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Banks R, Park J, Doan L, Healy E, Harris JP. Metastatic pilomatrix carcinoma treated with stereotactic body radiation therapy. JAAD Case Rep 2024; 47:50-53. [PMID: 38645801 PMCID: PMC11033044 DOI: 10.1016/j.jdcr.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Rufus Banks
- University of California–Irvine, Irvine, California
| | - Jino Park
- Department of Radiation oncology, UC Irvine Medical Center, Orange, California
| | - Linda Doan
- Department of Dermatopathology, UC Irvine Medical Center, Orange, California
| | - Erin Healy
- Department of Radiation oncology, UC Irvine Medical Center, Orange, California
| | - Jeremy P. Harris
- Department of Radiation oncology, UC Irvine Medical Center, Orange, California
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2
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Mlay K, Shija P, Magwizi M, Karuga EG, Mtenga P, Mremi A. Giant pilomatrix carcinoma of the scalp with intracranial extension: A case report. Clin Case Rep 2023; 11:e8123. [PMID: 37927987 PMCID: PMC10625130 DOI: 10.1002/ccr3.8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
Key Clinical Message A very rare skin cancer. Malignant variant of pilomatricoma. It is unique because of its highly aggressive behavior. Responds poorly to chemotherapy and radiotherapy. Treated with a wide surgical excision with safe margins. Abstract Pilomatrix carcinoma is uncommon and locally aggressive tumor of the hair follicle matrix. It is a malignant variant of pilomatricoma. If left untreated for a long time may attain massive size and has the potential for distant spread. Only few cases with brain extension have been reported in the literature. Diagnosis of these tumors is established by histopathology. Although pilomatrixoma and pilomatrix carcinoma are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. The tumors respond poorly to chemotherapy and radiotherapy. Thus, recommended treatment is a wide surgical excision with safe margins. Herein, we report the case of a 39-year-old African woman with pilomatrix carcinoma of the scalp eroding the skull bone with intracranial extension.
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Affiliation(s)
- Kenneth Mlay
- Department of OtorhinolaryngologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Peter Shija
- Department of OtorhinolaryngologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Marco Magwizi
- Department of OtorhinolaryngologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Ezekiel G. Karuga
- Department of OtorhinolaryngologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Philbert Mtenga
- Department of OtorhinolaryngologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Alex Mremi
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of PathologyKilimanjaro Christian Medical CentreMoshiTanzania
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3
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Anand R, Kanuj M, Shirley S. Pilomatrix Carcinoma-Rare Presentation of an Unusual Cutaneous Malignancy. Gulf J Oncolog 2023; 1:107-110. [PMID: 36804165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 02/23/2023]
Abstract
INTRODUCTION OR BACKGROUND Pilomatrix carcinoma is a rare malignant neoplasm arising from the root of hair follicles, with only 150 cases described in the world literature. It is most commonly seen in the head and neck region. CASE PRESENTATION We describe a case of malignant pilomatrix carcinoma in a 62-year-old gentleman presenting as a solitary globular mass over the right anterior chest wall along with a brief review of literature. DISCUSSION AND CONCLUSION Surgical excision with a wide margin is the current standard of care for chest wall pilomatrix carcinoma and is associated with the least recurrence. Role of radiation as definitive treatment of the primary or as adjuvant therapy has not been clearly established.
