Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation.

BACKGROUND: Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. MATERIALS AND METHODS: Records of patients with pilomatricomas (n = 63), epidermoid cysts (n = 76), and dermatofibrosarcoma protuberans (n = 19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. RESULTS: Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. CONCLUSION: A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.

A comparative study of pilomatricoma and epidermoid cyst with ultrasound.

AIM: To explore and compare the ultrasonic (US) features of pilomatricoma (PM) and epidermoid cyst (EC) in the differential diagnosis and improve the accuracy of US diagnosis of PM. MATERIALS AND METHODS: Three hundred and nine patients who underwent US examination before surgery with a histopathological diagnosis of PM or EC after surgery were analysed retrospectively. The patients were categorised into the training and validation sets according to the inspection times. Univariate analysis was undertaken on the US and clinical features of PM and statistically significant variables (p<0.05) were included in the multivariate logistic regression model to establish a diagnostic model. RESULTS: The results demonstrated that the multivariate logistic regression model for PM was statistically significant (p<0.001). The risk factors included posterior echo attenuation and hypoechoic halos (odds ratio [OR] = 9.277, 10.254) and the protective factors included age, diameter thickness, and posterior echo enhancement (OR=0.936, 0.302, 0.156). The performance of the diagnostic model was tested using the training set (area under the receiver operating characteristic curve [AUC] = 0.974, 95% confidence interval [CI] = 0.955-0.994) and the validation set (AUC = 0.967, 95% CI = 0.926-1.000), which demonstrated good discriminant ability. CONCLUSIONS: The diagnostic accuracy for PM was higher than that for EC when the nodule is characterised by posterior echo attenuation, hypoechoic halos, smaller thickness, and younger age. The US diagnostic model developed may be used to guide the diagnosis of PM.

Giant Pilomatricoma Mistaken for a Malignant Tumor.

Pilomatricomas are tumors originating from the matrices of hair follicles. Giant pilomatricomas, defined as pilomatricomas that are 5 cm or larger, are benign but may appear malignant clinically. We present the case of a 69-year-old man with a rapidly growing mass on his scalp. When he visited our department, the tumor measured 10.0×6.0×4.0 cm and showed inflammation and ulceration. Magnetic resonance imaging and 18 F-fluorodeoxyglucose positron emission tomography-computed tomography showed findings resembling lymph node metastasis from a malignant tumor. However, upon an incisional biopsy, the tumor was diagnosed as a pilomatricoma. Therefore, we performed an excisional biopsy instead of radical surgery and lymph node dissection. The tumor was ultimately diagnosed as a giant pilomatricoma based on the excisional biopsy, and the patient received reconstruction only at the site of the defect. A giant pilomatricoma can be mistaken for a malignant tumor due to its characteristics. In such uncertain cases, it can be helpful to first perform an excisional biopsy.

Radiología de las tumoraciones palpables en el paciente pediátrico. Parte 2 / Imaging palpable tumors in pediatrics: Part 2

Las tumoraciones palpables en los niños son un motivo de consulta muy habitual para el radiólogo. El origen de las lesiones es muy variado, y algunas de ellas no reciben atención en los libros clásicos de Radiología, pese a encontrarse frecuentemente.El objetivo de esta serie de 2 artículos es revisar las características clínico-radiológicas de una selección de estas entidades que consideramos importante conocer. (AU)

Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them.This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with. (AU)

Cranial pilomatricoma: a diagnosis to consider.

Pilomatricomas are benign tumors of the hair follicle that occur frequently in the scalp region. They occur most often in children. We describe a case of pilomatricoma in a teenager, referred to neurosurgery for excision. This diagnosis should be considered in the workup of scalp lesions, and this case report should serve to draw attention to this entity.

Giant pilomatrixoma with bullous appearance on the back: A case report and discussion of misdiagnosis.

Pilomatrixoma is a benign, asymptomatic skin tumor that forms from hair follicle matrix cells. Most are under 3 cm in diameter and occur on the head, face, or neck. Bullous appearance is very rare in pilomatrixoma. In this case report, we present a case of bullous pilomatrixoma of unusual size, region, symptoms, and patient age. It had been misdiagnosed as a keloid and as dermatofibrosarcoma protuberans. Early treatments were ineffective. The patient approached our outpatient facility and underwent excision. He was then diagnosed with pilomatrixoma by pathological examination. The clinical appearance of this case was quite difficult to diagnose, even MRI and B-ultrasonic examinations provided limited diagnostic evidence. Given the revelations from this case, we reemphasize the importance of performing a biopsy (if patients refused operation or preferred conservative treatment) before any invasive treatment to minimize economic or time loss of patients who have difficulties in diagnosis.

Ultrasound findings in 156 children with 169 pilomatricomas.

