Difference between revisions of "Dermatofibroma"

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| Width      =
| Width      =
| Caption    = Dermatofibroma. [[H&E stain]].
| Caption    = Dermatofibroma. [[H&E stain]].
| Micro      = Prominent fibrous bundles - especially at the edge of the lesion ("collagen-trapping"), loss of adnexal structures, +/-"dirty fingers" ([[acanthosis]], basal keratinocyte hyperpigmentation)
| Micro      = prominent fibrous bundles - especially at the edge of the lesion ("collagen-trapping"), loss of adnexal structures, +/-"dirty fingers" ([[acanthosis]], basal keratinocyte hyperpigmentation)
| Subtypes  = Cellular, deep penetrating, lipidized, epithelioid cell histiocytoma, fibrotic, aneurysmal, granular cell dermatofibroma, dermatofibroma with monster cells
| Subtypes  = cellular, deep penetrating, lipidized, epithelioid cell histiocytoma, fibrotic, aneurysmal, granular cell dermatofibroma, dermatofibroma with monster cells
| LMDDx      = [[DFSP]], [[neurofibroma]], [[blue nevus]], [[melanoma]], esp. desmoplastic neurotropic-type, [[fibromatosis]]
| LMDDx      = [[DFSP]], [[neurofibroma]], [[blue nevus]], [[melanoma]], esp. desmoplastic neurotropic-type, [[fibromatosis]]
| Stains    =
| Stains    =
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| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx = previous trauma
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence = common
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  = benign
| Other      = previous trauma
| Other      =  
| ClinDDx    =
| ClinDDx    =
}}
}}
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==General==
==General==
*Reactive process -- it is ''not'' a neoplasm.
*Classically considered a reactive process - ''not'' a neoplasm.
*Usually associated with previous trauma.
*Usually associated with previous trauma.
**In women... usually legs.
**In women... usually legs.
*Multiple dermatofibromas are described in association [[Down syndrome]].<ref name=pmid36219648>{{cite journal |authors=Zimmerman TJ, George SJ |title=Multiple Eruptive Dermatofibromas Associated With Down Syndrome |journal=Cutis |volume=110 |issue=2 |pages=E21–E23 |date=August 2022 |pmid=36219648 |doi=10.12788/cutis.0600 |url=}}</ref><ref name=pmid23879455>{{cite journal |authors=Lamb RC, Gangopadhyay M, MacDonald A |title=Multiple dermatofibromas in Down syndrome |journal=Int J Dermatol |volume=53 |issue=4 |pages=e274–5 |date=April 2014 |pmid=23879455 |doi=10.1111/ijd.12037 |url=}}</ref>


==Microscopic==
==Microscopic==
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*[[Melanoma]], esp. desmoplastic neurotropic-type.
*[[Melanoma]], esp. desmoplastic neurotropic-type.
*[[Fibromatosis]].
*[[Fibromatosis]].
*[[Dermal scar]].


Images:
Images:
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*[http://www.pacificderm.org/newsflashcpcapril04.html DF - several images (pacificderm.org)].
*[http://www.pacificderm.org/newsflashcpcapril04.html DF - several images (pacificderm.org)].
*[http://biocare.net/products/antibodies/f/357/ DF stained with factor XIIIa (biocare.net)].
*[http://biocare.net/products/antibodies/f/357/ DF stained with factor XIIIa (biocare.net)].
*[http://dermpathexpert.com/imagelib/sitebuilder/misc/show_image.html?linkedwidth=560&linkpath=http://dermpathexpert.com/sitebuildercontent/sitebuilderpictures/webassets/.pond/SB073911DermatofibromaFactorXIIIa40x.jpg.w560h422.jpg&target=_self&title=Dermatofibroma DF stained with factor XIIIa (dermpathexpert.com)].<ref>URL: [http://dermpathexpert.com/id8.html http://dermpathexpert.com/id8.html]. Accessed on: 19 July 2013.</ref>


===Subtypes===
===Subtypes===
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*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802171836877 Cellular dermatofibroma (surgicalpathologyatlas.com)].
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802171836877 Cellular dermatofibroma (surgicalpathologyatlas.com)].
*[http://www.dermpedia.org/node/2292 Cellular dermatofibroma (dermpedia.org)].<ref>URL: [http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#  http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#]. Accessed on: 4 February 2012.</ref>
*[http://www.dermpedia.org/node/2292 Cellular dermatofibroma (dermpedia.org)].<ref>URL: [http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#  http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#]. Accessed on: 4 February 2012.</ref>
===Epithelioid cell histiocytoma===
Features:
*Epithelioid cells.
*No lesional cells in epidermis.
DDx:
*[[Melanocytic lesions]] - esp. [[malignant melanoma]].


