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Clinical Note |

Cystic Pilomatrixoma A Diagnostic Challenge

Kiran Kakarala, MD; Matthew T. Brigger, MD, MPH; William C. Faquin, MD, PhD; Christopher J. Hartnick, MD, MS; Michael J. Cunningham, MD
Arch Otolaryngol Head Neck Surg. 2010;136(8):830-833. doi:10.1001/archoto.2010.130.
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Pilomatrixoma is a benign neoplasm of ectodermal hair follicle germinal matrix cell origin. At least 50% of pilomatrixomas are reported to arise in the head and neck, and 40% occur before the age of 10 years.13 Pilomatrixoma is the third most common reason for excision of a cervicofacial mass in children, after lymphadenopathy and epidermoid cysts.

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Figure 1.

Intraoperative photographs from case 1. A, Protuberant, red-purple, cystic, preauricular mass. B, Preauricular face-lift approach with dissection of the thin skin from the underlying mass.

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Figure 2.

The pilomatrixoma is cystic and surrounded by a dense fibrous stroma with chronic inflammation. Basaloid and keratinizing squamous cells surround ghost cells and keratin debris in the central cystic space (hematoxylin-eosin, original magnification ×50).

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Figure 3.

Axial computed tomogram with contrast demonstrates a subcutaneous cystic mass with homogeneous low-attenuation cyst contents and absence of calcifications.

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Figure 4.

Histopathologic slides from case 2. A, A combination of basaloid cells and keratinizing squamous cells surround the central cystic space containing keratin debris and ghost cells (hematoxylin-eosin, original magnification ×100). B, Ghost cells in sheets are a characteristic histologic feature of pilomatrixomas. Characteristics of these cells include distinct cell borders with eosinophilic cytoplasm and central clearing representing the outlines of an absent nucleus (hematoxylin-eosin, original magnification ×600).

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