Giant Pilomatrixoma: Report of Two Cases and Review of Diagnostic and Therapeutic Approach

Pilomatrixoma is a benign adnexal neoplasm derived from hair matrix cells. Giant pilomatrixoma (GP) is an uncommon clinical variant that may pose a diagnostic challenge because of its resemblance to soft tissue neoplasms. We report two cases of GP with distinct clinical presentations. The first case involved a 22-year-old woman presenting with a right suprascapular mass measuring 14 × 8 × 5 cm, with slow progressive enlargement over three years. Magnetic resonance imaging revealed a well-circumscribed lesion with calcification foci. Complete surgical excision was performed, and histopathological examination demonstrated extensive calcium deposits, abundant ghost cells, and scarce basaloid cells, confirming an advanced-stage GP. The second case corresponded to a 54-year-old man with a four-year history of a left retroauricular mass measuring 6.5 × 4.5 × 3 cm. Surgical excision and histopathological analysis confirmed pilomatrixoma. Both patients had favorable postoperative outcomes without recurrence during follow-up. These cases highlight the variable clinical presentation of GP and the diagnostic challenge posed by its large size and atypical presentation. They emphasize the importance of clinicoradiologic and histopathologic correlation for establishing an accurate diagnosis and guiding appropriate surgical management.