Pilomatricoma Mimicking Tubercular Lymphadenopathy

Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a rare benign skin tumor arising from hair follicle matrix cells. It mostly involves head and neck region but can affect other body parts also. Usually, it presents clinically as a single swelling but may present at times as multiple swellings. The affected hair follicle matrix cells undergo calcification and form a hard lump beneath the skin. We present a case of 7-year-old male child who presented with a painless, progressively enlarging swelling on the right side of the neck. The child was otherwise healthy, with no associated symptoms or significant medical history. Multiple unilateral anterior cervical lymph nodes at cervical level 2, 3, 4 which were firm, matted, mobile and non- tender, as identified on clinical examination. Ultrasonography showed prominent lymph nodes and fine-needle aspiration cytology (FNAC) showed clusters and sheets of atypical cells. Excisional biopsy showed sheets of basaloid cells, ghost cell, giant cell reaction and calcification with no malignant cells which confirmed pilomatricoma without malignancy. Followups at 1 and 3 months showed no recurrence. The child is still monitored continuously. Pilomatricoma should always be considered in such cases of cervical lymphadenopathy for accurate diagnosis and management.