Multiple clustered dermatofibroma with overlying sebaceous hyperplasia

Multiple clustered dermatofibroma is a very rare clinical variant of the dermatofibroma, and sebaceous differentiation overlying dermatofibromas is also unusual. We report the first case of a multiple clustered dermatofibroma with overlying sebaceous hyperplasia.     

Multiple cutaneous fibrous histiocytomas in association with systemic lupus erythematosus

Cutaneous fibrous histiocytomas are usually regarded as superficial lesions and commonly known as dermatofibromas; however, unusual cases histologically showing fibrohistiocytic proliferation extending into the deeper dermis or subcutaneous tissues are occasionally experienced. Some authors propose this type as benign fibrous histiocytoma of the skin, distinct from dermatofibroma. We describe herein a case of systemic lupus erythematosus (SLE) who developed multiple nodules on the face, trunk and extremities. The nodule on the forehead did not present a typical clinical appearance of dermatofibroma, and histopathological examination showed fibrohistiocytic proliferation with a storiform pattern extending into the deep dermis and subcutaneous tissues. By contrast, histology of the nodule on the abdomen showed fibrohistiocytic proliferation confined to the dermis and compatible with dermatofibroma. Although multiple dermatofibromas are occasionally seen in patients with SLE, benign fibrous histiocytoma of the skin showing deeper invasion than dermatofibroma is rarely associated with SLE.     

Lentiginous Melanocytic Hyperplasia Overlying Dermatofibroma

There are occasional reports of proliferative epidermal changes overlying dermatofibromas. We report the first case to our knowledge of a dermatofibroma with overlying lentiginous melanocytic hyperplasia.     

Multiple clustered dermatofibroma presenting in a segmental distribution

Multiple dermatofibromas is a rare entity consisting of more than fifteen lesions. Multiple clustered dermatofibroma is a distinct variant of multiple dermatofibromas and is defined as a well‐demarcated plaque composed of individual dermatofibromas. We report a 16‐year‐old boy with multiple clustered dermatofibroma in a segmental distribution, which has previously not been reported in the literature.     

Dermatofibroma: a possible model of local fibrosis with epithelial/mesenchymal cell interaction

Dermatofibromas are benign dermal nodules usually seen on the extremities; however, whether a dermatofibroma is a reactive fibrous hyperplasia or a true neoplasm is still unclear. Fibrous type dermatofibromas might be regarded as the symptom of local fibrotic processes and thus present a possible model of local fibrosis. Interaction between proliferated dermatofibroma fibroblasts and overlying elongated epidermis suggests a relationship between keratinocytes and mesenchymal cells. We herein describe current insights into the pathogenesis of dermatofibromas and explore the possible involvement of immunocytes around fibroblasts and effector cells which play an important role in the development of dermatofibromas.

Conflicts of interest

None declared     

Multiple eruptive dermatofibromas: a review of the literature

In this review we summarize the characteristic features of multiple eruptive dermatofibromas based on an analysis of cases in the literature. Many researchers have reported multiple eruptive dermatofibromas diagnosed using the definition of "multiple" as the presence of at least 15 lesions. However, this criterion is arbitrarily chosen and might not be entirely valid for all cases. A more precise definition may include the eruption of several multiple eruptive dermatofibromas reported within a short period of time. Because more than half of the patients with multiple eruptive dermatofibromas have underlying diseases, and more than 80% of the underlying diseases are immune-mediated, multiple eruptive dermatofibromas could possiblv be considered as a partial manifestation of an immune-mediated disease. This underscores the possibility of early diagnosis of immune-mediated diseases in patients with multiple eruptive dermatofibromas.     

Familial eruptive dermatofibromas in atopic dermatitis

Multiple eruptive dermatofibromas (MEDF) are rare and their aetiology is unknown. More than half of the patients with MEDF have underlying diseases, and more than 80% of the underlying diseases are immune mediated. Familial cases suggesting a genetic cause have also been reported. We report a case of familial eruptive dermatofibromas associated with atopic dermatitis, possibly caused by both hereditary factors and compromised immunity.     

