Quick Case: Pilomatric Carcinoma Presenting as Huge Scapular Swelling with Bone Destruction

A 74-year-old male presented with a subcutaneous small cystic subcutaneous nodule, just medial to the right shoulder joint, measuring 2.5 cm in diameter. An attempt to excise the nodule resulted in partial removal, rupture and secondary infection, resulting in a huge painful swelling, measuring about 12 cm in diameter within a two-week duration. X-ray revealed a multiloculated solid-cystic mass with soft tissue as well as bone involvement, with intra-tumor calcification / bone formation. The imaging impression was that of osteogenic sarcoma with necrosis. FNAC performed from the swelling yielded 200 ml of pus that grew Staphylococcus aureus on routine culture. Smears prepared from the material contained anucleate squames as well as dysplastic squamous cells. Trucut biopsy performed from the mass confirmed pilomatric carcinoma with a central cystic component, which was secondarily infected. No sarcomatous component was identified. No parasite. The patient died 3 months after diagnosis, due to extensive metastatic disease.

Learning Points/Take Home Messages

A tissue diagnosis is mandatory before interrupting any tumorous nodule, especially in elderly.