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Annales de Dermatologie et de Vénéréologie
Volume 137, n° 11
pages 718-721 (novembre 2010)
Doi : 10.1016/j.annder.2010.08.002
Received : 10 Mars 2010 ;  accepted : 6 August 2010
Ostéome cutané primaire à type de plaque rétro-auriculaire érythémateuse et grenue
Osteoma cutis presenting as an erythematous and grainy, retroauricular plaque
 

A. Salhi a, , M. Wassef b, O. Enjolras c
a Service de dermatologie, université de médecine d’Alger, cité de l’Orangeraie villa no 8, Benaknoun, Alger 16000, Algérie 
b Laboratoire d’anatomie pathologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France 
c Service de maxillo-faciale et de chirurgie plastique, hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France 

Auteur correspondant.
Résumé
Introduction

Les ossifications cutanées secondaires font suite à des lésions inflammatoires telles que celles de l’acné, ou sont post-traumatiques. Les ostéomes primaires peuvent s’intégrer dans des syndromes polymalformatifs avec troubles endocriniens mais d’autres sont isolés. Nous en rapportons un cas, original par sa présentation clinique.

Observation

Un homme de 22 ans sans antécédent consultait pour un placard érythémateux rétro-auriculaire droit, télangiectasique et de consistance pierreuse. L’analyse histologique montrait une ossification dans le derme, faite d’os mature au contact de vaisseaux dilatés. Le patient n’avait pas d’antécédent de malformation veineuse ou de lésion vasculaire. Le diagnostic retenu était celui d’ostéomes cutanés primaires.

Discussion

La survenue d’ostéomes cutanés acquis de petite taille chez un jeune adulte sans anomalie endocrinienne ni malformative associée nous conforte dans le diagnostic d’ostéomes cutanés primaires. L’existence de vaisseaux dilatés nous a fait suspecter une malformation veineuse. Mais l’absence de toute anomalie antérieure permettait d’écarter le diagnostic. Notre patient n’avait pas un ostéome primaire solitaire classique, de type nodulaire ou en grande plaque, mais une variété originale en petits éléments, purement localisés, comme dans le milium en plaque rétro-auriculaire.

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Summary
Background

Authentic bone tissue can be observed in the skin, in both the epidermis and dermis, where it produces cutaneous osteomas. These lesions are classed as either primary or secondary ossifications. Secondary ossifications are the consequence of inflammatory lesions such as acne or injuries while primary ossifications are neither preceded by preexisting lesions nor associated with other lesions.

Patients and methods

A 22-year-old man with no prior history consulted for a grainy, erythematous, telangiectatic retroauricular plaque on the right side. Palpation revealed hard grainy lesions giving a tactile sensation of small stones. Histological analysis showed an ossification in the dermis resulting from mature bone in contact with dilated vessels. A diagnosis of venous malformation with osseous metaplasia was initially proposed, but the patient insisted that no vascular anomaly had preceded the grainy lesions. Further histological analysis demonstrated that the vascular anomalies were restricted to the ossified regions and the final diagnosis was of primary cutaneous osteoma.

Discussion

In our patient, the absence of any endocrine anomalies and of any vascular malformation supported the diagnosis of primary cutaneous osteoma. Certain vascular anomalies such as haemangiomas or venous malformation can lead to bone formation. The coexistence in the dermis of osteomas and dilated vessels initially led us to suspect osteomas secondary to venous malformation. However, the absence of any vascular anomalies preceding the cutaneous osteoma contradicted this diagnosis. In venous malformations, phleboliths are usually seen as a result of calcium deposits on thrombus rather than authentic osteomas. Our patient had no standard primary solitary osteoma of either the nodular or the plaque type, and this case thus constitutes a new original form of primary cutaneous osteoma.

The full text of this article is available in PDF format.

Mots clés : Ostéome cutané, Métaplasie, Ostéome primaire, Ostéome secondaire, Ostéoblastes, Ostéoclastes

Keywords : Cutaneous osteoma, Metaplasia, Primary osteoma, Secondary Osteoma, Osteoblast, Osteoclast




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