Dermoscopic findings of haemosiderotic and aneurysmal dermatofibroma: report of six patients

BACKGROUND: The clinical diagnosis of dermatofibroma is commonly easy. However, the differentiation of dermatofibroma from other cutaneous tumours is difficult in some instances, primarily in atypical cases and rare variants. Haemosiderotic dermatofibroma is a variant composed of numerous small vessels, extravasated erythrocytes and intra- and extracellular haemosiderin deposits. Aneurysmal dermatofibroma is a variant composed of large, blood-filled spaces without endothelial lining. Some authors consider that haemosiderotic dermatofibroma is an early stage in the development of aneurysmal dermatofibroma. The clinical differential diagnosis of haemosiderotic or aneurysmal dermatofibroma must include melanoma and other melanocytic tumours, vascular neoplasms, adnexal tumours and nonspecific cysts. Dermoscopy improves the diagnostic accuracy in pigmented and nonpigmented skin lesions. OBJECTIVES: To evaluate specific dermoscopic criteria. METHODS: Dermoscopic examination (using the DermLite Foto; 3Gen, LLC, Dana Point, CA, U.S.A.) of six patients with haemosiderotic or aneurysmal dermatofibromas was performed to evaluate specific dermoscopic criteria. RESULTS: A multicomponent pattern with a central bluish or reddish homogeneous area in combination with white structures and a peripheral delicate pigment network along with vascular structures was noted in five of six lesions. CONCLUSIONS: This dermoscopic pattern yielded the diagnosis of haemosiderotic or aneurysmal dermatofibroma in most cases. However, this multicomponent pattern may present in some melanomas and although it is useful in determining a clinical diagnosis of aneurysmal dermatofibroma, it may not be specific to this entity.     

Multiple clustered dermatofibroma: case report and review of the literature

The presence of multiple dermatofibromas is rare and is defined as more than 15 lesions. Multiple clustered dermatofibroma (MCDF) is a distinct entity with only 12 reported cases in the literature. MCDF occurs in healthy individuals of both sexes in the first to third decades on the lower half of the body and portends an excellent prognosis. On histology, MCDF is consistent with benign dermatofibromas. We report a 31‐year‐old healthy Hispanic woman with a 14‐year history of slowly progressive MCDF located on her right hip initially misdiagnosed as dermatofibrosarcoma protuberans. We believe this case represents the 13th report of MCDF in the literature and the second from North America. Gershtenson PC, Krunic AL, Chen HM. Multiple clustered dermatofibroma: case report and review of the literature.     

Multiple eruptive dermatofibromas in 2 patients infected with the human immunodeficiency virus

Multiple eruptive dermatofibromas are an uncommon clinical entity in which several lesions appear in a short period of time. Baraf and Shapiro defined them in 1970 as the appearance of at least 15 dermatofibromas in a few months. Given that incipient cases might be omitted, appearance of 5 to 8 dermatofibromas in 4 months has been proposed as sufficient to establish diagnosis. Although this entity has been reported in healthy subjects, it usually appears with underlying autoimmune diseases (lupus erythematosus), human immunodeficiency virus (HIV) infection, or treatment with certain drugs. We report 2 cases of multiple eruptive dermatofibromas associated with HIV infection. One of these patients was unaware of being infected with HIV, and so we believe that the appearance of these skin lesions could help early diagnosis of autoimmune diseases or patients with immunodepression.     

The Atrophic Dermatofibroma: A Delled Dermatofibroma

Atrophic dermatofibroma has been proposed as a term to designate a new and specific type of dermatofibroma. We report the clinical and histopathological findings in two cases of atrophic dermatofibroma. The peculiar morphology of these lesions simply represents a conspicuous example of the frequently seen central depression in dermatofibroma. On histopathology, no authentic atrophy is present, because the thinning of the dermis compared with that of the adjacent non-lesional skin results from this depression rather than from loss of tissue of the dermis. Delled dermatofibroma is a more appropriate appellation than atrophic dermatofibroma, because of the striking shape of these lesions.     

Multiple eruptive dermatofibromas in a patient with HIV infection: case report and literature review

Multiple eruptive dermatofibromas have been reported in the setting of autoimmune diseases treated with immunosuppressive drugs and more recently in the course of human immunodeficiency virus (HIV) infection. We report herein the ninth case of multiple eruptive dermato fibromas associated with HIV infection. The relevant literature is reviewed and the differences of these lesions from "ordinary" dermatofibromas are discussed.     