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Affiliation(s)
- Raja Anand
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Malik Kanuj
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
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4
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Santoro A, Travaglino A, Valente M, Arciuolo D, Scaglione G, D’Alessandris N, Sfregola S, Addante F, Fulgione C, Raffone A, Minucci A, Inzani F, Zannoni GF. Pilomatrix-like High-Grade Endometrioid Carcinoma of the Ovary: Case Report, Literature Review, and Differential Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12123146. [PMID: 36553153 PMCID: PMC9777718 DOI: 10.3390/diagnostics12123146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Pilomatrix-like high-grade endometrioid carcinoma (PiMHEC) has recently been described as an aggressive variant of endometrial carcinoma. Herein, we described a case of ovarian PiMHEC, comparing it to endometrial PiMHEC and assessing previously published cases of putative ovarian PiMHEC. A 65-year-old woman underwent hysterectomy for an ovarian tumor characterized by solid nests of basaloid cells with prominent ghost cell keratinization. Immunohistochemistry showed nuclear β-catenin and CDX2 expression and loss of estrogen and progesterone receptors and PAX8. These features were consistently observed in all previously published cases and may represent diagnostic criteria of PiMHEC. Other frequent features were geographic necrosis and a low-grade endometrioid component. CK7, neuroendocrine, and basal/squamous markers were inconsistently expressed. All cases with available follow-up showed poor prognosis. PiMHEC should be distinguished from mimickers, such as high-grade endometrioid carcinoma with geographic necrosis, low-grade endometrioid carcinoma with ghost cell keratinization, and undifferentiated/dedifferentiated carcinoma. In conclusion, PiMHEC can also occur in the ovary and shows several consistent clinical, morphological, and immunophenotypical features. These features support that PiMHEC is a distinct entity requiring an aggressive management.
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Affiliation(s)
- Angela Santoro
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Michele Valente
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Damiano Arciuolo
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Giulia Scaglione
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicoletta D’Alessandris
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefania Sfregola
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70121 Bari, Italy
| | - Caterina Fulgione
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, 80131 Naples, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Angelo Minucci
- Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Frediano Inzani
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
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5
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Weisman P, Park K, Xu J. FIGO Grade 3 Endometrioid Adenocarcinomas With Diffusely Aberrant β-Catenin Expression: An Aggressive Subset Resembling Cutaneous Pilomatrix Carcinomas. Int J Gynecol Pathol 2022; 41:126-131. [PMID: 33811207 PMCID: PMC8484367 DOI: 10.1097/pgp.0000000000000775] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterine endometrioid adenocarcinomas are known for their morphologic plasticity. In addition to a multiplicity of metaplasias, uterine endometrioid adenocarcinomas may also undergo high-grade divergent differentiation in the form of high-grade neuroendocrine carcinoma, neuroectodermal differentiation or carcinosarcoma; others may dedifferentiate completely. Here we describe 5 cases of uterine endometrioid adenocarcinomas with high-grade divergent differentiation showing a striking morphologic and immunophenotypic resemblance to cutaneous pilomatrix carcinoma. Specifically, the high-grade component in all cases exhibited solid, basaloid morphology with conspicuous tumor cell necrosis and the presence of shadow cells, accompanied by diffusely aberrant (nuclear and cytoplasmic) β-catenin expression as well as variably diffuse CDX2 expression. In addition, the high-grade component in all cases showed loss of ER and PAX8 expression, retained MMR expression, wild-type p53 expression, patchy p16 expression, and diffusely positive cytokeratin expression (AE1/AE3 and CK7); at least focal neuroendocrine marker expression was present in all cases. CK20 was negative in all cases, with the exception of very focal staining in a single case (2% of tumor cells). All 5 of our tumors had at least a focal conventional FIGO grade 1 component. In all 4 cases tested, the low-grade component retained both PAX8 and ER expression and had, at best, focally aberrant β-catenin expression. Two of our cases had molecular analysis performed and both harbored mutations in exon 3 of CTNNB1 as expected; molecular analysis also revealed that both cases lacked POLE or TP53 mutations and showed no microsatellite instability. The tumors in this series were uniformly aggressive. Four of the 5 patients in our cohort had available follow-up information; of these, 3/4 died of their disease within 14 mo of diagnosis and the fourth patient had distant metastatic disease at presentation and is alive with disease 1 mo following diagnosis. The 1 patient without follow-up information also had distant metastatic disease at presentation and was lost to follow-up 17 mo later. The cases described in this series (1) represent a highly aggressive CTNNB1-mutated subset of the "no specific molecular profile" category of endometrioid adenocarcinomas; (2) illustrate a form of high-grade divergent differentiation resembling cutaneous pilomatrix carcinoma already described in carcinomas at other anatomic sites; and (3) underscore the difficulty in recognizing this phenotype at distant metastatic sites, which are frequent even at the time of presentation, given the consistent loss of ER and PAX8 expression and concurrent CDX2 expression.
