Giant pilomatricoma with angiomyxoid stroma: Unusual presentation of a benign tumor

Fig 1. Giant pilomatricoma. An 18-year-old Hispanic man with an 8-cm 3 9-cm firm, exophytic, pedunculated, reddish tumor with punctate ulcerations and yellow serous drainage on the anterior aspect of the chest. CASE REPORT On presentation, the patient had an 8-cm 3 9-cm firm, exophytic, pedunculated, reddish tumor with punctate ulcerations, yellow serous drainage, and linear hypertrophic scars at the base (Fig 1). The tumor was noted 6 years prior and had been slowly growing since. He denied any prior surgery or trauma to the affected area. There was no family history of similar lesions or known genetic syndromes. Biopsy results were nonspecific, including skin with hemorrhage and increased vasculature with large fibrohistiocytic cells. These histologic changes were considered reactive and unrepresentative of the larger mass. Therefore, the entire tumor was completely excised under tumescent anesthesia, sectioned, and submitted for further histopathologic analysis. Sectioning of the mass found significant calcification of the involved tissue (Fig 2). A delayed repair was planned pending further histologic evaluation. Routine hematoxylin-eosin staining of the tumor found aggregates of basaloid, matrical cornified material with shadow cells and calcification surrounded by fibrosis and granulomatous inflammation (Fig 3). Extensive loose, myxoid connective