Optimal Timing of Surgical Excision in Pediatric Pilomatricoma: Association between Clinicopathological Features and Cosmetic Outcomes

BackgroundThe treatment of choice for pilomatricomas is surgical excision; however, data for the optimal timing of treatment and cosmetic outcomes are limited.ObjectiveThis study aimed to investigate the optimal timing of treatment in pilomatricomas by considering clinicopathological findings and cosmetic outcomes.MethodsSeventy-three pilomatricomas patients aged ≤15 years were retrospectively reviewed. Patients were classified into early excision (disease duration ≤12 months, group A) and delayed excision groups (disease duration >12 months, group B). Tumor characteristics, and histopathological features with evolutionary stages were assessed. Cosmetic outcomes were evaluated by the Modified Vancouver Scar Scale (MVSS), 5-point patient satisfaction score, and complication rates.ResultsGroup A showed better cosmetic outcomes than group B in the MVSS (1.53±1.22 vs. 3.68±1.84), 5-point patient satisfaction score (4.08±0.89 vs. 3.18±1.01), and complication rates (11.8% vs. 36.4%), respectively (p<0.05). Secondary anetoderma, tent sign, calcification, and late regressive stage (evolutionary stage IV) were more common in group B, (p<0.05). Moreover, evolutionary stages showed a positive correlation with mean MVSS (r=0.670, p<0.05).ConclusionEarly excision (disease duration ≤12 months) provides superior cosmetic outcomes compared to delayed procedures. Early recognition, diagnosis, and management for pediatric pilomatricomas is important to improve overall cosmetic outcomes.     

Estudio retrospectivo de pilomatricomas: 261 tumores en 239 pacientes

Introduction and objectivesPilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis. The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables: patient age and sex, tumor site, symptoms, previous trauma, clinical diagnosis, associated diseases, number of cases of multiple tumors, ultrasound findings, anesthetic and surgical techniques, and postoperative complications.Material and methodThis was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital.ResultsWe found 261 pilomatricomas in 239 patients (120 female and 119 male) between 1 and 83 years of age (mean age, 26.4 years). The most common presentation was as a firm subcutaneous nodule, which was asymptomatic in 82% of cases. Tumors most commonly affected the head and neck (49.81%). Preoperative diagnosis was correct in 54.4% of cases, concomitant diseases were present in 59 cases, and 7 patients reported a history of trauma in the area of the tumor. There were 17 cases of multiple tumors, 1 case in a patient with familial disease and 2 in patients with Steinert disease. Soft-tissue ultrasound was performed on 57 lesions; images were compatible with pilomatricoma in 48 cases. Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76. The postoperative complications were hypertrophic scarring and wound dehiscence (1 case each).ConclusionsThis was a retrospective study with the largest series recorded in Spain and with one of the highest incidences. In addition, we report on variables not described in other studies.     

Preauricular pilomatricoma: An uncommon entity in a dental pediatric patient

IntroductionPilomatricomas are benign follicular skin appendage tumors, commonly occurring in children and young adults. Most patients admit to dermatologists to seek treatment and are well known by them; however, dental professionals, especially pediatric dentists are not familiar with these tumors.Presentation of caseThis report presents a 16-year-old female with preauricular pilomatricoma, located beneath the overlying skin of the temporomandibular region. Clinical examination revealed an asymptomatic lump, the overlying skin revealed no abnormalities. Patient was unaware of the lesion.DiscussionPilomatricomas are commonly encountered in the maxillofacial region, although not considered in differential diagnosis by dental professionals. They usually present as, asymptomatic, subcutaneous masses; although symptomatic cases have been reported. In literature, common differential diagnosis for head and neck pilomatricoma includes sebaceous cyst, ossifying hematoma, giant cell tumor, chondroma, dermoid cyst, foreign body reaction, degenerating fibroxanthoma, metastatic bone formation, and osteoma cutis. We are of the opinion that temporomandibular joint disease should also be considered in differential diagnosis for preauricular pilomatricoma.ConclusionPediatric dentists should be aware of the condition and consider it in the differential diagnosis of pediatric conditions involving the temporomandibular joint.     

Pilomatricoma. A clinical, histopathologic and histochemical study of 22 patients

We have studied the clinical, histopathologic and histochemical features of pilornatricoma in a series of 22 cases. In early lesions, basophilic cells constituted the main tumor cell population and underwent four ways of maturation. Calcification was observed in 16 cases and ossification in two lesions. Melanin pigment was found in seven specimens and hemosiderin in six. Glycogen granules were present in most tumor parenchyma and less frequently in the stroma. Mitotic figures were frequent but cellular atypia was not observed.     

Pilomatrixoma--accuracy of clinical diagnosis

Background/Purpose

Pilomatrixoma is a common tumor of skin appendages in children. The aim of the study was to assess the accuracy of clinical diagnosis and factors contributing to misdiagnosis.

Methods

A retrospective case note review of patients who had pilomatrixoma excised during a 5-year period in a tertiary referral children's hospital in the UK.