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Affiliation(s)
- Paul Weisman
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kay Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jin Xu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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6
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Kenny B, Osmond A. CDX2 and SATB2 positivity in pilomatrix carcinoma: Avoiding an erroneous diagnosis of cutaneous metastasis of gastrointestinal origin. J Cutan Pathol 2021; 49:399-402. [PMID: 34797586 DOI: 10.1111/cup.14172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 12/20/2022]
Abstract
An 80-year-old female presented with a slowly growing 2-cm nodule on her shoulder over a 1-year period. Histopathologic sections of a biopsy specimen showed a multinodular, dermal-based basaloid tumor with areas of clear-cell change, stromal induction, as well as significant cytologic atypia and atypical mitotic activity. An initial investigation revealed positive staining of CDX2, a well-known marker of tumors of gastrointestinal origin. The case was referred to our dermatopathology service for consultation to determine if the lesion was in keeping with a cutaneous metastasis. On receipt of the case, an extended immunohistochemical panel was performed including SATB2, which displayed a similar pattern of staining as seen with CDX2. Although pathologists are most familiar with CDX2 and SATB2 as markers of gastrointestinal origin, the recent dermatopathology literature highlights that primary adnexal lesions of the skin also display positivity for CDX2 and can exhibit SATB2 positivity. We share a case of pilomatrix carcinoma with positive expression of nuclear CDX2 and SATB2, adding to the recent literature to (a) increase recognition of this staining pattern in hair follicle tumors, and (b) discuss briefly the shared molecular underpinnings in the tumorigenesis of gastrointestinal tumors and tumors of hair follicle origin that help clarify this underrecognized immunohistochemical pattern.
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Affiliation(s)
- Bret Kenny
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Allison Osmond
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
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7
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Weng G, Li F, Xu M. Pilomatrix carcinoma of the male breast: a case report. Int J Clin Exp Pathol 2020; 13:2153-2157. [PMID: 32922613 PMCID: PMC7476948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Pilomatrix carcinoma (PC) is a rare skin adnexal neoplasm derived from piliferous follicles, usually occurring in the head and neck region. An optimal treatment for PC has not yet been established, while surgery with wide margins is recommended, with radiation therapy (RT) and chemotherapy improving the curative effect. Location of this tumor in the breast is exceedingly rare, especially for a male. We now report an unusual case of a 53-year-old male who presented with 2 palpable masses in the right breast, which had been removed surgically about 4 and a half years prior, but recurred after 7 months. Ultrasonography revealed 2 irregular low-echo masses with a well-defined boundary, and computed tomography (CT) showed 2 soft tissue masses in subcutaneous tissue of the right breast. The tumors were completely removed without RT and chemotherapy. After about 4 years' follow-up, the patient remains free of local recurrence and metastasis. To the best of our knowledge, only 2 cases of PC in the breast region have been reported, but were female.
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Affiliation(s)
- Gaolong Weng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei Province, China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei Province, China
| | - Maolin Xu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei Province, China
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8
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Eckhoff MD, Tadlock J, Kafchinski LA. Pilomatrix Carcinoma of the Antecubitum. Cureus 2020; 12:e6821. [PMID: 32190433 PMCID: PMC7054892 DOI: 10.7759/cureus.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present the case of a 46-year-old male with atypically large left elbow pilomatrix carcinoma present for 10 years with emergent excision after developing life-threatening hemorrhage. Pilomatrix carcinoma is a dermal-based malignant tumor typically of the head and neck region. Histopathology shows islands of basaloid cells, shadow cells, and fibromyxoid fibroma. Reoccurrence is seen in 23% of cases on an average of six months after primary excision. The current standard of care is wide excision with close follow-up.
