Pi omatrica Ca ci noma: Case eport nd Review f t h e Literature Tony Nakhla, DO; Michael Kassardjian, DO Pilomatrical arcinoma s a rare malignant umor hat originates rom hair matrix ells. ilomatrical carcinoma may arise de novo as a solitary esion, r through ransformation ro m its benign counterpart, ilomatrixoma. ifferentiation etween pilomatrixoma n d pilomatrical arcinoma requires lose histologic xamination nd often is difficult. Although uncommon, ilomatrical carcinoma as he potential o metastasize; herefore, rompt diagnosis n d appropriate anage- ment s essential. ilomatrical carcinoma i s t he malignant counterpart of pilomatrixoma, a benign cutaneous tumor originating from th e hair ma[rix. It is a rare, aggressive umor with a high probability of recurrence after simple excision, an d th e potential to metastasrze. We report a case of a 56-year-old white man diagnosed with pilomatrical carcinoma. The patient presented with a 2-month history of ar1 enlarging asymptomatic growth on the cheek. Physical exami- nation revealed a 2-cm, well-demarcated, nontender, moveable, hard subcutaneous nodule on the right mandible (Figure l). No skin changes or lymphad- enopathy was noted. The clinical diagnosis strongly favored a calcified epidermoid cyst or other benign adnexal tumor. An excisional biopsy was performed at t he request of th e patient. Sections were evaluated histologically and revealed a multifragmented biopsy of dermal and subcutaneous tissue containing basaloid proliferation with collections of ghost cells, typical of pilomatrixoma (Figure 2) . Dr. I'laLthla s from OC Shin Institute, Santa Ana, California. Dr. Kassardlian s an ntern, Pacific Hospital, Long Beach, California. Th e authors report no conflict tf interest in relation to this article. Correspondence: ichael Kassardjian, DO, PO Box 2152, Palos erdes en, CA 90275 ([email protected]). 3I 4 Cosmetic ermatology@ JULY 010 vol. 23 No . 7 In so m e areas, he lesional cells are relatively bland an d noninfiltrative appearirg. However, this case also shorvs areas with larger more squamoid appearing cells urth aLyprcal eatures, includ- irg Iargenuclei with prominent nucleoli as well as areas of infiltrative appearing cells, features highly concerning fo r malignancy (Figure 3) . In th e infiltrative appearrngarea, there is dense stromal sclerosis associated u-ith highly atyprcal squamoid and spindle cells, with ser-eral mitotic figures found within these cells (Figure +) In many areas of the biopsy, there is granulomatolls inflamma- tion, hemorrhage , and granulation tissue consistent with a reaction to ruptured material from th e tumor (Figure 5) While th e latter findings often are seen in ruptured pilomatrixoma, the infiltratn\-e areas with atyprcal spindle cells would not be erpected in a benign pilomatrixoma, an d th e findings ar e most con- sistent with a diagnosis of malignant pliomarrixoma (pilom afitcal carcinoma) . Multiple laboratory tests using immunohrstochemi- cal stains, including p63, cytokeratrn i/6, synap- tophysin, p53, an d Ki-67 also \\-ere rer-iewed. Th e tumor cells were strongly and diffusely- positive fo r p63, highlighting th e nuclei of th e infiltrative an d spindle cells, which is positirre in mos[ primary cuta- neous malignancies including adnexal carcinomas. In addition, results of cytokeratin 5/6 staining aiso were moderately positive within lesional cells, including th e www.cosderm.com
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cal Carcinoma a Case Report by Dr. Tony Nakhla of OC Skin Institute
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8/8/2019 cal Carcinoma a Case Report by Dr. Tony Nakhla of OC Skin Institute