Difference between revisions of "Dermatofibroma"

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#redirect [[Non-malignant_skin_disease#Dermatofibroma]]
'''Dermatofibroma''', abbreviated ''DF'', is a common benign skin lesion.  It is also known as '''benign fibrous histiocytoma''' and '''fibrous histiocytoma'''.


==General==
*Reactive process -- it is ''not'' a neoplasm.
*Usually associated with previous trauma.
**In women... usually legs.
==Microscopic==
Features:<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*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":<ref>BD. 13 April 2011.</ref>
**Acanthosis (thickened epithelial layer - specifically thickened ''stratum spinosum'').
**Basal keratinocyte hyperpigmentation.
DDx:
*[[Dermatofibrosarcoma protuberans]] (DFSP) - usu. deeper, classically has adnexal structures and fat within lesion.
*[[Neurofibroma]].
*[[Blue nevus]].
*[[Melanoma]], esp. desmoplastic neurotropic-type.
*[[Fibromatosis]].
Images:
*[http://www.flickr.com/photos/euthman/4344426358/in/pool-dermpath DF (flickr.com/euthman)].
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatofibroma.html Dermatofibroma (ucsf.edu)].
*[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)].
===Subtypes===
Like all common things... there are subtypes:<ref>{{Ref Sternberg5|51}}</ref>
*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:
*[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>
==IHC==
Features:<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*Factor XIIIa +ve.
**Usually negative in [[DFSP]].
*CD34 -ve.
**Usually positive in DFSP.
Others:
*D2-40 +ve.<ref name=pmid20062007>{{cite journal |author=Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G |title=D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans |journal=Mod. Pathol. |volume=23 |issue=3 |pages=434–8 |year=2010 |month=March |pmid=20062007 |doi=10.1038/modpathol.2009.176 |url=}}</ref>
**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>
==Sign out==
<pre>
SKIN LESION, LEFT SHOULDER, EXCISION:
- DERMATOFIBROMA.
</pre>
===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==
*[[Dermatopathology]].
*[[Non-malignant skin disease]].
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 15:33, 3 July 2013

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

General

  • Reactive process -- it is not a neoplasm.
  • Usually associated with previous trauma.
    • In women... usually legs.

Microscopic

Features:[1]

  • 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":[2]
    • Acanthosis (thickened epithelial layer - specifically thickened stratum spinosum).
    • Basal keratinocyte hyperpigmentation.

DDx:

Images:

Subtypes

Like all common things... there are subtypes:[3]

  • 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:

IHC

Features:[5][6]

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

Others:

  • D2-40 +ve.[7]
    • 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.[8]

Sign out

SKIN LESION, LEFT SHOULDER, EXCISION:
- DERMATOFIBROMA.

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. ↑ 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.
  2. ↑ BD. 13 April 2011.
  3. ↑ 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.
  4. ↑ URL: http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#. Accessed on: 4 February 2012.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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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