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Nodular Mass in the Earlobe of an 18-Month-Old Girl

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

An 18-month-old girl presented with a 1-year history of a slow-growing mass in the right earlobe. There were no symptoms, such as tenderness or discharge, associated with the mass. She had no history of underlying medical disease or trauma. On physical examination, a 1.5 × 1.0–cm, firm, nodular, angulated, pinkish, nontender mass was observed in the posterior aspect of the right earlobe (Figure, A). The skin over the mass was semitransparent, and the mass moved freely beneath the skin. Under suspicion of a tumorous lesion, complete excision was performed after the patient received general anesthesia. Histopathologic findings were characteristic for 2 cell types; basaloid cells with a nucleus were present in the periphery, and ghost cells without a nucleus were present in the center (Figure, B). Six months after surgery, the wound had healed well, and there has been no recurrence.

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B. Pilomatricoma

Pilomatricoma is a benign tumor that originates from hair follicle matrix cells.17 It occurs frequently during the first 2 decades of life, especially in children 10 years or younger, and appears more in females than in males.1,3,68 The head and neck are the most commonly involved regions, particularly the neck and preauricular regions.1,3,6,8 Pilomatricoma is rare in the auricle.3,6

Pilomatricoma was first described by Malherbe and Chenantais as a benign neoplasm of the sebaceous gland in 1880 and was named calcifying epithelioma of Malherbe.1,3,5,8 In 1942, the tumor was thought to originate from hair cortex cells, and, in 1961, the term pilomatrixoma was proposed to describe its origin in the hair follicle matrix by Forbis and Helwig. The term was modified to pilomatricoma in 1977.3

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Article Information

Corresponding Author: Hyun Seung Choi, MD, Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea (choihyunseung@gmail.com).

Published Online: July 8, 2021. doi:10.1001/jamaoto.2021.1441

Conflict of Interest Disclosures: None reported.

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

References
1.
Lan  MY , Lan  MC , Ho  CY , Li  WY , Lin  CZ .  Pilomatricoma of the head and neck: a retrospective review of 179 cases.   Arch Otolaryngol Head Neck Surg. 2003;129(12):1327-1330. doi:10.1001/archotol.129.12.1327PubMedGoogle ScholarCrossref
2.
Thompson  LD .  Pilomatricoma.   Ear Nose Throat J. 2012;91(1):18-20. doi:10.1177/014556131209100106PubMedGoogle ScholarCrossref
3.
Rajeshwary  A , Somayaji  G , Manohar  S .  Pilomatricoma of the pinna.   Ear Nose Throat J. 2013;92(1):34-40. doi:10.1177/014556131309200111PubMedGoogle ScholarCrossref
4.
Van Gysel  D , De Raeve  H , Bruylants  B .  An infant with a lump on the earlobe.   Pediatr Dermatol. 2016;33(3):347-348. doi:10.1111/pde.12822PubMedGoogle ScholarCrossref
5.
Pinheiro  TN , Fayad  FT , Arantes  P , Benetti  F , Guimarães  G , Cintra  LTA .  A new case of the pilomatrixoma rare in the preauricular region and review of series of cases.   Oral Maxillofac Surg. 2018;22(4):483-488. doi:10.1007/s10006-018-0724-8PubMedGoogle ScholarCrossref
6.
Inagaki  A , Yamashita  Y , Mori  Y , Takeuchi  E , Asaoka  K , Murakami  S .  An unusual tumor of the ear: pilomatricoma in a middle-aged woman.   Case Rep Otolaryngol. 2019;2019:4975216. doi:10.1155/2019/4975216PubMedGoogle Scholar
7.
Nistel  M , Lee  SH , Born  H , Greinwald  JH , Abdaljaleel  M , Sobolewski  B .  The girl with the bleeding earlobe mass.   Pediatr Emerg Care. Published online March 21, 2019. doi:10.1097/PEC.0000000000001809PubMedGoogle Scholar
8.
Schwarz  Y , Pitaro  J , Waissbluth  S , Daniel  SJ .  Review of pediatric head and neck pilomatrixoma.   Int J Pediatr Otorhinolaryngol. 2016;85:148-153. doi:10.1016/j.ijporl.2016.03.026PubMedGoogle ScholarCrossref
9.
Jung  SY , Kim  MG , Boo  SH ,  et al.  Clinical analysis of auricular benign masses.   Korean J Audiol. 2012;16(1):10-13. doi:10.7874/kja.2012.16.1.10PubMedGoogle ScholarCrossref
10.
Jeong  J , Kim  Y , Eo  TS , Choi  HS .  Cavernous hemangioma of the external auditory canal in patients older than 60 years: a rare tumor.  Published online November 24, 2019.  Ear Nose Throat J. 2019;145561319888134. doi:10.1177/0145561319888134PubMedGoogle Scholar
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