Anetodermic cutaneous changes overlying pilomatricomas

Pilomatrixoma of the Arm: A Case Report and Review of Literature

Pilomatrixoma (PMX), also known as calcifying epithelioma of Malherbe, is a rare benign neoplasm that arises from the hair matrix cells, commonly in the head, neck, and upper trunk regions, infrequently affecting upper and lower extremities. It has to two peaks of presentation: under 20 years of age or between 50 and 65 years of age, slightly more common in females. The neoplasm exhibits diverse clinical manifestations and is frequently subject to misdiagnosis with alternative dermatological diseases. We present an atypical case of PMX affecting the upper extremity of a 62-year-old female patient. Surgical removal of the affected tissue under local anesthesia was performed, and subsequent histopathological analysis confirmed the presence of PMX. Based on the literature search we performed, we found out that this pathology is underreported in Jordan, with only one study published describing this tumor in the maxillofacial region. Physicians should be aware of this condition and its different presentations to include it in the differential diagnosis of suspected cases to provide the appropriate management and follow-up.

Bullous Pilomatricoma: A Report of Clinical and Pathologic Findings and Review of Dermal Bullous Disorders

Background:

Pilomatricoma is a common benign adnexal tumor differentiating toward elements of the hair matrix and shaft. It typically presents as a solitary, deep, dermal nodule. We describe a case of a pilomatricoma with the unusual feature of a thick-walled dermal bulla overlying the tumor.

Objective:

We describe a case of bullous pilomatricoma and discuss the potential etiology of the bullous feature of the lesion.

Methods:

This article includes a case report and a literature review.

Conclusions:

Bullous pilomatricoma has rarely been described. A common pathological feature in this type of pilomatricoma is the presence of dilated lymphatics. Bullous morphea associated with dermal lymphatic dilation has also been described. In both bullous pilomatricoma and morphea, it is possible that individual pathological features of the lesion lead to obstruction and congestion of the dermal lymphatics thereby inducing enough dilation and edema to form a dermal bulla.

Antécédents:

Le pilomatrixome (épithéliome calcifiant de Malherbe) est une tumeur annexielle bénigne qui ressemble aux éléments de la matrice et de la tige pilaires. Il se manifeste typiquement par un nodule sous-cutané solitaire. Nous rapportons un cas de pilomatrixome présentant la caractéristique inhabituelle d'une bulle dermique à paroi épaisse située au-dessus de la tumeur.

Objectifs:

Décrire un cas de pilomatrixome bulleux et présenter l'étiologie potentielle d'une telle manifestation.

Méthodes:

Cet article comporte une étude de cas ainsi qu'une revue de la littérature.

Conclusion:

Le pilomatrixome bulleux a rarement été décrit. La dilatation des vaisseaux lymphatiques constitue une manifestation pathologique fréquente de cette forme de pilomatrixome. La morphée bulleuse a également été associée à une dilatation de vaisseaux lymphatiques. Il est possible que les caractéristiques pathologiques individuelles des lésions du pilomatrixome bulleux et de la morphée entraînent une obstruction et une congestion des vaisseaux lymphatiques, provoquant ainsi une dilatation et un œdème suffisamment importants pour former une bulle.

Perforating pilomatricoma with anetodermic epidermis in an adolescent with lymphoma

Pilomatricoma is a benign neoplasm originating from primitive cells of the hair matrix. Occasionally the skin overlying pilomatricomas assumes peculiar clinical features, and anetodermic change of the skin overlying pilomatricomas is sometimes seen, but perforation in pilomatricoma is a rare event. We report a case of perforating pilomatricoma with anetoderma in an adolescent with lymphoma.

Follicular induction in a case of molluscum contagiosum: possible link with secondary anetoderma-like changes?

Molluscum contagiosum (MC) can rarely show follicular neogenesis as a result of proliferation of virus-infected basal cells. We report a case of molluscum contagiosum showing multifocal areas of primitive follicular induction involving the adjacent surface epidermis. The underlying dermis showed histological features suggestive of secondary anetoderma. The pathogenetic mechanisms behind development of these microscopic features and the putative link between follicular induction and secondary anetoderma are explored. Awareness of this unusual phenomenon will be helpful in avoiding a misdiagnosis of a superficial basal cell (trichoblastic) carcinoma in such cases.

Anetodermic pilomatricoma

A pilomatricoma, or Malherbe's calcifying epithelioma, is an uncommon tumor originating from hair matrix cells. It is clinically characterized by a solitary, firm nodule. As the skin overlying the pilomatricoma may change in color and texture, its clinical presentation can vary. We report an unusual case of pilomatricoma with associated anetoderma on the lower extremity of a 12-year-old girl. Histology revealed a thinned dermis replaced by myxomatous tissue between the surface and a deep-seated tumoral mass. This mass is formed of irregular islands of basaloid cells, shadow cells, calcified areas and discrete inflammatory and foreign-body reactions surrounding it. Anetodermic cutaneous changes may occur in pilomatricomas without histological evidence of triggering factors.

