Abstract
We report a rare case of cutaneous hybrid tumor composed of epidermal cyst and cystic pilomatricoma that presented in an unusual way in a child. A 14-year-old teen girl presented with a skin lesion on the inner side of the left arm, approximately at the level of the elbow. The lesion was initially observed 5 months before and was continuously increasing in size during that time resembling other benign or malignant cutaneous tumors.
Key words: Child, epidermal cyst, Malherbe epithelioma, pilomatricoma
CASE PRESENTATION
We report the case of a 14-year-old teen girl who presented with a skin lesion on the inner side of the left arm, approximately at the level of the elbow [Figure 1]. The lesion was initially observed 5 months before and was continuously increasing in size during that period. The history and the clinical examination of the patient did not reveal any other pathological background.
Upon examination, the lesion had a cystic, semi-transparent, fluid-filled, pedunculated appearance. At its inside, multiple, stony-hard, nodule-like structures were observed. The approximate dimensions of the lesion were 30 mm × 20 mm. During palpation, the patient did not refer any discomfort or pain.
The magnetic resonance imaging with and without the use of contrast media demonstrated a well-demarcated, broadly based mass with centrally solid and peripherally cystic structures [Figure 2]. That abnormal structure did not infiltrate the muscular or the bone tissues though. There was also an afferent vessel, originating from the basilar artery. The differential diagnosis based on the clinical finding of rapid growth included a subcutaneous sarcoma (fibroma-like or pseudogranulomatous), but the radiologic findings were more suggestive of a benign subcutaneous ring-like granuloma or a subcutaneous fibroma.
The lesion was surgically excised, and surgical exploration of the underlying tissue did not reveal any local infiltration or spread.
Histopathology showed a tumorous formation (diameter ~ 3 cm) of subcutaneous origin consistent with the morphology of calcified Malherbe's epithelioma. It was also consisted of dermoid cysts and dilated lymphatic vessels. No malignant cells were found [Figures 3 and 4].
Cutaneous hybrid tumor composed of epidermal cyst and cystic pilomatricoma as in our case is very rare.[1] Pilomatricoma (pilomatrixoma), or calcifying epithelioma of Malherbe, is a tumor with differentiation toward hair cells, particularly hair cortex cells. Pilomatricoma occurs usually as a solitary lesion. The face and the upper extremities are the most common sites. In general, the tumor varies in diameter from 0.5 to 3.0 cm, but it may be as large as 5 cm. The tumors may arise in persons of any age, but about 40% of them arise in children younger than 10 years of age, and about 60% in persons in the first two decades of life.[2]
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
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