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Affiliation(s)
- Michael D Eckhoff
- Orthopedics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Joshua Tadlock
- Orthopedics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Lisa A Kafchinski
- Orthopedics, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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9
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Affiliation(s)
- Lin Xing
- Department of Medicine, Division of Dermatology, University of Ottawa, Ottawa, Canada
| | - Sean A Marzolf
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Affiliation(s)
- Giulia Maria Ravaioli
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Massimiliano Pazzaglia
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Barbara Corti
- Pathology, Unit Department of Diagnostic and Prevention Medicine, University of Bologna, Bologna, Italy
| | - Pier Alessandro Fanti
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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11
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Abed K, Stopa Z, Siewert-Gutowska M. Primary cutaneous anaplastic large-cell lymphoma: A case report. Medicine (Baltimore) 2018; 97:e9645. [PMID: 29369180 PMCID: PMC5794364 DOI: 10.1097/md.0000000000009645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary cutaneous anaplastic large-cell lymphoma (C-ALCL) is a rare cancer belonging to the group of primary T-cell lymphoproliferative diseases. C-ALCL is characterized by the presence of single or multiple ulcerated lesions on the skin's surface. PATIENT CONCERNS This is the case of a 73-year-old man who reported to the Clinic of Cranio-Maxillofacial and Oral Surgery and Implantology, Medical University of Warsaw, owing to a skin tumor in the right parotideomasseteric region, initially diagnosed as discoid lupus erythematosus. During treatment for discoid lupus erythematosus, biopsy was repeated because of significant disease progression and dynamic tumor growth. Histopathological examination revealed the presence of pilomatrix carcinoma (trichilemmal carcinoma). Because of the discrepancy between clinical and histopathological findings, the tumor specimen was submitted to another facility, wherein lymphoma infiltration by anaplastic large cells was found in the dermis and subcutaneous tissue. DIAGNOSIS C-ALCL. INTERVENTIONS The patient was transferred to the Lymphoid Tumours Clinic of the Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, where chemotherapy was initiated. OUTCOMES After 4 cycles of chemotherapy, a complete remission of skin lesions was achieved. During the 5-year follow-up, no recurrence occurred. LESSONS C-ALCL is a rare type of cancer. Misdiagnosis can lead to inappropriate therapy and result in disease progression or unnecessary harm to the patient.
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Abstract
Pilomatrix carcinoma is an exceedingly rare skin adnexal neoplasm derived from piliferous follicles, usually occurring in the head and neck region. Localization of this tumor in the breast is a rarity. We now report an unusual case of a 49-year-old female who presented with a palpable mass in the left breast for 2 years. Mammogram revealed a large, lobulated opacity with calcification, and positron emission tomography–computed tomography showed a metabolically active soft tissue mass measuring 15 cm involving all the quadrants of the left breast. Subsequently, the patient underwent radical mastectomy, and histopathologic diagnosis of pilomatrix carcinoma of the breast was offered. Pilomatrix carcinoma, although exceedingly rare, can have an intramammary location and can be misdiagnosed as breast carcinoma on limited material. A high index of suspicion is required to arrive at an accurate diagnosis so as to obviate neoadjuvant chemotherapy.
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Affiliation(s)
- Trupti Pai
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shweta R Harwani
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vani Parmar
- Department of Surgical, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Sangeeta B Desai
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Papadakis M, de Bree E, Floros N, Giannikaki E, Xekalou A, Manios A. Pilomatrix carcinoma: More malignant biological behavior than was considered in the past. Mol Clin Oncol 2017; 6:415-418. [PMID: 28451423 DOI: 10.3892/mco.2017.1148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022] Open
Abstract
Pilomatrix carcinoma is a very rare malignancy, with ~130 cases reported in the literature. In the past, pilomatrix carcinoma was considered to be a low-grade malignant tumor. Currently, however, its significant recurrence and metastatic potential has been well documented. Lymph node and systemic metastases are frequently observed. Wide surgical excision of the primary lesion is the principal modality of treatment, whereas adjuvant radiotherapy may be beneficial in local tumor control. Lymph node metastases may be treated surgically or with radiotherapy. Systemic disease is not responsive to chemotherapy, and is hence associated with a poor prognosis. Since the majority of nodal and systemic metastases present after the initial diagnosis and treatment, follow-up examinations of these patients may be warranted, despite the currently inadequate treatment options. In the present study, a case of pilomatrix carcinoma of the parotid region with early local recurrence only 2 months after complete excision with negative surgical margins is reported. The local recurrence was treated by excision and radiotherapy. The associated literature is also discussed.
