilomatricoma, comprising of nests of basaloid cells, few islands of ghost cells along with many foreign body giant cells and large areas of calcification [Figure 2]a and b.{Figure 2}


Pilomatricoma is a benign cutaneous appendegal tumor. It has a predilection for head and neck region and also upper extremities. [9] The cytological diagnosis is based on a combination of presence of basaloid cells, ghost cells and foreign body giant cells. Basaloid cells show high N: C ratio and can be seen as single cells or in clusters. [10] Despite these well-described features, these tumors pose a potential difficulty when diagnosed on FNAC. [7] Not only the diagnosis can be misinterpreted as malignancy either primary or secondary but can also be missed because of low cellularity on cytology due to less number of basaloid cells, ghost cells and areas of calcification. Wang et al. [11] noted that 45% of cases of pilomatricoma were incorrectly diagnosed by FNAC based on their review of multiple case reports and series. From the perspective of diagnostic cytopathology, this case teaches us two things. First, initial assessment of smears should precede correlation with the clinical picture. This means that in the relevant situation, as in our case pursuing possibilities that seem plausible from morphology alone may be rewarding. Second, it pays to thoroughly familiarize oneself with the appearance of basaloid cells and ghost cells even when there is scanty cellularity in smears.


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