Orbit, 2015; 34(4): 234–235 ! Informa Healthcare USA, Inc. ISSN: 0167-6830 print / 1744-5108 online DOI: 10.3109/01676830.2015.1039141
C ASE REPORT
Rapid Onset of Eyebrow Pilomatrixoma After Blunt Trauma Yu-Yun Huang and Chieh-Chih Tsai
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Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
or subcutaneous mass.1 We present a case of rapidly growing eyebrow pilomatrixoma following trauma. An 8-year-old girl presented with a lump on the tail of left eyebrow noticed after blunt trauma. Ophthalmic examination revealed a rock-hard, red-bluish mass
CASE REPORT Pilomatrixoma is a benign cutaneous neoplasm that arises from hair follicle matrix cells. It typically presents a superficial, slow-growing, painless dermal
FIGURE 1. (A) Clinical photograph of an 8-year-old girl with a rock-hard, non-tender, red-bluish mass, along the lateral aspect of the left eyebrow, freely movable over the subcutaneous tissue, but not from the overlying skin. (B) Orbital CT showing an ovoid mass measuring 13 6 13 mm in size on the lateral aspect of the left periorbital region. (C) Five months after first visit, the lesion enlarged progressively to a 17 15 mm blue-yellowish mass. (D) Histopathology shows classical eosinophilic ghost cell (upper), surrounded by basophilic cells (lower), foreign body giant cells and inflammatory cells, along with some areas of keratinization (H&E, original magnification 40). The shadow cells have a distinct border and central unstained area, corresponding to the lost nucleus. (E and F) Increased bcl-2 staining in the peripheral basophilic cells.
Received 11 January 2015; Accepted 5 April 2015; Published online 2 June 2015 Correspondence: Chieh-Chih Tsai, Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan, R.O.C. Tel: 886-2-28757325. Fax: 886-2-28213984. E-mail: [email protected]
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Eyebrow Pilomatrixoma After Trauma 235 (Figure 1A). Orbital CT showed a 13 6 13 mm mass (Figure 1B). Organized hematoma was initially diagnosed. Two months later the lesion continued to enlarge (Figure 1C). Surgical excision was performed and pathologic examination demonstrated an admixture of basaloid hair matrix cells and eosinophilic anucleated shadow cells, compatible with the diagnosis of pilomatrixoma (Figure 1D). The immunostain showed positive for Bcl-2 in the peripheral basaloid cells (Figures 1E and 1F). The differential diagnosis of a superotemporal mass in children after trauma includes dermoid cyst or calcified hematoma. Clinically, pilomatrixomas appears as a rock-hard mass freely movable over the subcutaneous tissue, but not from the overlying skin, which are different to dermoid cysts. Rapidly growth pilomatrixoma is rare.2,3 Trauma-associated inflammation or hemorrhage into the pre-existing lesion may give rise to rapidly increase in size. Bcl-2 could be induced after traumatic insults,4 and may contribute to the rapidly growing of pilomatrixoma by faulty suppression of apoptosis.5,6 In conclusion, this case emphasizes pilomatrixoma should be on the list of differential diagnoses of rapidly growing mass following trauma.
!
2015 Informa Healthcare USA, Inc.
However, whether increased expression of Bcl-2 after trauma play a role in the rapidly growing of pilomatrixoma requires further investigation.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES 1. Ahmad M, Khan IU, Khan AH, et al. Pilomatricoma: a retrospective study. Int J Dermatol 1992;31:703–705. 2. Jallouli M, Yengui H, Khabir A, Mhiri R. Pilomatrixoma of earlobe. J Cutan Aesthet Surg 2009;2:36–37. 3. Mathen LC, Olver JM, Cree IA. A large rapidly growing pilomatrixoma on a lower eyelid. Br J Ophthalmol 2000;84: 1203–1204. 4. Clark RS, Kochanek PM, Chen M, et al. Increases in Bcl-2 and cleavage of Caspase-1 and Caspase-3 in human brain after head injury. FASEB J 1999;13:813–821. 5. Farrier S, Morgan M. Bcl-2 expression in pilomatricoma. Am J Dermatopathol 1997;19:254–257. 6. Nakamura T. A reappraisal on the modes of cell death in pilomatricoma. J Cutan Pathol 1999;26:125–129.
