Zaheeruddin Qureshi.
Pilomatricoma: Benign Calcifying Epithelioma.
J Coll Physicians Surg Pak Jan ;12(1):62-3.

Pilomatricoma is a subcutaneous tumour, originating from the hair matrix. It occurs most commonly in the neck and face, children are affected more often and there is male preponderance. Average size is 1-3 cm . Most of the cases are benign, however, death from local invasion and even metastatic lesions has been reported in cases of pilomatrical carcinoma. Pilomatricoma should be included in the differential diagnosis of all hard subcutaneous lumps. A giant pilomatricoma is reported, (size 24 x 24 x 12 cms) in the upper chest involving the neck, specially the sternomastoid muscles and extending deep into the suprasternal notch. It is rare to come across such a pilomatricoma. The tumour was excised partially as it was bleeding profusely and its close proximity to big vessels. However, the treatment is total excision and recurrence is unusual.

Case Report: A 50 years old man presented in the outpatient department with history of a lesion in front of the chest for the last 6 years. To start with it was small to the size of a pea and only enlarged a little in 5 years period but started rapid enlargement in the last year. There was no history of pain, fever, loss of weight, dyspnoea or dysphagia. On examination the patient looked healthy with a pulse of 80/min. blood pressure of 130/80. There was a huge swelling in the front of the chest over the upper part of the sternum and extending up into the neck. Size was 24x24x18 cms. The skin over it was normal in colour and smooth; there were no visible pulsations and no prominent veins. Neck movements were not affected. Palpation revealed that it was neither hot nor tender, skin was fixed to it and the tumour was also fixed to the underlying structures. There was no bruit over it. Superiorly, the swelling had involved the clavicular heads of the sternocleidomastoid muscles. Clinically there were no palpable lymph nodes in the cervical and axillary regions. All the investigations were unremarkable and a provisional diagnosis of a chondrosarcoma and of a sebaceous cyst was made. The patient was prepared and operated through an elliptical incision. The swelling was a cyst with calcified walls specially where it joined the sternum. It contained brown necrotic material and extended deep into the suprasternal notch. The cyst was excised partially due to extensive bleeding, adhesion and uncertain diagnosis as it was extending very deep in close proximity to big vessels e.g. subclavian vein or superior vena cava. All of the excised mass was sent for histopathology. The wound was closed primarily with a drain inside. Microscopic examination showed the tumour of skin consisting of islands of epithelial cells embedded in fibrous stroma. The islands consisted of basophilic cells and shadow cells. Multinucleated giant cells and foci of bone formation were also seen. The diagnosis was skin: Pilomatricoma (Calcifying Epithelioma of Malherbe). The patient, however, refused surgery for complete excision after the histopathological report.

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