Abstract:
Pilomatricomas are frequently misdiagnosed benign neoplasms of the skin derived from hair matrix cells. Pilomatricomas may undergo calcification and ossification although the latter is rare and poorly documented, with only eight cases reported since 2006. We present a case of pilomatricoma with osseous metaplasia arising from the scalp in an 87-year-old female patient. She was referred by her general practitioner via the two-week cancer referral pathway, for a suspicious lesion. On examination, there was a 2 x 1cm nodule, with protruding hardened yellow material, on the right side of the patient\'s occipital scalp. The lump was hard, non-tender and had been present for 17 years. The surrounding area was bleeding and slightly ulcerated. A clinical diagnosis of a ruptured epidermal cyst was made, and the patient was prepared for excision under local anaesthesia. The excised lesion of 23 x 18 x 10mm with 22 x 9mm of skin was sent for histology. This revealed a partially ulcerated dermal lesion composed of islands of keratin with \'ghost cell\' outlines. Foreign body granulomas, transition to mature lamellar bone, and foci of calcification were noted. There were no definite populations of basaloid cells and features of malignancy were not seen. These findings are consistent with benign pilomatricoma with osseous metaplasia. The patient was discharged 4 weeks later with satisfactory wound healing. Differentiating this tumour from other commonly encountered benign masses remains a challenge, as seen in this case which was initially misdiagnosed as a ruptured epidermal cyst.
摘要:
毛囊瘤经常被误诊为源自毛发基质细胞的皮肤良性肿瘤。毛囊瘤可能会发生钙化和骨化,尽管后者很少见,文献很少,自2006年以来仅报告了8例病例。我们在一名87岁的女性患者中介绍了一例由头皮引起的骨性上皮瘤。她的全科医生通过两周的癌症转诊途径转诊,因为一个可疑的病变.在检查中,有一个2x1厘米的结节,带有突出的硬化黄色材料,患者右侧的枕骨头皮。肿块很硬,不招标,已经存在了17年。周围区域出血并有轻微溃疡。临床诊断为表皮囊肿破裂,病人准备在局部麻醉下切除。切除的23×18×10mm的病灶和22×9mm的皮肤被送去进行组织学检查。这显示了部分溃疡的真皮病变,由带有“幽灵细胞”轮廓的角蛋白岛组成。异物肉芽肿,过渡到成熟的板层骨,并注意到钙化灶。没有明确的基底细胞群,也没有看到恶性肿瘤的特征。这些发现与良性绒毛瘤伴骨化生一致。4周后患者出院,伤口愈合满意。区分这种肿瘤与其他常见的良性肿块仍然是一个挑战,如在这种情况下,最初被误诊为表皮囊肿破裂。