Pilomatricome ou épithélioma calcifié de Malherbe : à propos d'une série de 89 cas chez l'enfant

The authors report an exclusive pediatric review of 89 pilomatricomas operated in 83 patients. This tumor, also known as calcifying epithelioma of Malherbe, is common in the pediatric population and occurs mainly on the head and neck region. It is a benign skin neoplasm usually misdiagnosed and yet the most common hair follicle tumor. The treatment is a surgical excision taking the overlying skin. Principal characteristics and clinical presentation of this tumor are discussed.

Pilomatricomal Horn

We describe a pilomatricomal horn on the right arm of a 39-year-old man. Although initially the tumor was clinically thought to be a verruca vulgaris, the microscopic features were similar to those found in classic pilomatricoma, except for the epidermal location and the presence of a cutaneous horn. Light microscopy showed replacement of the epidermis by basaloid cells, with masses of cornified material containing shadow cells that formed a cutaneous horn. Whereas classic pilomatricoma is confined to the deep reticular dermis or subcutis, the present case represents a unique heretofore unreported epidermal variant of pilomatricoma that pathologists should be aware of to differentiate it from malignant epidermal tumors.

[Myxofibrosarcoma associated with anetoderma]

BACKGROUND

Association of malignant cutaneous tumor and secondary anetoderma is rare. Secondary anetoderma in myxofibrosarcoma has not been described to date. We report a case below.

CASE REPORT

A 80-year-old woman presented with a 40 x 40 mm, round, flesh-colored lesion on her left buttock. Physical examination showed a soft, protuberant lesion, without firm underlying subcutaneous mass. Pathologic examination of the surgical specimen revealed a myxofibrosarcoma, with focal loss of elastic fibers in the overlying dermis. There was no evidence of systemic involvement. One year later, she developed a recurrent tumor at the same site, with similar clinical presentation, which was treated by broad excision.

DISCUSSION

Secondary anetoderma is usually seen in association with cutaneous infections and benign skin tumors. An anetodermic presentation of myxofibrosarcoma has not been reported to our knowledge. Myxofibrosarcoma (formerly referred to as myxoid malignant fibrous histiocytoma) is characterized by an abundant myxoid background in at least one half of the tumor. The tumor recurs in almost two-thirds of cases and metastasizes in one-fourth. Our case confirms that a unique, acquired anetodermic lesion can reveal a malignant tumor. A large deep biopsy should be performed systematically when this variety of anetoderma is observed.

Multiple familial pilomatricomas: an unusual case

Although solitary pilomatricomas are relatively common, multiple pilomatricomas occur rarely, in 2-3.5% of reported cases. The majority of cases of familial multiple pilomatricomas occur in association with myotonic dystrophy. The occurrence of multiple familial pilomatricomas in patients who are otherwise well is extremely rare. We describe a 29-year-old man with multiple pilomatricomas whose father and brother also had similar lesions. There is no history of myotonic dystrophy.

An unusual presentation of anetoderma: a case report

Background

Anetoderma is a benign condition with focal loss of dermal elastic tissue resulting in localized areas of flaccid or herniated saclike skin. Currently, anetoderma is classified as either primary (idiopathic), or secondary anetoderma (which is associated with a variety of skin conditions, penicillamine use, or neonatal prematurity). Lesions appear on the upper arms, trunk, and thighs.

Case presentation

We report a 14-year-old boy, which was noticed to have had multiple, white, non-pruritic areas on the acral sites of upper and lower extremities for two years. In physical examination, the patient had normal mental development. Skin lesions consisted of scattered, white to skin-colored papules, less than 1 cm in diameter, and with central protrusion, with distribution on dorsal part of the index finger, forearms, distal portion of thighs and calves. Lesions were detected neither on the trunk nor the proximal areas of extremities. There are no sensory changes associated with the lesions. Otherwise, his general health was good. He did not have any medication consumption history. Family history was negative. Laboratory examinations were within normal limits. Skin biopsy from one of his lesions was done, that confirmed the diagnosis of anetoderma.

Conclusions

In summary, we report a case of anetoderma on unusual sites of the skin. We could not find similar reports of anetoderma developing on distal extremities without involvement of the upper trunk and proximal arms, in the medical literature.

Pilomatricoma with a bullous appearance

BACKGROUND

Pilomatricoma is a benign, cutaneous neoplasm with differentiation toward hair matrix. The tumor is usually a deep-seated, solitary, firm nodule with overlying normal epidermis. Pilomatricoma with a bullous appearance is very rare.

METHODS

A 16-year-old Chinese girl with a soft, purplish, translucent bulla on the left shoulder for 6 months and a nodule underlying the bulla is described.

RESULTS

The histopathologic findings were consistent with pilomatricoma. There was extraordinary dilation of lymphatic vessels in the overlying dermis, which explains the clinical bullous appearance. The surrounding dermis had an edematous appearance. A Verhoeff-van Gieson stain disclosed the marked reduction of the elastic fibers, and an alcian blue stain was negative.

