Pediatric ghost cell lesions of the head and neck: a pilot case series

Abstract

Ghost cell change describes specific epithelial alterations including, cell swelling, prominent eosinophilic cytoplasm and, loss of nuclear stainability. Whether the result of coagulative necrosis or aberrant keratinization, these "ghost" or "shadow" cells appear prone to dystrophic calcification. Ghost cells have only been described in a limited number of pathologic conditions, both odontogenic and nonodontogenic. We present three lesions of the head and neck recently encountered at the Nationwide Children's Hospital that shared the common histologic feature of ghost cells. The first case involved a thirteen-year-old girl with a hard, circumscribed scalp mass. Excisional biopsy led to a di- agnosis of pilomatricoma. In the second case, a twelve-year-old girl with a history of craniopharyngioma presented with signs and symptoms suspicious for recurrence. This was confirmed following a second resective surgical pro- cedure. The third case involved a seven-yearold girl with painless facial asymmetry secondary to an expansile radiolucent lesion of left maxilla that filled the sinus and displaced several teeth. Histopathologically, the lesion was found to be calcifying odontogenic cyst. Although uncommon, three lesions containing characteristic ghost cell features were encountered over a short period at the Nationwide Children's Hospital. Given the relative lack of data regarding these lesions in the pediatric population, an additional retrospective analysis would appear warranted.