Case Letter
A case of multiple perforating pilomatricomas
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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"paginaInicial" => "263" "paginaFinal" => "264" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mai Endo, Toshiyuki Yamamoto" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Mai" "apellidos" => "Endo" "email" => array:1 [ 0 => "enmai04@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 780 "Ancho" => 2083 "Tamanyo" => 187425 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A), A reddish firm nodule with central crusts on the upper arm. (B), A perforated pilomatricoma lesion with elimination of pilomatricoma cells (Hematoxylin & eosin stain; ×40). (C), Histopathology of another nodule, showing central ulceration and an eosinophilic tumor mass with peripheral basaloid tumor cells (Hematoxylin & eosin stain; ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 22-year-old man was referred to our department for evaluation of a slightly painful nodule on the arm that had increased in size over the previous four months. He had a history of surgical resection of several nodules on the nape, back, and arm at other dermatology clinics. He complained of myotonic symptoms with difficulty in relaxing his hands after contraction and was followed at the Neurology Department of our hospital under suspicion of myotonic dystrophy, but he refused to undergo genetic testing. Physical examination showed a 10 × 10 mm, slightly elevated, firm reddish nodule with central brownish crusts on the left upper arm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). The tumor was surgically removed under local anesthesia. Histopathological examination showed a well-circumscribed tumor mass penetrating the dermis. The epidermis was ulcerated, and the lateral acanthotic epidermis extended downwards in a tongue-like projection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Tumor cells were composed of different types of cells, such as eosinophilic, basophilic, and transitional cells. Partial elimination of tumor cells through the epidermis was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). There was an inflammatory reaction with mononuclear cells, and a number of foreign-body type giant cells were found around the mass. We retrospectively examined three specimens of previously resected tumors. One of the specimens also showed proliferation of eosinophilic and basaloid tumor cells in the dermis with central ulceration of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c), whereas the other two tumors were pilomatricoma without perforation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Perforating pilomatricoma is a rare variant of pilomatricoma, which clinically presents with inflammatory papules, cutaneous horn-like nodules, craters, and ulcers resembling keratoacanthoma or solid masses.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Most of the reported cases are solitary lesions, and one case has been reported in which perforating pilomatricoma was observed in one of the multiple pilomatricomas;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> however, to our knowledge, only one case of multiple onset of perforating pilomatricomas has been reported.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In that case, the patient presented Churg-Strauss syndrome and Rubinstein-Taybi syndrome and developed a total of 15 tumors. Although the exact number was not specified, multiple lesions were classified as perforating pilomatricomas.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our patient was suspected of myotonic dystrophy, which, however, was not genetically confirmed. Myotonic dystrophy is an autosomal dominant inherited disease caused by a mutation in the dystrophia myotonica protein kinase gene on chromosome 19. The occurrence of multiple pilomatricomas has been reported to be associated with myotonic dystrophy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our patient developed multiple firm nodules on the nape, back, and upper arm. The total number of the nodules was five, four of which were subjected to histopathological examination. All of the four nodules were diagnosed as pilomatricomas. Of interest, two of the nodules were perforating pilomatricomas, showing perforation and partial elimination of the eosinophilic tumor cells. Recent studies have shown that matrix metalloproteinase-9 and -12 derived from tumor cells, fibroblasts, and macrophages may be relevant to the partial elimination of the tumor, by degradation of collagen and elastic fibers.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> When superficially located, the elimination of pilomatricoma is accelerated by virtue of epidermal catharsis mechanisms.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">Mai Endo: Designed the study; performed the research and contributed to analysis and interpretation of data; wrote the initial draft of the manuscript; read and approved the final version of the manuscript.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto: Designed the study; performed the research and contributed to analysis and interpretation of data; assisted in the preparation of the manuscript; read and approved the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-07" "fechaAceptado" => "2020-09-21" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 780 "Ancho" => 2083 "Tamanyo" => 187425 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A), A reddish firm nodule with central crusts on the upper arm. (B), A perforated pilomatricoma lesion with elimination of pilomatricoma cells (Hematoxylin & eosin stain; ×40). (C), Histopathology of another nodule, showing central ulceration and an eosinophilic tumor mass with peripheral basaloid tumor cells (Hematoxylin & eosin stain; ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perforating pilomatricoma with anetodermic epidermis in an adolescent with lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Miura" 1 => "T. 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Ishiwaka" 5 => "Amano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1346-8138.15138" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2020" "volumen" => "47" "paginaInicial" => "82" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31677179" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009700000002/v2_202204021027/S0365059621003020/v2_202204021027/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009700000002/v2_202204021027/S0365059621003020/v2_202204021027/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621003020?idApp=UINPBA00008Z" ]
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| 2023 Fevereiro | 44 | 34 | 78 |
| 2023 Janeiro | 70 | 46 | 116 |
| 2022 Dezembro | 54 | 48 | 102 |
| 2022 Novembro | 80 | 59 | 139 |
| 2022 Outubro | 161 | 58 | 219 |
| 2022 Setembro | 50 | 78 | 128 |
| 2022 Agosto | 46 | 42 | 88 |
| 2022 Julho | 61 | 64 | 125 |
| 2022 Junho | 72 | 94 | 166 |
| 2022 Maio | 117 | 59 | 176 |
| 2022 Abril | 111 | 89 | 200 |
| 2022 Março | 129 | 87 | 216 |
| 2022 Fevereiro | 27 | 37 | 64 |
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