Dermatofibroma with monster cells

Nineteen cases of dermatofibroma associated with monster cells are reported. The term "monster" (an animal with a strange or terrifying shape, one unusually large for its kind) implies a strikingly atypical cell with an extremely large nucleus. Except for monster cells, these 19 lesions had all of the typical histopathological findings of dermatofibroma. The clinical diagnosis for 16 of these lesions was dermatofibroma (or histiocytoma). Three lesions were submitted without any clinical diagnosis. Eighteen of 19 lesions occurred on the extremities. One was on the back. Monster cells are seen in the early, histiocytic stage of dermatofibroma when lipophages and/or siderophages are usually present in large numbers. Only rarely were mitotic figures seen in dermatofibromas with monster cells, and they were neither numerous nor atypical. It is important for histopathologists to distinguish dermatofibroma with monster cells from cutaneous malignant fibrous histiocytoma and radiation sarcoma. The criteria for differentiation concern primarily the architectural pattern of the lesion rather than its cytological features.     

皮肤纤维瘤105例分析

皮肤纤维瘤是来源于皮肤成纤维细胞的一种良性肿瘤。还是类似于癜痕组织的一种炎症后反应,就上述问题查阅105例皮肤纤维瘤病例,重新阅片并结合病史加以总结。组织病理显示所有的切片均表现为纤维组织不同程度的增生,其外周血管充血及炎细胞浸润。结合病史认为皮肤纤维瘤是类似于瘢痕组织的一种炎症后反应。     

150例皮肤纤维瘤组织病理与临床分析

目的 分析皮肤纤维瘤（DF）的组织病理与临床特征,探讨两者的相互联系。方法 回顾分析2017年9月至2018年8月在上海市皮肤病医院病理科经皮肤组织病理检查确诊的150例DF患者的临床和组织病理资料。结果 150例患者中,男65例,女85例,年龄（42 ± 13.8）岁,病程3个月至 > 30年,部分有伴随症状,主要表现为瘙痒,有自发痛、轻压痛,18例皮损有外伤、虫咬或感染病史。皮损主要位于四肢（107例,71.3%）,以单发皮损为主（105例,70%）。病理检查前拟诊为“DF”102例,“表皮样囊肿”16例,“色痣”13例,“瘢痕疙瘩”3例,“皮肤肿物”12例,“恶性黑素瘤”1例,“黄色肉芽肿”1例,“结节性痒疹”1例,“神经纤维瘤”1例。在这些患者的169张苏木精-伊红染色切片中,66张（39.1%）为细胞性,36张（21.3%）硬化性,25张（14.8%）表现为动脉瘤样型DF,22张（13.0%）上皮样型。12张切片内可见两种或两种以上亚型并存的现象。还可见少数新的变异型,如DF伴汗腺导管增生（1例）、深在型DF（3例）、上皮样细胞与增生胶原相间的DF（1例）等。动脉瘤样型DF病程长短不一,7个月至> 30年,多表现为发生于下肢的皮肤肿物样损害。细胞性DF病程相对较短,常发现数月后就诊,好发于四肢,常伴痒痛。硬化性或萎缩性DF病程长,为数年或数十年,好发于上肢,多无伴随症状。上皮样型DF病程长短不一,临床表现多样,多发于下肢,无伴随症状。结论 DF的临床表现及病理表现均具有多样性,不同的DF皮损可有相似的典型组织病理学表现,不典型的病理表现可干扰疾病诊断。     

Dermatofibroma with sclerotic areas resembling a sclerotic fibroma of the skin

BACKGROUND: Dermatofibromas are common benign tumors that occur as single or multiple nodules on the extremities in adults. Sclerotic fibroma of the skin (SFS) is a benign tumor characterized histopathologically by a well-demarcated, non-encapsulated dermal nodule composed of hypocellular, sclerotic collagen bundles with prominent clefts. The pathogenesis of these two conditions is still in dispute. METHODS: We present a case of dermatofibroma with sclerotic areas resembling a sclerotic fibroma of the skin and a review of the literature. RESULTS: The tumor showed a well-demarcated dermal, fibrocollagenous tumor with three different histopathological features. One-fourth of the lesion was consistent with dermatofibroma. Another area adjacent to dermatofibroma revealed hyalinized eosinophilic collagen bundles arranged in the characteristic interwoven pattern with prominent clefts, as is described in sclerotic fibroma of the skin. One-half of the lesion between the dermatofibroma and sclerotic fibroma showed transitional changes from dermatofibroma to sclerotic fibroma. CONCLUSION: According to these findings, the possibility that sclerotic fibroma is an ancient or degenerated stage of dermatofibroma cannot be completely ruled out, but some authors still consider that dermatofibroma and sclerotic fibroma of the skin are completely different neoplasms.     

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.     

Polypoid dermatofibroma with a slim pedicle: a case report

Dermatofibroma, also called cutaneous fibrous histiocytoma or sclerosing hemangioma, is a fairly common, benign cutaneous tumor. Polypoid dermatofibroma is an unusual and poorly recognized form of this entity. We describe a peculiar case of this variant presenting with a unique morphology characterized by a round flat shape with a slim pedicle, although its histopathological picture was rather typical of that of ordinary dermatofibroma.     

