Clinical and Dermoscopic Changes In A Case of Posttraumatic Acute Onset Proliferated Pilomatricoma
Bildiriler > Tam Metin Bildiri · 2023
Yazarlar: Ayris ÖZTÜRK, Nilay DUMAN, Banu YAMAN
32nd Congress of the European Academy of Dermatology and Venereology, Almanya, Berlin, Uluslararası, Poster, Tam Metin Bildiri, 2023-2023, cilt -, ss ---
Özet
<p><strong>Introduction & Objectives:</strong></p><p>Pilomatricoma (PM) is a benign adnexal hair follicle tumor defined as a well-circumscribed bluish-red, hard, solitary nodule, usually located on the scalp, and upper extremities. Proliferating pilomatricoma (PPM) is a type of PM composed of a large lobular proliferation of basaloid cells and focal shadow cells, which has been scarcely reported. Herein, we present clinical and dermoscopic changes in a case of posttraumatic acute onset PPM.</p><p><strong>Materials & Methods:</strong></p><p>A 70-year-old male patient was admitted with a rapidly growing pink-red hemorrhagic nodule appeared 15 days after trauma in the left frontal area. An exophytic, 8x7 millimeters, red, bleeding, fluctuating nodule in the left frontal region was seen.</p><p><strong>Results:</strong></p><p>A chaotic appearance with ulceration on a pink background was observed in the dermoscopic examination, as well as polymorphic vessels on the surface consisting of finely calibrated branching, linear irregular and dotted vessels, blue-gray structureless areas, irregular yellow-white structureless areas, and gray-white streaks. Dermoscopy revealed an increase in ulceration, blue-gray structureless areas on the ground, and irregular yellow-white structureless areas, streaks, and polymorphic vessels. Histopathology was consistent with PPM.</p><p><strong>Conclusion:</strong></p><p>Histopathology of PM shows a well-circumscribed multilobular tumor in the deep dermis or subcutaneous, surrounded by stroma. Tumor lobules consist of basaloid cell clusters with mitotic figures in the periphery. Ghost cells, also called shadow cells, are anucleated dead cells that retain their cellular shape and contain large masses of eosinophilic cornified material in the center.</p><p>Irregular yellow-whitish structures and streaks correspond to calcification and large quantities of eosinophilic cornified material located in the center of well-developed PM lobules. The presence of proliferating vessels in the papillary dermis and bleeding can explain the reddish homogeneous area. Structureless gray-blue areas correspond to melanin pigment within basaloid cell clusters or the presence of melanophages or siderophages in the inflammatory infiltrate.</p><p>Dermoscopic findings of PM include irregularly shaped reddish and yellow-white homogeneous areas, hairpin and linear irregular vessels, and white streaks. Dotted vessels, ulceration, and structureless blue-gray areas are also often accompanied. No specific dermoscopic signs of melanocytic or non-melanocytic lesions are observed.</p><p>PM is characterized mainly by the high proliferative activity of matrix cells in its early phase, while typical ghost cells and eosinophilic keratinization develop later. During the early stage or rapidly developing PPM, structureless blue-gray areas due to basaloid cell clusters are more common, while yellowish-whitish structures and streaks expressing the eosinophilic cornified material of ghost cells may develop in the later period. Our case report supports this idea, as we observed a predominance of structureless blue-gray areas in the lesion on the 15th day and a predominance of yellowish-white areas in the 3rd week. To our knowledge, this is the first case demonstrating dermoscopic findings in early and established PPM lesions, as well as dermoscopic changes in follow-up.</p>