Pilomatrixoma is a benign skin adnexal tumor arising from the hair-follicle matrix. While typically small and slowly growing, rare "giant" variants (>5 cm)-especially in the cervical region-may clinically and radiologically mimic malignant masses, posing a significant diagnostic challenge. We report a case of a 29-year-old male presenting with a solitary, firm, subcutaneous mass (~6 cm) in the left anterior cervical region, which enlarged rapidly over 6 months without pain or systemic symptoms. Contrast-enhanced CT revealed a well-defined, heterogeneous subcutaneous lesion without muscular or vascular invasion. Core needle biopsy (CNB) supported a diagnosis of pilomatrixoma. The mass was completely excised under IV sedation and local anesthesia. Histopathology confirmed classic pilomatrixoma features (basaloid cells, shadow cells, foreign-body giant cell reaction). At one-year follow-up the patient was disease-free, and scar outcome was excellent. This case underscores the importance of including giant pilomatrixoma in the differential diagnosis of large cervical soft-tissue masses. Histopathological examination remains essential for definitive diagnosis, while CNB can guide preoperative planning. Complete surgical excision yields excellent outcomes with minimal morbidity, avoiding overtreatment for suspected malignancy.
Urechescu et al. (Tue,) studied this question.