Results

From 75 patients, 78 pilomatrixomata were excised. The diagnosis was achieved preoperatively in 46% of patients. Other diagnoses included sebaceous and dermoid cysts, foreign body reaction, calcification in lymph gland, and fat necrosis.

Conclusion

Factors contributing to misdiagnosis include cystic lesions with varying consistency, punctum-like appearance, atypical location, and absence of clinically recognizable calcification. Despite close excision, the recurrence rate is low.     

毛母质瘤中β联蛋白的突变基因分析

目的 探讨β联蛋白的突变基因及其蛋白表达与毛母质瘤发生的关系。方法 选取67例毛母质瘤的组织标本进行β联蛋白的免疫染色,提取基因组DNA,进行β联蛋白的PCR扩增及测序,用克隆、测序及限制性内切酶的方法证实突变的存在。结果 毛母质瘤中嗜碱粒细胞β联蛋白免疫染色阳性率为81%(26/32),β联蛋白外显子3基因突变率为61%(14/23)。其突变均位于β联蛋白外显子3的磷酸化位点或邻近位点。结论 β联蛋白的基因突变及其核阳性与毛母质瘤的发生有关。     

流脑疫苗接种后毛母质瘤1例

患者女,6岁,右上臂外侧肿物半年余。皮肤科情况:右上臂外侧见一约5.0 cm×2.0 cm×1.0 cm大小椭圆形淡红色肿物,边界清楚,质稍硬,可推动,无触痛。皮损组织病理示:基底样细胞增生并过渡为影细胞,伴异物肉芽肿形成及炎细胞浸润。诊断:毛母质瘤。     

Characteristics of pilomatrixoma in children: A review of 137 patients

Objective

To describe our institutional experience with pilomatrixoma in the pediatric population, specifically examining its clinical presentation, associated conditions, surgical treatment and future implications.

Methods

This is a retrospective review of a single tertiary care center. Subjects included 137 patients with diagnosis of pilomatrixoma between the years of 2000 and 2013 up to the age of 19. Patient gender, age at excision, number of tumors, tumor size, tumor location, preoperative diagnosis, recurrence, patient race and zip code, along with associated medical conditions were assessed.

Results

There were a total of 174 tumors in 137 patients. The median age at excision was 7.1 years old, with the youngest patient at 6 months and the oldest at 19 years. Head and neck tumors predominated with 70% (n = 122) of all pilomatrixomas, followed by the upper extremity with 22% (38). Other locations included the hair-bearing back, chest and lower extremities. A male to female ration of 1:1.2 was observed. Tumor diameter size ranged from 0.2 to 5.2 cm with an average diameter of 1.4 cm. There were no cases of recurrence. Associated diagnoses included Turner syndrome and Sticker syndrome.

Conclusions

Pilomatrixoma, previously thought to be a rare lesion, is one of the most common causes of superficial head and neck masses in children. This study demonstrates clinical presentations that should help guide differential diagnoses. We demonstrate associations that are consistent with the proposed pathophysiology of pilomatrixoma. Surgical excision is curative.     

A skin tumor from an orthopedic oncology perspective: Pilomatrixoma in extremities (11 years experience with 108 cases)

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign skin neoplasm originating from hair follicle matrix cells. Pilomatrixoma is a common skin neoplasm that is often misdiagnosed as another type of skin condition. The aim of our study is to review 11 years' worth of experience in examining clinical and histopathological presentations, imaging findings, management approaches, and treatment outcomes of pilomatrixoma at a tertiary hospital. A review of the pathology database revealed that 108 extremity pilomatrixomas were excised between 2007 and 2018. Hospital charts, and pathology and orthopedic clinic records, were reviewed for patient data such as age, gender, clinical and histopathological presentations, preoperative diagnosis and imaging results, management approach, recurrence, and treatment outcomes. The main presenting symptom was a hard, subcutaneous, slowly growing mass. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma in only 35 cases (32%). The optimal diagnostic tool for pilomatrixoma seems to be ultrasound imaging of superficial tissue, and the optimal first‐line treatment might be surgical excision with clear margins. However, pilomatrixoma is a benign tumor, with atypical forms, and there no tumor‐specific diagnostic tool is available other than careful histopathological examination.     

11例毛母质瘤误诊为婴幼儿血管瘤的病例回顾分析

目的探索毛母质瘤的临床特征,避免误诊为血管瘤而延误最佳治疗时机。方法对2016—2018年收治的11例毛母质瘤误诊为婴幼儿血管瘤患者的临床资料进行回顾性分析。结果共纳入11例患儿,发病年龄平均11个月(1~34个月),病程平均6.5个月(2~10个月)。均初步诊断为血管瘤,患儿接受血管瘤常规治疗(包括药物外敷、激光照射、口服普萘洛尔片和经皮瘤体内药物注射等)后效果不佳或无效,经手术切除送病理组织学检查结果为毛母质瘤。结论毛母质瘤与婴幼儿血管瘤在发病特点及临床表现存在相似之处,但两者治疗方案不尽相同。应进一步增强对毛母质瘤临床特征的认识,提高诊断的准确率,避免延误治疗。