CONCLUSIONS

The patient is diagnosed as bullous variant of pilomatricoma.

Anetoderma arising in cutaneous B-cell lymphoproliferative disease

Anetoderma is circumscribed atrophy of the skin due to a localized deficiency in elastic tissue. It can follow inflammatory skin diseases of several types, and occasionally is present in the skin around neoplasms. There are a few reports of anetoderma in the lesional skin of cutaneous lymphoma. We report on two patients who presented with multiple lesions of anetoderma and who later proved to have low-grade cutaneous B-cell lymphomas. One patient (Patient 1) is a 39-year-old man and the other patient is a 26-year-old woman who is a renal transplant recipient (Patient 2). Some biopsy specimens from the anetodermic skin of Patient 1 appeared to show an urticarial reaction, although plasma cells were present. A large nodule showed lymphoid follicles surrounded by plasmacytoid lymphocytes, with loss of elastic tissue in the adjacent dermis. The plasmacytoid cells stained overwhelmingly for lambda light chain, and staining of the urticarial lesions from this patient also showed a marked majority of lambda positive cells. Immunoglobulin heavy chain gene (IgH) rearrangements showed a dominant clonal pattern in the nodular lesion. We classified the disease in Patient 1 as marginal zone lymphoma and the disease in Patient 2 as a post-transplant lymphoproliferative disorder. Because of the intimate association of anetoderma and cutaneous B-cell lymphoproliferative disorders in these two patients, it seems possible that anetoderma could result from either a local effect of the neoplastic cells or associated inflammatory cells, especially neutrophils as in Case 1. The infiltrates of Case 1 had many interstitial neutrophils and only a few clonal plasmacytoid lymphocytes, indicating that this presentation of B-cell lymphoma can be a diagnostic pitfall. Given these two cases and similar ones in the literature, biopsy of lesional skin in anetoderma should be performed to ensure that lymphomatous infiltrates are not present. Even if plasma cells are sparse, studies to detect clonality are appropriate. Cutaneous B-cell lymphoma can be added to the list of associations of elastolysis and cutaneous lymphoma, which includes granulomatous slack skin (T-cell lymphoma) and cutis laxa (myeloma).

Anetoderma secondary to generalized granuloma annulare

Anetoderma is a rare disorder of cutaneous atrophy with loss of dermal elastic tissue. Secondary anetoderma is seen after a variety of dermatoses. We describe a 33-year-old woman with secondary anetoderma after generalized granuloma annulare lesions that were most pronounced on sun-exposed areas.

A clinical review of 209 pilomatricomas

BACKGROUND

Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed. This can result in extensive surgery for an essentially benign condition.

OBJECTIVE

The purpose of this study was to define the clinical and histologic spectrum of these tumors to aid diagnosis.

METHODS

Two hundred nine cases were analyzed retrospectively with regard to age at presentation, site, size, and physical appearance.

RESULTS

Pilomatricomas appear at any age, with peak presentation bimodally in the first and sixth decade. Their most common site is the head and neck. Presentation is of a hard nodule, either deeply subcutaneous and invisible or superficial with possible erosion through the skin surface. This may lead to a false diagnosis of malignancy or of an epidermoid cyst. An association with myotonic dystrophy has been confirmed, as is the rare occurrence of malignant transformation.

CONCLUSION

Careful clinical examination and a high index of suspicion results in an accurate diagnosis, appropriate treatment, and the avoidance of unnecessarily extensive surgery.

Pilomatricoma with a bullous appearance

A 15-year-old Japanese girl had an asymptomatic nodule on the right thigh of seven months' duration. The clinical appearance was similar to that of a bulla. There was a history of blunt trauma from dog scratch to the skin over the tumor shortly before tumor growth. Histopathological findings were consistent with pilomatricoma. In the overlying dermis, the collagen bundles were compressed to the tissue surrounding the tumor and the large space was seen. Around the tumor, some dilated endothelium-lined vascular channels were found, which were identified as lymphatic vessels.

Magnetic resonance imaging of pilomatricoma

Two patients (a 16-month-old boy and a 53-year-old man) were referred for MR imaging of a small, subcutaneous nodule at the forearm. Plain films were available in one patient and showed a non-specific well-circumscribed lesion. Upon ultrasonography (1 patient), a nodular, well-circumscribed, hyperechoic lesion was seen. In both cases spin-echo (SE) T1-weighted images (T1WI) showed homogeneous, intermediate signal intensity (SI). On gadolinium-enhanced T1WI (1 patient), no enhancement was observed. Both lesions showed predominant low-to-intermediate SI on T2WI. At histological examination characteristic findings of pilomatricoma were observed.

Multiple pilomatricomas and myotonic dystrophy in a patient with AIDS

We report a 43-year-old man with myotonic dystrophy who developed multiple pilomatricomas 2 years after being diagnosed as having AIDS. This is the first report of pilomatricomas developing in an HIV-1 seropositive patient.