Pilomatrixoma Workup

  • Author: Jaggi Rao, MD, FRCPC; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 21, 2010
 

Imaging Studies

The following imaging studies may be helpful:

  • Radiography: Plain radiography often shows nonspecific calcification of the lesion.
  • Ultrasonography: In one review of 25 pediatric patients, investigators found that ultrasonography characteristically showed an ovoid complex mass at the junction of the dermis and subcutaneous fat, with focal thinning of the overlying dermis.[70] It consistently appeared as a target lesion, with a hypoechoic rim and an echogenic center. The hypoechoic rim corresponded to the connective tissue capsule; the irregular echogenic center corresponded to the central island of epithelial cells. Ultrasonography also shows calcification. For lesions overlying the parotid gland, ultrasonography helps delineate the relationship between the lesion and the parotid gland.
  • Magnetic resonance imaging: In one 4-year-old girl with a pilomatricoma on the neck, MRI showed a tumor with well-defined margins and high-signal intensity relative to the neck musculature on T1- and T2-weighted images.[71] MRI may be diagnostic if further reports can confirm the correlation between the high-signal bands in T2-weighted images and the bands formed by basaloid cells evident upon histologic examination.[72]
  • CT scanning: In 4 of 33 patients, CT scanning of the parotid region was performed and showed a well-delineated subcutaneous tumor containing microcalcifications, but the diagnosis proposed by the radiologist was adenopathy.[4]
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Other Tests

Fine-needle aspiration has been studied as a diagnostic tool[73, 74, 75, 76, 77] ; however, misinterpretation of the lesion as carcinoma, basal cell carcinoma, and pleomorphic adenoma with squamous metaplasia has been reported. The presence of ghost cells, basaloid cells, and calcium deposits in the appropriate clinical setting permits diagnosis by aspiration.

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Procedures

Take a biopsy specimen of lesions to look for characteristic changes that establish the diagnosis and to rule out other conditions that can clinically resemble pilomatrixoma.

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Histologic Findings

The lesion is usually found in the lower dermis and subcutaneous fat. It is sharply demarcated and is usually surrounded by a connective tissue capsule. Irregularly shaped islands of epithelial cells are seen; they can be recognized as either basophilic cells or shadow cells. Basophilic cells are usually arranged either on one side or along the periphery of the tumor islands. The shadow cells have a central unstained area, corresponding to the lost nucleus. As the lesion ages, the number of basophilic cells decreases.[78] Calcium deposits are seen in 75% of lesions with von Kossa staining. See the images below.

Pilomatricoma with prominent basaloid cells. Pilomatricoma with prominent basaloid cells. Ghost cells (shadow cells) and basaloid cells, assGhost cells (shadow cells) and basaloid cells, associated with a granulomatous reaction. Shadow cells are also seen in this high-power micrograph.
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Contributor Information and Disclosures
Author

Jaggi Rao, MD, FRCPC  Associate Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry; Founder and Director, Acne Clinics of Canada, Inc; Teledermatologist, Telederm Canada, Inc

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Dermatology Association, Canadian Medical Association, Canadian Medical Protective Association, Pacific Dermatologic Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew Lin, MD, FRCPC  Associate Professor, Department of Internal Medicine, Division of Dermatology, University of Alberta

Andrew Lin, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Smeena Khan, MD  Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Pilomatricoma with prominent basaloid cells.
Ghost cells (shadow cells) and basaloid cells, associated with a granulomatous reaction. Shadow cells are also seen in this high-power micrograph.
 
 
 
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