C ASE REPORT
Rapid Onset of Eyebrow Pilomatrixoma After Blunt Trauma Yu-Yun Huang and Chieh-Chih Tsai
Orbit Downloaded from informahealthcare.com by RMIT University on 08/17/15 For personal use only.
Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
or subcutaneous mass.1 We present a case of rapidly growing eyebrow pilomatrixoma following trauma. An 8-year-old girl presented with a lump on the tail of left eyebrow noticed after blunt trauma. Ophthalmic examination revealed a rock-hard, red-bluish mass
CASE REPORT Pilomatrixoma is a benign cutaneous neoplasm that arises from hair follicle matrix cells. It typically presents a superficial, slow-growing, painless dermal
FIGURE 1. (A) Clinical photograph of an 8-year-old girl with a rock-hard, non-tender, red-bluish mass, along the lateral aspect of the left eyebrow, freely movable over the subcutaneous tissue, but not from the overlying skin. (B) Orbital CT showing an ovoid mass measuring 13 6 13 mm in size on the lateral aspect of the left periorbital region. (C) Five months after first visit, the lesion enlarged progressively to a 17 15 mm blue-yellowish mass. (D) Histopathology shows classical eosinophilic ghost cell (upper), surrounded by basophilic cells (lower), foreign body giant cells and inflammatory cells, along with some areas of keratinization (H&E, original magnification 40). The shadow cells have a distinct border and central unstained area, corresponding to the lost nucleus. (E and F) Increased bcl-2 staining in the peripheral basophilic cells.
Received 11 January 2015; Accepted 5 April 2015; Published online 2 June 2015 Correspondence: Chieh-Chih Tsai, Department of Ophthalmology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan, R.O.C. Tel: 886-2-28757325. Fax: 886-2-28213984. E-mail: [email protected]
234
Orbit Downloaded from informahealthcare.com by RMIT University on 08/17/15 For personal use only.
Eyebrow Pilomatrixoma After Trauma 235 (Figure 1A). Orbital CT showed a 13 6 13 mm mass (Figure 1B). Organized hematoma was initially diagnosed. Two months later the lesion continued to enlarge (Figure 1C). Surgical excision was performed and pathologic examination demonstrated an admixture of basaloid hair matrix cells and eosinophilic anucleated shadow cells, compatible with the diagnosis of pilomatrixoma (Figure 1D). The immunostain showed positive for Bcl-2 in the peripheral basaloid cells (Figures 1E and 1F). The differential diagnosis of a superotemporal mass in children after trauma includes dermoid cyst or calcified hematoma. Clinically, pilomatrixomas appears as a rock-hard mass freely movable over the subcutaneous tissue, but not from the overlying skin, which are different to dermoid cysts. Rapidly growth pilomatrixoma is rare.2,3 Trauma-associated inflammation or hemorrhage into the pre-existing lesion may give rise to rapidly increase in size. Bcl-2 could be induced after traumatic insults,4 and may contribute to the rapidly growing of pilomatrixoma by faulty suppression of apoptosis.5,6 In conclusion, this case emphasizes pilomatrixoma should be on the list of differential diagnoses of rapidly growing mass following trauma.
!
2015 Informa Healthcare USA, Inc.
However, whether increased expression of Bcl-2 after trauma play a role in the rapidly growing of pilomatrixoma requires further investigation.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES 1. Ahmad M, Khan IU, Khan AH, et al. Pilomatricoma: a retrospective study. Int J Dermatol 1992;31:703–705. 2. Jallouli M, Yengui H, Khabir A, Mhiri R. Pilomatrixoma of earlobe. J Cutan Aesthet Surg 2009;2:36–37. 3. Mathen LC, Olver JM, Cree IA. A large rapidly growing pilomatrixoma on a lower eyelid. Br J Ophthalmol 2000;84: 1203–1204. 4. Clark RS, Kochanek PM, Chen M, et al. Increases in Bcl-2 and cleavage of Caspase-1 and Caspase-3 in human brain after head injury. FASEB J 1999;13:813–821. 5. Farrier S, Morgan M. Bcl-2 expression in pilomatricoma. Am J Dermatopathol 1997;19:254–257. 6. Nakamura T. A reappraisal on the modes of cell death in pilomatricoma. J Cutan Pathol 1999;26:125–129.
