PILOMATRICOMA

 
PILOMATRICOMA
  • Synonyms-calcifying epithelioma of Malherbe, pilomatrixoma and trichomatricoma
  • The tumor shows features of matrical follicular differentiation.
  • Age – Occurs bimodaly in age group below 25 years and above 50 years
  • Site – Most common is head and neck but can also arise in any part.
  • Common presentation
    • Slow growing cystic nodule 
    • Multiple tumors occur in familial cases having myotonic dystrophy (steinert’s syndrome)
  Morphology
  • Tumor is initially a cystic dermal proliferation which is lined by both germinative matrical cells and infundibular type of cells.
  • Germinative matrical cells have basaloid appearance and exhibit monotonous round nuclei with small nucleoi and amphophilic cytoplasm. Brisk mitotic activity can be seen.
  • These basaloid cells phase into an intermediate zone in which cytoplasm is eosinophilic and nuclei appears to washed away(ghost cells)
  • Dsytrophic calcification can occur in this zone and later metaplastic ossification can also occur.
  • Giant cell reaction occurs in the adjacent region due to extravasated keratin.
  • In ancient pilomatricoma secondary heterotpoic ossification can occur and intratumoral medullary hematopoiesis may also be seen.
  • Few tumors may show budding groups of tumor cells which infiltrate into the surrounding tissue and elicit a desmoplastic Tumor with this configuration are termed as  atypical, invasive or aggressive pilomatricoma. These tumors have increased risk of recurrence.
  • Melanization of tumor cells can alos oocur.
  • Differential diagnosis-Pilar basal cell carcinoma.
References
  1. James W. Patterson, Mark R. Wick. Nonmelanocytic tumors of the skin. AFIP Atlas of tumor pathology. Series 4.

 

 

 

Pilomatrixoma

Pilomatricoma: Tumor showing basophilic tumor cells (left side) and ghost cells (right side). Interstitial fibrocollagenous tissue with chronic inflammatory cells (H&E,X100)

 

Pilomatricoma

Pilomatricoma: Tumor showing basophilic tumor cells (left side) and ghost cells (right side)  (H&E,X400)

 

Pilomatricoma

Pilomatricoma: Basophilic monotonous tumor cells having round nuclei with nucleoli (H&E,X400)

 

Pilomatricoma

Pilomatricoma: Ghost cells surrounded by foreign body giant cells and chronic inflammatory cells. Foci of calcification is present (left bottom) (H&E, X100)

 

Pilomatricoma

Pilomatricoma: Monotonous basophilic cells and ghost cells (left side) with adjacent fibrocollagenous tissue showing chronic inflammatory cells and foci of calcification (H&E, X100)

 

Pilomatricoma

Pilomatricoma: Sheets of monotonous basophilic tumor cells and ghost cells. Interstitial stroma shows multinucleated foreign body giant cells and chronic inflammatory cells (H&E,X100)

 

 

Pilomatricoma: Tumor is composed of basophilic cells phasing into eosinophilic ghost cells. Adjacent fibrocollagenous stroma shows chronic inflammatory cells and multinucleated giant cells (H&E,X50)

 

Pilomatricoma: Tumor is composed of basophilic cells phasing into eosinophilic ghost cells. Adjacent fibrocollagenous stroma shows chronic inflammatory cells (H&E,X100)

Pilomatricoma: Tumor with lobules of basophilic cells. Adjacent fibrocollagenous stroma shows chronic inflammatory cells (H&E,X50)

 

Pilomatricoma: Tumor with lobules of monotonous basophilic cells (H&E,X100)

 

Pilomatricoma: Tumor showing basophilic tumor cells phasing into eosinophilic ghost cells surrounded by fibrocollagenous tissue with chronic inflammatory cells and multinucleated giant cells (H&E,X50)

 

Pilomatricoma: Tumor showing basophilic tumor cells (right side) and  ghost cells (left side). Interstitial  fibrocollagenous tissue with chronic inflammatory cells (H&E,X100)

 

Pilomatricoma: Tumor with sheets of monotonous basophilic cells with round nuclei. Adjacent fibrocollagenous tissue shows congested blood vessels (H&E,X100)

 

Pilomatricoma: Basophilic monotonous tumor cells having round nuclei with nucleoli (H&E,X400)

 

Pilomatricoma: Tumor with basophilic cells phasing out into eosinophilic ghost cells with washed out nuclei (H&E,X50)

 

Pilomatricoma: Tumor with basophilic cells phasing out into eosinophilic ghost cells with washed out nuclei (H&E,X400)

 

Pilomatricoma: Tumor with basophilic cells phasing out into eosinophilic ghost cells with washed out nuclei (H&E,X400)

 

Pilomatricoma: Tumor with eosinophilic ghost cells having washed out nuclei (H&E,X400)

 

Pilomatricoma: Tumor with eosinophilic ghost cells having washed out nuclei (H&E,X400)

 

Pilomatricoma: Tumor with eosinophilic ghost cells having washed out nuclei (H&E,X400)

 

Pilomatricoma: Tumor with eosinophilic ghost cells surrounded by multinucleated foreign body giant cells (H&E,X100)

 

Pilomatricoma: Tumor with eosinophilic ghost cells surrounded by multinucleated foreign body giant cells (H&E,X100)

 

Pilomatricoma: Tumor with eosinophilic ghost cells surrounded by multinucleated foreign body giant cells (H&E,X200)

 

Pilomatricoma: Tumor with eosinophilic ghost cells surrounded by multinucleated foreign body giant cells (H&E,X400)

 

Pilomatricoma: Eosinophilic ghost cells with areas ofcalcification. Adjacent fibrocollagenous tissue shows chronic inflammatory cells (H&E,X100)

 

Pilomatricoma: Eosinophilic ghost cells with areas ofcalcification. Adjacent fibrocollagenous tissue shows chronic inflammatory cells and foriegn body giant cells (H&E,X100)

 

Pilomatricoma: Eosinophilic ghost cells with areas ofcalcification. Adjacent fibrocollagenous tissue shows chronic inflammatory cells (H&E,X100)