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Affiliation(s)
- Marios Papadakis
- Department of Plastic Surgery, Helios Clinic Wuppertal, University Hospital Witten-Herdecke, D-42283 Wuppertal, Germany
| | - Eelco de Bree
- Department of Surgical Oncology, University Hospital of Crete, 71110 Heraklion, Greece
| | - Nikolaos Floros
- Department of Surgery, University Hospital Witten-Herdecke, D-42283 Wuppertal, Germany
| | - Elpida Giannikaki
- Department of Pathology, General Hospital 'Venizeleio and Pananio', 71409 Heraklion, Greece
| | - Athina Xekalou
- Department of Pathology, General Hospital 'Venizeleio and Pananio', 71409 Heraklion, Greece
| | - Andreas Manios
- Department of Surgical Oncology, University Hospital of Crete, 71110 Heraklion, Greece
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14
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Bailey EE, Rushovich AM, Kim J. A growing nodule on the forearm of an 84-year-old man. J Cutan Pathol 2016; 44:1-4. [PMID: 28000246 DOI: 10.1111/cup.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Jinah Kim
- Stanford University, Departments of Dermatology and Pathology
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15
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Sia PI, Figueira E, Allende A, Selva D. Malignant hair follicle tumors of the periorbital region: A review of literature and suggestion of a management guideline. Orbit 2016; 35:144-56. [PMID: 27171562 DOI: 10.1080/01676830.2016.1176048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant hair follicle tumors are rare skin adnexal malignancies that have a predilection for the head and neck region. They can be categorized into a number of different subtypes. Histologically, they are distinct from their benign counterpart. To the best of our knowledge, there is no extensive review of these malignancies, especially in the periorbital region. We aim to provide a literature review and a guideline for management of these malignant tumors in the periorbital region. Database from Medline, PubMed, Embase, and Google Scholar were consulted. A total of 16 cases from the literature on hair follicle malignancies in the periorbital region were included in this review. The clinical presentations, diagnostic patterns, investigations used, and best management approach of these tumors are discussed. The American Joint Committee on Cancer (AJCC) 7(th) edition carcinoma of the eyelid staging system was used to describe their behaviors. We recommend wide excision surgery and a close follow-up for these tumors. Tumors presenting with a late stage require work-up for distant metastasis and consideration for exenteration procedures. The role of radiotherapy and chemotherapy in this context is still uncertain.
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Affiliation(s)
- Paul Ikgan Sia
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Edwin Figueira
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
| | - Alexandra Allende
- b Douglass Hanly Moir Pathology , Sydney , New South Wales , Australia
| | - Dinesh Selva
- a South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences , University of Adelaide , Adelaide , Australia
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Goodwin CR, Sankey EW, Liu A, Elder BD, Kosztowski T, Lo SFL, Fisher CG, Clarke MJ, Gokaslan ZL, Sciubba DM. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases. J Neurosurg Spine 2015; 24:837-49. [PMID: 26544595 DOI: 10.3171/2015.4.spine15239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p < 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%-88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0.2%-100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%-33.3%). Age greater than 65 years, sacral spinal involvement, presence of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.