==IHC==
==IHC==
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**Usually negative in DFSP.
**Usually negative in DFSP.
**There is not much literature on D2-40 in this context. Molecular work on the protein (podoplanin) the antibody is directed at has shown it is present in DFSP.<ref name=pmid21234520>{{Cite journal  | last1 = Xu | first1 = Y. | last2 = Ogose | first2 = A. | last3 = Kawashima | first3 = H. | last4 = Hotta | first4 = T. | last5 = Ariizumi | first5 = T. | last6 = Li | first6 = G. | last7 = Umezu | first7 = H. | last8 = Endo | first8 = N. | title = High-level expression of podoplanin in benign and malignant soft tissue tumors: immunohistochemical and quantitative real-time RT-PCR analysis. | journal = Oncol Rep | volume = 25 | issue = 3 | pages = 599-607 | month = Mar | year = 2011 | doi = 10.3892/or.2011.1141 | PMID = 21234520 }}</ref>
**There is not much literature on D2-40 in this context. Molecular work on the protein (podoplanin) the antibody is directed at has shown it is present in DFSP.<ref name=pmid21234520>{{Cite journal  | last1 = Xu | first1 = Y. | last2 = Ogose | first2 = A. | last3 = Kawashima | first3 = H. | last4 = Hotta | first4 = T. | last5 = Ariizumi | first5 = T. | last6 = Li | first6 = G. | last7 = Umezu | first7 = H. | last8 = Endo | first8 = N. | title = High-level expression of podoplanin in benign and malignant soft tissue tumors: immunohistochemical and quantitative real-time RT-PCR analysis. | journal = Oncol Rep | volume = 25 | issue = 3 | pages = 599-607 | month = Mar | year = 2011 | doi = 10.3892/or.2011.1141 | PMID = 21234520 }}</ref>
Image:
*[http://pathinfo.wikia.com/wiki/File:CD34.DFSP.100x.jpg DFSP - CD34 (wikia.com)].


==Sign out==
==Sign out==
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</pre>
</pre>


<pre>
SKIN LESION, LEFT UPPER ARM, EXCISION:
- DERMATOFIBROMA.
COMMENT:
The histologic impression is supported by immunostains; a CD34 immunostain
is negative and a factor XIIIa immunostain is weakly positive.
</pre>
===Micro===
===Micro===
The sections show skin with bland spindle cells interspersed between fibrous bundles.
The sections show skin with bland spindle cells interspersed between fibrous bundles.

Latest revision as of 15:50, 7 August 2024

Dermatofibroma
Diagnosis in short

Dermatofibroma. H&E stain.
LM prominent fibrous bundles - especially at the edge of the lesion ("collagen-trapping"), loss of adnexal structures, +/-"dirty fingers" (acanthosis, basal keratinocyte hyperpigmentation)
Subtypes cellular, deep penetrating, lipidized, epithelioid cell histiocytoma, fibrotic, aneurysmal, granular cell dermatofibroma, dermatofibroma with monster cells
LM DDx DFSP, neurofibroma, blue nevus, melanoma, esp. desmoplastic neurotropic-type, fibromatosis
Site skin
Clinical history previous trauma
Prevalence common
Prognosis benign

Dermatofibroma, abbreviated DF, is a common benign skin lesion. It is also known as benign fibrous histiocytoma and fibrous histiocytoma.

