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A Solitary Lump on the Scalp

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A woman in her early 70s was referred to the dermatology department for evaluation of a solitary, asymptomatic lump on her scalp. She was born with the lesion but noticed some growth following a minor local trauma a couple of months prior to seeking medical evaluation. The patient denied local inflammation, purulent discharge, and systemic symptoms. Her medical history was unremarkable apart from an allegedly benign breast nodule resection in her teenage years. In addition, her father died of metastatic cutaneous melanoma at 83 years old.

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B. Cutaneous meningeal heterotopia

Brain magnetic resonance imaging demonstrated a nonenhancing tumor with sharp margins in the subcutaneous tissue of the scalp with no underlying bone or intracranial involvement (Figure, B). Histopathologic study findings revealed an infiltration by monomorphic cells with ovoid nuclei and eosinophilic cytoplasm amid a fibrous stroma in the lower dermis (Figure, C). Cells did not display discernible cell membranes and tended to form whorls and strands around collagen bundles (Figure, D). There were no adnexal structures overlying the lesion, and the epidermis was spared. Immunostaining was strongly positive for vimentin and epithelial membrane antigen (EMA), focally positive for progesterone receptor, and showed an estimated 1% positivity for Ki-67. Cells were negative for cytokeratins AE1/AE3, S100, CD45, CD68, factor XIII, actin, glial fibrillary acidic protein, and octamer-binding transcription factor 4. The clinicopathologic correlation was compatible with the diagnosis of a cutaneous meningeal heterotopia (CMH).

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Article Information

Corresponding Author: Lucas Samuel Perinazzo Pauvels, MD, Department of Dermatology, Clinicas Hospital of Porto Alegre, 2350 Ramiro Barcelos St, Zone 13, 90035-903, Porto Alegre, Rio Grande do Sul, Brazil (dermatolucas@gmail.com).

Published Online: October 7, 2020. doi:10.1001/jamadermatol.2020.3577

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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