
 pilomatricoma usually appears in the first two decadesusually , an asymptomatic lesion with an occasional inflammation . 
 
pilomatricoma usually appears in the first two decades usually , an asymptomatic lesion with an occasional inflammation .
usually , they present as a solitary nodule / cystic lesion distributed on head , neck , and upper trunk area . sometimes , there is associated inflammation .
a 36-year - old obese , hypothyroid female patient presented in surgery outpatient department of a tertiary care medical college of eastern bihar with a bluish - red , nodular lesion over the upper back [ figure 1 ] .
she gave a history of 68 months duration and complained of some sticky material coming out from the lesion intermittently whenever there was pain and redness .
she was treated outside with intermittent antibiotic and anti - inflammatory agents with an apparent resolution of the symptoms followed by recurrence in a few weeks . on examination , we found a violaceous nodulo - cystic lesion on the upper back with a size of 2 cm  1.5 cm ; the center of the lesion was eroded , and there was a visible yellow - colored cheesy discharge from that area [ figure 2 ] .
depending on the site , the nodulo - cystic nature of the lesion , the recurrent history of inflammation and discharge , a provisional diagnosis of the ruptured epidermal cyst was placed .
the patient was managed conservatively till discharge subsided , and the epithelialization of central area was complete .
nodule covered with yellow cheesy discharge and crust in scanner view , the epidermis was acanthotic . in the dermis
, there was a nodular basaloid cell proliferation extending from papillary to reticular dermis [ figure 3 ] .
there was also the proliferation of squamoid cells with the disappearance of nucleus leaving behind a shadow ( ghost cells / shadow cells ) [ figures 4 and 5 ] .
the dermis was covered by mononuclear inflammatory infiltrate along with the formation of foreign body type giant cells [ figures 6 and 7 ] . in view of these findings
h and e ( scanner view ) : basaloid cells h and e ( scanner view ) : ghost cells ghost cells with nuclear shadow , ( h and e , 40 ) stromal inflammation , ( h and e , 10 ) foreign body giant cells , ( h and e , 40 )
in scanner view , the epidermis was acanthotic . in the dermis , there was a nodular basaloid cell proliferation extending from papillary to reticular dermis [ figure 3 ] .
there was also the proliferation of squamoid cells with the disappearance of nucleus leaving behind a shadow ( ghost cells / shadow cells ) [ figures 4 and 5 ] .
the dermis was covered by mononuclear inflammatory infiltrate along with the formation of foreign body type giant cells [ figures 6 and 7 ] . in view of these findings
h and e ( scanner view ) : basaloid cells h and e ( scanner view ) : ghost cells ghost cells with nuclear shadow , ( h and e , 40 ) stromal inflammation , ( h and e , 10 ) foreign body giant cells , ( h and e , 40 )
in scanner view , the epidermis was acanthotic . in the dermis , there was a nodular basaloid cell proliferation extending from papillary to reticular dermis [ figure 3 ] .
there was also the proliferation of squamoid cells with the disappearance of nucleus leaving behind a shadow ( ghost cells / shadow cells ) [ figures 4 and 5 ] .
the dermis was covered by mononuclear inflammatory infiltrate along with the formation of foreign body type giant cells [ figures 6 and 7 ] . in view of these findings
h and e ( scanner view ) : basaloid cells h and e ( scanner view ) : ghost cells ghost cells with nuclear shadow , ( h and e , 40 ) stromal inflammation , ( h and e , 10 ) foreign body giant cells , ( h and e , 40 )
usually , they appear in early age , the average age of onset being childhood to adolescence . they usually present as a solitary firm nodule or cyst distributed on any nonglabrous area , but mostly restricted to head - neck and upper trunk .
sometimes , the lesion shows an inflammatory sign . in histology , usually there is a cyst formation with matrical keratinization .
there are two kinds of cells ; outer basaloid matrical cells and central squamatized cells with the remnant of nuclear outline ( shadow or ghost cells ) . in the early stage ,
particularly , in the elderly population , the basaloid cells predominate , and these tumors are called proliferating pilomatricoma .
the treatment is basically surgical excision ; recurrence has been reported following the surgical excision . in our case ,
the pilomatricoma appeared at 36 years of age , and clinically mimicked ruptured epidermal cyst .
the goal of this presentation is to highlight the fact that pilomatricoma may appear late in life and matrical cyst of pilomatricoma can rupture and give rise to a clinical picture mimicking ruptured epidermal cyst .
 pilomatricoma is a benign tumor arising from the hair matrical cells . 
 most pilomatricomas appear in the first two decades of life as a solitary skin to a bluish colored nodule on head - neck area with an occasional sign of inflammation . here , we present a case of pilomatricoma which appeared at 36 years of age with a history of recurrent inflammation and discharge mimicking ruptured epidermal cyst . 