General

  • Classically considered a reactive process - not a neoplasm.
  • Usually associated with previous trauma.
    • In women... usually legs.
  • Multiple dermatofibromas are described in association Down syndrome.[1][2]

Microscopic

Features:[3]

  • Prominent fibrous bundles, especially at the edge of the lesion.
    • Surrounded by spindle cells (fibroblasts).
      • Usually thought of as fibroblasts surrounded by fibrous material ("collagen-trapping").
  • Lack of adnexal structures, i.e. no sweat glands, no hair.
  • +/-Epidermal changes - known as "dirty fingers":[4]
    • Acanthosis (thickened epithelial layer - specifically thickened stratum spinosum).
    • Basal keratinocyte hyperpigmentation.

DDx:

Images:

Subtypes

Like all common things... there are subtypes:[6]

  • Cellular.
  • Deep penetrating.
  • Lipidized - with foamy macrophages, hemorrhage and Touton-like giant cells.
  • Epithelioid cell histiocytoma.
  • Fibrotic.
  • Aneurysmal - large blood filled + features of lipidized.
  • Granular cell dermatofibroma.
  • Dermatofibroma with monster cells.

Cellular dermatofibroma

Features:

  • High cell density in the dermis - "blue" at low power.
  • Collagen bundles - key feature.

Images:

Epithelioid cell histiocytoma

Features:

  • Epithelioid cells.
  • No lesional cells in epidermis.

DDx:

IHC

Features:[8][9]

  • Factor XIIIa +ve.
    • Usually negative in DFSP.
  • CD34 -ve.
    • Usually positive in DFSP.

Others:

  • D2-40 +ve.[10]
    • Usually negative in DFSP.
    • There is not much literature on D2-40 in this context. Molecular work on the protein (podoplanin) the antibody is directed at has shown it is present in DFSP.[11]

Image:

Sign out

SKIN LESION, LEFT SHOULDER, EXCISION:
- DERMATOFIBROMA.

SKIN LESION, LEFT UPPER ARM, EXCISION:
- DERMATOFIBROMA.

COMMENT:
The histologic impression is supported by immunostains; a CD34 immunostain
is negative and a factor XIIIa immunostain is weakly positive.

Micro

The sections show skin with bland spindle cells interspersed between fibrous bundles. The fibrous bundles are prominent at the periphery of the lesion (collagen-trapping). Focal acanthosis is present.

The lesion does not extend to the adipose tissue. No atypia is apparent. No mitotic activity is identified.

The lesion extends to the edge of the tissue.

See also

References

  1. ↑ Zimmerman TJ, George SJ (August 2022). "Multiple Eruptive Dermatofibromas Associated With Down Syndrome". Cutis 110 (2): E21–E23. doi:10.12788/cutis.0600. PMID 36219648.
  2. ↑ Lamb RC, Gangopadhyay M, MacDonald A (April 2014). "Multiple dermatofibromas in Down syndrome". Int J Dermatol 53 (4): e274–5. doi:10.1111/ijd.12037. PMID 23879455.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 492. ISBN 978-0781765275.
  4. ↑ BD. 13 April 2011.
  5. ↑ URL: http://dermpathexpert.com/id8.html. Accessed on: 19 July 2013.
  6. ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 51. ISBN 978-0781779425.
  7. ↑ URL: http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#. Accessed on: 4 February 2012.
  8. ↑ Abenoza P, Lillemoe T (October 1993). "CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans". Am J Dermatopathol 15 (5): 429–34. PMID 7694515.
  9. ↑ Goldblum JR, Tuthill RJ (April 1997). "CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma". Am J Dermatopathol 19 (2): 147–53. PMID 9129699.
  10. ↑ Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G (March 2010). "D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans". Mod. Pathol. 23 (3): 434–8. doi:10.1038/modpathol.2009.176. PMID 20062007.
  11. ↑ Xu, Y.; Ogose, A.; Kawashima, H.; Hotta, T.; Ariizumi, T.; Li, G.; Umezu, H.; Endo, N. (Mar 2011). "High-level expression of podoplanin in benign and malignant soft tissue tumors: immunohistochemical and quantitative real-time RT-PCR analysis.". Oncol Rep 25 (3): 599-607. doi:10.3892/or.2011.1141. PMID 21234520.
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