 Hi, good evening all. Sharing one interesting case which walked into the clinic, 50 year old female with a painless mass which was there on her arm aspect since almost more than 10 years. And similar in appearance, only thing this mass has been long standing and was bothersome for this lady. In fact, she came for ultrasound of the axilla sent by the surgeon to look for lymph nodes in the axilla before surgical excision of this legion. So interestingly the axilla scan was completely normal and there was no regional lymphadenopathy. But what was interesting was the scan of this patient which showed this pinkish calcified heart legion in the dermal layers of the skin. So today with high frequency ultrasound you can evaluate such legions also beautifully on sonography. So if you see this b-mode sonography, it showed that in the superficial sub dermal layers was standing this calcified mass with dense acoustic shadowing seen on b-mode ultrasound. Doppler showed no vascularity in within this mass. So if you look at this legion very carefully, the legion is situated in the dermal layers of the skin. It shows strong posterior acoustic shadowing the way we see in gallbladder calculi or even renal calculi on ultrasound. So all in all when you see such kind of appearance, the first thing or a diagnosis which should come to your mind is pylometricoma. So pylometricomas are nothing but benign neoplasm that are thought to be arise from the hair cortex cells. So they are typically called as pylometricomas or calcifying epithelomas of malbarbe. The reporting incidence rate is rarer but they make up for the cutaneous neoplasms of the hair follicle more commonly seen in females and classically has a bimodal peak either in the first decade of life or in the fifth or sixth decade of life. Now usually these are legions are solitary. They could be multiple and they are usually seen in the head trunk region followed by the upper extremities and less likely in the lower extremities. The associations could be sacroidosis, turners, gardener, syndromes and Steenhurst disease and Rubenstein-Tibie syndrome. Now clinically these legions are painless slow growing in nature and superficial mobile and palpably they are very hard and location as I said they are more commonly in the head neck and upper extremities. So an important take home in this case is that if you see a superficial legion which is painless therefore long years and situated in the sub dermal region of the skin of the hand forearm or the head neck region do raise a possibility of pylometricoma. Usually they are excised by the surgeons and histopathologically confirmed post surgery. Thank you.