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Affiliation(s)
- C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Kosztowski
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles G Fisher
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada; and
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Liu JF, Li B, Fan ZX, Jiao T, Li C, Qin S, Lang JY, Chen JX. Pilomatrix carcinoma on the left side of the parotid region: A case report and review of the literature. Oncol Lett 2015; 10:313-316. [PMID: 26171021 DOI: 10.3892/ol.2015.3192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/15/2015] [Indexed: 11/05/2022] Open
Abstract
Pilomatrix carcinoma (PC) is a rare neoplasm, particularly in the parotid region. Thus, it is easily misdiagnosed and an optimal treatment regimen has not yet been established. The present study reports the case of a 43-year-old female who presented with a PC of the parotid region and reviews the associated published literature. The patient underwent three surgical excisions prior to the tumor being completely removed, and was misdiagnosed four times prior to the correct diagnosis. Once the tumor was completely removed, the patient received radiation therapy (RT). At the 2-year follow-up, the patient remained free of local recurrence and metastasis. To the best of our knowledge, only 3 cases of PC on the parotid region have been reported. Although an optimal treatment regimen has not been established, surgery with wide margins is recommended, with RT and chemotherapy producing mixed results.
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Affiliation(s)
- Ji-Feng Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Bin Li
- Department of Otolaryngology, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Zi-Xuan Fan
- Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Ting Jiao
- North Sichuan Medical College, Nanchong, Sichuan 637007, P.R. China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Sheng Qin
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Jin-Yi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Jin-Xiu Chen
- Department of Imageology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R. China
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18
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Arslan D, Gündüz S, Avci F, Merdin A, Tatli AM, Uysal M, Tural D, Başsorgun Cİ, Savaş B. Pilomatrix carcinoma of the scalp with pulmonary metastasis: A case report of a complete response to oral endoxan and etoposide. Oncol Lett 2014; 7:1959-1961. [PMID: 24932268 PMCID: PMC4049690 DOI: 10.3892/ol.2014.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/26/2014] [Indexed: 11/27/2022] Open
Abstract
Pilomatrix carcinoma is an extremely rare skin tumor derived from basaloid cells in the hair follicles; it often exhibits locally aggressive behavior with a tendency toward local recurrence. The average age of occurrence is 45 years, and there appears to be a male to female incidence ratio of 4:1. Although pilomatrix carcinomas are predominantly identified in the neck and scalp, there are studies in the literature reporting other tumor development sites, including the upper extremities, torso and popliteal fossa. If diagnosed at an early stage, this malignant tumor is generally treated with wide surgical resection. However, for the advanced-stage tumors, there are no standard treatment procedures known to produce good results. The current study presents the case of a 76-year-old male with pilomatrix carcinoma originating from the scalp with metastases to the lung. The patient had a rapid and complete clinical response following an oral combination chemotherapy regimen of cyclophosphamide and etoposide.
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Affiliation(s)
- Deniz Arslan
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Seyda Gündüz
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Fatma Avci
- Department of Internal Medicine, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Alparslan Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Mükremin Uysal
- Department of Medical Oncology, Afyon Kocatepe University, Ahmet Necdet Sezer Research and Practice Hospital, Afyon, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | | | - Burhan Savaş
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
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Herrmann JL, Allan A, Trapp KM, Morgan MB. Pilomatrix carcinoma: 13 new cases and review of the literature with emphasis on predictors of metastasis. J Am Acad Dermatol 2014; 71:38-43.e2. [PMID: 24739254 DOI: 10.1016/j.jaad.2014.02.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pilomatrix carcinoma is a rare cutaneous tumor derived from follicular matrix cells with few cases documented in the literature. OBJECTIVE We sought to better characterize this tumor by analyzing its epidemiologic, clinical, and histopathologic features in 13 new cases and by reviewing the literature. METHODS All cases of pilomatrix carcinoma from a large regional dermatopathology practice were identified and analyzed by chart review for clinical and histopathologic characteristics. Similar characteristics were compiled from an additional 123 cases in the English-language literature. Cox proportional hazards regression models were used to determine risk factors associated with the development of metastasis for all identified metastatic tumors. RESULTS Our 13 tumors were most common in middle-aged to older white men and presented mostly on the head/neck. Histopathologically, tumors were asymmetric, were poorly circumscribed, were composed of basaloid and "ghost" cells, had frequent atypical mitoses, and had infrequent lymphovascular invasion. Wide excision was considered the most definitive treatment modality, but local recurrence was common. When analyzing all reported cases of metastasis using statistics, metastasis was significantly associated (hazard ratio 3.45, P < .0413) with local tumor recurrence. LIMITATIONS The retrospective, single-center design and the reliance on electronic medical records are limitations. CONCLUSIONS This study helps better characterize pilomatrix carcinoma and identifies potential predictors of metastasis.
