Post-traumatic pilomatricoma presenting as rapidly enlarging pediatric scalp mass

Abstract

Pilomatricomas (PM) are benign neoplasms that arise from hair follicle matrix cells. They are one of the most frequently excised pediatric skin masses. A typical clinical presentation is a slow growing, painless, firm, superficial mass in the head and neck of a child. We present a rare presentation of PM. A preschool aged girl presented with an enlarging scalp mass following a history of minor blunt trauma to the area. Two months prior, the child sustained a ground level fall and subsequently developed a painless “bump” at the site of injury on the scalp. The ``bump” was initially the size of a “mosquito bite” and enlarged to the size of a “ping pong ball”. Given the rapid progression and history of trauma, there was a broad differential diagnosis. An extensive workup including sonography, computed tomography, MRI, and biopsy were performed. The final pathologic diagnosis was confirmed as pilomatricoma. An atypical presentation of PM in a child can mimic a wide variety of pathology. Our case demonstrates unusual features of rapid enlargement and preceding trauma. With the widespread use of sonography for evaluation of superficial lesions, the radiologist may be the first to suspect the diagnosis of PM. Knowledge of the typical imaging findings in PM can be valuable, especially in more unusual cases.

Keywords

• Pilomatricoma
• Pilomatrixoma
• Calcifying epithelioma of Malherbe
• Pediatric scalp mass
• Pediatric radiology
• Ultrasound