(a-c) Cytosmears showing basaloid cells arranged in loosely cohesive clusters and scattered singly with a high n/c ratio and a scant basophilic cytoplasm. The patient had undergone wide excision in an outside laboratory, and the histopathology slide was showing features of pilomatrixoma. Cell block of the patient showed a few fragments of ghost cells along with mature adipocytes. It also had similar features, and cytological diagnosis of the benign adnexal tumor-pilomatrixoma bullous type was given. The slides were returned to routine Giemsa and Papanicolaou staining. Numerous ghost-like cells along with a few multi-nucleated giant cells, inflammatory cells, and nuclear debris were also seen. Occasional amorphous dark-stained material was also seen. There were numerous benign-looking nucleated and anucleated squamous cells seen singly or in clusters. The nuclei were round to oval with a uniform outline and occasional nucleoli.
The basaloid cells were having a high nuclear/cytoplasm ratio and a scant basophilic cytoplasm. Cytosmears were showing moderate cellularity with clusters and sheets of basaloid cells along with ghost cells and foci of calcification. The aspirate was a whitish granular material. (c and d) Ultra-sonography: soft tissue showing a well-defined marginated hypo-echoic lesion measuring 1.2 × 1 × 1 cmĬytology was performed using the non-aspirational method with rapid on-site evaluation using 1% aq. (a and b) Flaccid bullous lesion soft in consistency and pale-colored, with a firm nodule underneath the lesion. Ultra-sonography soft tissue showed a well-defined marginated hypo-echoic lesion measuring 1.2 × 1 × 1 cm with mild subcutaneous edema, and without any vascularity on color doppler, suggestive of sebaceous or dermoid cyst. Atrophic stria was noted at the edge of the lesion starting from 9’o clock position. On palpation, it was soft to cystic in consistency with a deep-seated nodule underneath.
On examination, a single erythematous swelling was noted measuring 3 × 4 cm. Personal, past, and family history were unremarkable. There was no history of any local trauma. Rapid on-site evaluation (ROSE) with FNAC can be a useful adjunct for proper sampling of these lesions with the added benefit of material for cell block or special stains.Ī 20-year-old female presented to our Dermatology out-patient department, with a swelling over the right suprascapular region for 3 months. Although the cytomorphological features of pilomatrixoma are well described in most cytopathology books, these lesions pose a diagnostic dilemma when there is focal sampling with a predominance of one/either component. Fine needle aspiration cytopathology (FNAC) of the cutaneous lesion is rarely practiced. It is usually located in the head, neck, or upper extremities with female predominance. It was first described in 1880 by Malherbe and Chenantais as “calcifying epithelioma of sebaceous origin”.
#Shadows of doubt google scholar skin
Pilomatrixoma is a benign tumor of skin appendages with presumed differentiation toward hair follicle matrix cells.
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