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Affiliation(s)
- Jennifer L Herrmann
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Adam Allan
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida
| | - Kara M Trapp
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael B Morgan
- Dermatology, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan; Pathology, University of South Florida Morsani College of Medicine, Tampa, Florida; and Dermpath Diagnostics in Tampa, Pensacola, and Marietta, Georgia
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20
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Satoh M, Ookouchi M, Yamamoto T. Photoletter to the editor: Proliferating pilomatricoma with no recurrence during a 3-year follow-up. J Dermatol Case Rep 2012; 6:127-9. [PMID: 23329994 DOI: 10.3315/jdcr.2012.1122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/17/2012] [Indexed: 11/11/2022]
Abstract
Proliferating pilomatricoma is a proliferative variant of pilomatricoma. Although it is considered as a benign tumor, local recurrence may occur. We report a case of a 49-year-old Japanese man with 3-year history of an asymptomatic subcutaneous tumor in the nuchal area. Histological evaluation demonstrated a cystic lesion lined by a basaloid epithelium at the periphery and filled with eosinophilic cornified material containing shadow cells in upper part of the tumor, and multilobular proliferation of basaloid cells in association with small foci of shadow cells in the remaining part. Based on these findings, the diagnosis of proliferating pilomatricoma was made. No recurrence has been observed during a 3-year follow-up.
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Affiliation(s)
- Masataka Satoh
- Department of Dermatology, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, 960-1295, Japan
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21
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Yadia S, Randazzo CG, Malik S, Gressen E, Chasky M, Kenyon LC, Ratliff JK. Pilomatrix carcinoma of the thoracic spine: case report and review of the literature. J Spinal Cord Med 2010; 33:272-7. [PMID: 20737803 PMCID: PMC2920123 DOI: 10.1080/10790268.2010.11689707] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT Pilomatrixoma is a common head and neck neoplasm in children. Its malignant counterpart, pilomatrix carcinoma, is rare and found more often in men. METHOD Case report of a 21-year-old man with pilomatrixoma of the thoracic spine that underwent malignant degeneration to pilomatrix carcinoma. FINDINGS The appearance of a painless mobile axillary mass was followed by severe back pain 1 year later. Imaging revealed a compression fracture at the T5 level. The patient underwent resection of the axillary mass and spinal reconstruction of the fracture; the pathology was consistent with synchronous benign pilomatrixomas. Three months later he presented with a recurrence of the spinal lesion and underwent further surgical resection; the pathology was consistent with pilomatrix carcinoma. He received adjuvant radiotherapy and at his 1-year follow-up examination had no sign of recurrence. CONCLUSION/CLINICAL RELEVANCE Pilomatrix carcinoma involving the spine is a rare occurrence. It has a high incidence of local recurrence, and wide excision may be necessary to reduce this risk. Radiotherapy may be a helpful adjuvant therapy. Clinicians should be aware of this entity because of its potential for distant metastasis.
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Affiliation(s)
- Sanjay Yadia
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ciro G Randazzo
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sajjad Malik
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric Gressen
- Department of Radiation Oncology, The Cancer Center at Frankford Hospital, Philadelphia, Pennsylvania
| | - Moshe Chasky
- Department of Medical Oncology, Philadelphia, Pennsylvania
| | - Lawrence C Kenyon
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John K Ratliff
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania,Please address correspondence to John K Ratliff, MD, Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut Street, 2nd floor, Philadelphia, PA 19107, 215 955 7000, 215 503 9170 (e-mail: )
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