Abstract
Visceral Carcinoma With Shadow Cell Differentiation Can Mimic Pilomatrix Carcinoma To the Editor: We read with interest a recent study of pilomatrix carcinomas by Hardisson et al. (1). The differential diagnosis includes, as described comprehensively by the authors, several cutaneous tumors with shadow cell differentiation (matricoma, proliferating and aggressive pilomatricoma, basal cell carcinoma with matrical differentiation). However, and as also mentioned in the study, some pilomatrix carcinomas show a high degree of nuclear anaplasia, thus being composed of entirely undifferentiated cells and shadow cells. We would like to stress that differential diagnosis of such poorly differentiated tumor with shadow cells should include also a metastasis from noncutaneous carcinoma with shadow cell differentiation. The shadow cell differentiation can occur in various visceral carcinomas (2,3), including poorly differentiated tumors with small-to-intermediate cells that resemble pleomorphic basaloid cells of pilomatrix carcinoma (3). The differential diagnosis is based on search for any pathologic feature of visceral carcinoma (e.g., focal glandular differentiation), and on exclusion of visceral primary by clinical examination. However, this can be difficult in very poorly differentiated or multiple tumors. We believe that some tumors interpreted in the past as pilomatrix carcinomas could have represented cutaneous metastasis from poorly differentiated visceral carcinoma with shadow cell differentiation (2,3). Michal Zamecnik Michal Michal Petr Mukensnabl
Published Version
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