Multiple cellular neurothekeomas in a middle‐aged woman including the lower extremity: A case report and review of the current literature

Cellular neurothekeoma is a benign cutaneous neoplasm that typically occurs on the head, neck, and upper body of young adults with a slight female predominance. It is a rare lesion to diagnose and multiple neurothekeomas in one patient are even more uncommon finding. We present a case of multiple neurothekeomas in a middle‐aged woman with lower extremity involvement and summarize the current literature on multiple neurothekeoma patients. A 46‐year‐old female presented with nearly one dozen skin‐colored papules on the head, upper limb, and lower limb. The lesions were clinically diagnosed as dermatofibromas and a nevus. Eight lesions were biopsied and confirmed to be cellular neurothekeomas, with one initially misinterpreted on histology as a dermatofibroma. Awareness of cellular neurothekeoma as a diagnostic entity and the possibility of atypical presentations as seen in our case (eg, in multiple numbers, in older adults, and on the lower extremity) are important in allowing for accurate clinical and histological diagnosis of these lesions. The possibility of a syndromic association with multiple cellular neurothekeomas should be explored further.     

A case of polypoid dermatofibroma

Dermatofibroma is a common benign cutaneous tumor that usually appears as a slowly growing firm nodule. Polypoid nodular dermatofibroma is a variant type that is rarely encountered. We reported a case of polypoid dermatofibroma with a review of the previously reported cases. Polypoid dermatofibroma tends to arise on the leg, especially below the knee. Its size is often larger than that of common dermatofibroma. It is speculated that both the underlying firm tissue and long-term development may lead the tumor to form a polypoid appearance.     

Multiple Dermatofibromas Accompanied by Eruptive Benign Keratoses in a Patient with Systemic Lupus Erythematosus

We describe a 39-year-old woman with systemic lupus erythematosus who developed 20 dermatofibromas accompanied by more than 30 eruptive benign keratoses while she was receiving systemic corticosteroid therapy. We are not aware of a previous case of multiple dermatofibromas accompanying multiple eruptive keratoses. The autoimmune disease or altered immunity, or both, may have played a role in the pathogenesis of these conditions.     

Squamous cell carcinoma in situ overlying dermatofibroma

There are occasional reports of benign proliferative epidermal changes overlying dermatofibromas and rare cases of invasive basal cell carcinoma. We report the first case to our knowledge of a dermatofibroma with overlying in situ squamous cell carcinoma.     

Atrophic dermatofibroma

Atrophic dermatofibroma, a newly proposed entity in recent times, is thought to be a specific variant of dermatofibroma. We report a typical case of atrophic dermatofibroma on the thigh of a 69-year-old female. The lesion consisted clinically of a light brown, intracutaneous nodule with a central crateriform depression, and histologically of fibrohistiocytic components in the thinning dermis. On elastica van Gieson stain, loss of elastic fibres and dense accumulation of elastic fibres around medium-sized vessels were observed in the lesion.     

Multiple dermatofibromas and systemic lupus erythematosus

We report on three black women with multiple dermatofibromas and systemic lupus erythematosus. In one patient occurrence of new dermatofibromas was definitely related to increases in corticosteroid dosage, but in another the dermatofibromas predated all treatment. Histopathologic, ultrastructural, and direct immunofluorescence studies of lesions of two of the patients showed characteristic changes of dermatofibroma but did not reveal a specific cause. This finding in patients with systemic lupus erythematosus is probably much more common than has previously been appreciated.     

Sebaceous hyperplasia overlying a dermatofibroma

Epithelial changes overlying dermatofibromas are well recognized. The presence of sebaceous differentiation overlying a dermatofibroma is unusual. We report two patients with sebaceous hyperplasia overlying a dermatofibroma and discuss possible mechanisms for induction of the epithelium and adnexa by the mesenchyme in a dermatofibroma.     

Giant dermatofibroma with monster cells.

We report a case of a 64-year-old woman with a giant dermatofibroma on her back with the unusual histologic feature of monster cells. The firm, exophytic, 3-cm nodule had purple and yellow components with surface telangiectasia. Histologic examination demonstrated characteristic findings of a dermatofibroma, including rete ridge flattening and bridging; a stroma containing scattered, large, round, eosinophilic collagen bundles; and a polymorphous dermal infiltrate of spindle and xanthomatous cells with scattered siderophages. Some xanthomatous cells demonstrated features consistent with monster cells, including huge bizarre nuclei and one or more nucleoli. Immunohistochemical staining for factor XIIIa was positive. A diagnosis of giant dermatofibroma with monster cells (DFMC) was made. Giant dermatofibromas are rare, with monster cells being an uncommon finding in dermatofibroma. To our knowledge, this is the first report of DFMC.