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Case of the Month

April 2019

Patient Data: 3 children in the age around 10 years old with palpable skin tumors examined for SONOZORG a primary care ultrasound facility

Clinical Info: Painless skin tumors in the face and arm

The lesion is located in the skin and shows echogenic contents

There are tiny punctate calcifications

The lesion is not vascularized

This is the lesion of the second patient. The lesion shows more prominent calcifications

Another image of the second patient

Again the lesion is not vascularized

This is the lesion of the third patient. There is a tiny cystic looking mass in the skin. We had no idea what it was and decided to wait for some time

Nearly a year later the lesion was completely calcified

Another image of the lesion. Although the lesion was not operated this could also very well be a pilomatrixoma

The tumors were pilomatrixomas or pilomatricomas
A pilomatrixoma or epithelial inclusion cyst of Malherbe, is a benign skin lesion associated with hairfollicles.They appear mainly in children or young adults. They present as a firm, mobile, painless swelling. Sometimes a blue discoloration is present. They vary in size from a few millimetres to 3 centimetres. The majority occur in the head and neck region.
On ultrasound a pilomatrixoma presents as an oval tumor located between the cutis and subcutis. It is hyperechoic, sometimes with calcification and acoustic shadowing. The wall is often hypoechoic and on color Doppler tiny vessels sometimes can be seen in the wall.
The most common differential diagnosis is a sebaceous cyst

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