BACKGROUND: Cutaneous lesions present a diagnostic challenge to radiologists and clinicians alike. Pilomatricoma is the second most common skin neoplasm in childhood, yet there are limited reports in the literature focusing on imaging in pediatric patients. OBJECTIVE: To characterize the typical and atypical US features of pilomatricoma in pediatric patients and to determine the performance of the adult-based Solivetti classification for assessing pilomatricomas in children. MATERIALS AND METHODS: We retrospectively reviewed 169 US scans of pathologically proven pilomatricomas in 156 children performed over a period of 66 months. We evaluated images for the size of the lesion, borders, morphology, content, calcification, location on the skin and Doppler characteristics. RESULTS: Most of the pilomatricomas presented as single dermohypodermic lesions with peripheral vascularity on color Doppler interrogation. The cheek was the most common location, followed by the arm. Solivetti type 2 US pattern was the most frequent, and peripheral hypoechoic halo was only observed in this type. One child had an anetodermic pilomatricoma, and 11 children had multiple lesions. CONCLUSION: We showed that pilomatricomas exhibit variable sonographic patterns. In our cohort, less than 50% of the lesions showed the characteristic hypoechoic rim and less than 30% of the cases presented as diffusely hyperechoic masses with posterior acoustic shadowing. Our results show that the Solvetti classification for the US assessment of pilomatricomas can be of value in children.

Pilomatrixoma: a common tumour of head and neck, but rarely reported.

Pilomatrixoma is a benign subcutaneous tumour arising from the sebaceous glands. Mutation in the CTNNB1 gene is seen, suggesting beta-catenin misregulation may be the cause of pilomatrixoma. The preoperative diagnosis may be improved by the awareness of the fact that pilomatrixoma is a common and benign skin tumour of the head and neck region. It presents as a well-defined mass, which may be firm to hard in consistency, usually attached to the skin, but not to the underlying tissue. The colour of overlying skin appears a reddish-brown tinge, indicating that it could be a case of pilomatrixoma. Here, we report a case of pilomatrixoma of the cheek in a woman along with the CT findings and histopathological appearances. Dental surgeons should consider it as one of the differential diagnosis in superficial head and neck swelling with calcification.

Pseudocystic pilomatricoma: A new variant and review of the literature.

A classic pilomatricoma, which usually presents with an asymptomatic, solitary, firm, subcutaneous nodule in the head, neck, or extremities of the paediatric population, is easily diagnosed based on its characteristic clinical and histopathological features. However, its variants often pose particular diagnostic challenges to clinicians due to their rarity and diverse clinicopathological features. We present a new pseudocystic variant, manifesting as solid lesions floating in a fluid-filled sac.

Sonographic characteristics of pilomatricomas and their association with symptom duration.

This study aimed to investigate the associations between the sonographic findings and duration of symptoms in children with pilomatricoma.This study included 86 children with 95 lesions confirmed to be pilomatricoma after pathological examination. The associations between symptom duration and sonographic observations, including the presence or absence of peritumoral hyperechogenicity, calcification, and vascularity were investigated. The internal echogenicity of each pilomatricoma was scored using a 5-point scale based on echogenic spots and calcification with posterior acoustic shadowing. The Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.We found that the absence of peritumoral hyperechogenicity and severity of calcification were associated with increased symptom duration. Calcification, (present, 19.19 ±â€Š18.99 months vs absent, 4.31 ±â€Š3.24 months; P < .01) and peritumoral hyperechogenicity (present, 5.02 ±â€Š5.80 months vs absent, 16.17 ±â€Š18.24 months; P < .01), and grade of internal echogenicity (grade 0/1/2/3/4 = 3 months [1 patient]/4.33 ±â€Š3.26 months [range, 1-12]/4.57 ±â€Š3.46 months [range, 2-12]/10.89 ±â€Š9.17 months [range, 3-28]/35.27 ±â€Š19.16 months [range, 9-60], respectively; P = .01 and <.01) were associated with significant differences in symptom duration. There were no significant between-group differences in vascularity (6.01 ±â€Š7.24 months; range, 1-48 vs 15.50 ±â€Š19.12 months; range, 1-60; P = .08).Pilomatricomas with a relatively short symptom duration were more likely to exhibit peritumoral hyperechogenicity and calcification with less severe posterior acoustic shadowing compared to lesions with a longer symptom duration. These sonographic findings provided useful information that facilitated the correct and rapid diagnosis of pilomatricoma.

Distinguishing a Trichilemmal Cyst From a Pilomatricoma With Ultrasound.

OBJECTIVES: To determine whether ultrasound (US) could distinguish a trichilemmal cyst from a pilomatricoma preoperatively. METHODS: Ultrasound images of 61 pathologically proven trichilemmal cysts and 90 pathologically proven pilomatricomas were analyzed retrospectively. Two radiologists evaluated several US features. The sensitivity, specificity, Youden index, and predictive values of statistically significant US features were assessed. Parallel combined tests, serial combined tests, or both were performed to identify US features with high statistical significance. RESULTS: Results from individual US features were not satisfactory; however, serial combined tests that included absence of complete internal echogenic foci, absence of a hypoechoic rim, absence of peritumoral hyperechogenicity, and absence of vascularity showed higher diagnostic utility. The sensitivity, specificity, Youden index, positive predictive value, and negative predictive value for correctly identifying a trichilemmal cyst were 74%, 88%, 0.62, 80%, and 83%, respectively. If 1 of these 4 US features was not a match for a trichilemmal cyst, pilomatricoma was considered. CONCLUSIONS: It may be possible to distinguish trichilemmal cysts from pilomatricomas preoperatively using US. A combined test is superior to using any individual US feature.

Nódulo brillante en la frente de un adulto / A Shiny Nodule on the Forehead of a Man

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Seguimiento de pilomatrixoma maligno metastásico agresivo mediante PET/TC con 18F-FDG / Aggressive metastatic malignant pilomatrixoma followed by 18F-FDG PET/CT

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