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.     

Mycosis fungoides exhibiting features of a dermatofibroma: a case report and review of the literature

We present the case of a 60-year-old male with known stage IA mycosis fungoides (MF) who developed a suspicious tumor within a pre-existing lymphomatous plaque of the right forearm. Microscopy revealed an unusual mixed fibrohistiocytic proliferation as well as atypical intraepidermal and dermal lymphocytes. There was no evidence of large-cell transformation. Histopathological, immunohistochemical and clinical clues suggest this lesion might not have represented a dermatofibroma, but rather a hitherto unreported dermatofibroma-like process arising within a lesion of MF. The potential impact of this atypical lesion on the prognosis and clinical management of this patient highlights the importance of recognizing unusual clinical presentations of more common, benign lesions within this patient population.     

Atypical polypoid dermatofibroma: report of two cases

Two cases of a hitherto undescribed special variant of dermatofibroma are reported. A man and a woman, aged 57 and 52 years, respectively, had slowly growing cutaneous tumors on the lower extremities. The tumors were exophytic and polypoid, 10 and 6 cm in maximal diameters, respectively; they were covered by rough nonulcerated skin and were joined by a short pedicle to an indurated base. Histologic examination showed some features of an otherwise conventional dermatofibroma, whereas the polypoid component was hypercellular and showed striking atypia and scattered mitotic figures. After 32 and 28 months' follow-up, the lesions did not recur after surgical excision. We suggest the term atypical polypoid dermatofibroma to summarize the special clinicopathologic features of these tumors.     

Variants of dermatofibroma - a histopathological study

Several variants of dermatofibroma have been described. They are essentially distinguished by their clinical and histopathological features. To review the mainfeaturesof these variants, a retrospective study of skin biopsies and tissue excisions of dermatofibromasperformed in the dermatology and venereology service at the Hospital Garcia de Orta between May 2007 and April 2012 was carried out. During that period, 192 dermatofibromas were diagnosed in 181 patients, the lesions being more common in women. Median age of the study population was 48 years. The most common lesion site was the limbs (74% of patients). The histopathological types found were common fibrous histiocytoma (80%) and the aneurysmal (5.7%),hemosiderotic (5.7%), epithelioid (2.6%), cellular (2.1%), lipidized (2.1%), atrophic (1.0) and clear cell (0.5%) variants. Based on these findings, this review focuses on the clinical and histological features of the various variants of dermatofibroma in terms of their clinical presentation, distinct histopathological features, differential diagnosis and prognosis.     

Lichenoid, erosive and ulcerated dermatofibromas. Three additional clinico-pathologic variants

On the occasion of a case of dermatofibroma with histological lichenoid features, we reviewed from our files all the cases in which the epidermis, usually hyperplastic in dermatofibroma, was, in some way, partially or completely destroyed. Among a total of 484 dermatofibromas, we found three lichenoid, six erosive and two ulcerated cases. In the three lichenoid cases, the columnar epidermal basal cells were lacking (squamotization of the basal layer) and in two of them there was a cleft between the epidermis and the dermatofibroma. Three of the six eroded cases were large pedunculated dermatofibromas with inflammatory phenomena of variable intensity. One case was in the center of a plaque of lichen simplex chronicus with some eroded area. In the other two cases, as well as in the two ulcerated lesions, neither inflammation nor epidermal changes usually attributed to rubbing or scratching were seen. Only in three of the eleven cases dermatofibroma was proposed (with question mark) as a clinical diagnosis. Both follow-up and histopathology supported the benign nature of these cases. We may conclude that: i) Lichenoid, erosive and ulcerated changes in dermatofibroma are infrequent phenomena which may make a clinical diagnosis difficult; and ii) in the presence of an otherwise histopathologically typical dermatofibroma, erosion and ulceration should not be considered as suspicious of malignancy.     

Dermatofibroma in a black tattoo: report of a case

Tattooing has been associated with a variety of complications including inflammatory and granulomatous reactions, transmission of infections, and neoplasms. We report a case of a 24-year-old male who presented with a 2-month history of an erythematous nodule involving a newly made tattoo on the right leg. An excisional biopsy was performed and the histopathological evaluation was consistent with dermatofibroma. Only three cases of dermatofibroma associated with tatooing were reported in litetature. We report an additional case and review the literature regarding cutaneous reactions to tattoos.     

Primary cutaneous aggressive epidermotropic CD8(+) T-cell lymphoma: Proposed diagnostic criteria and therapeutic evaluation

Primary cutaneous aggressive epidermotropic CD8(+) T-cell lymphoma is a rare cytotoxic lymphoma characterized clinically by aggressive behavior and histologically by prominent epidermotropism of atypical CD8(+) lymphocytes. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still awaiting. Herein, we study and analyze the different clinical, histopathological, and immunohistochemical features described in the reported cases. Different therapeutic modalities and their impact on the prognosis of the tumor are also evaluated and presented. We propose two sets of diagnostic criteria. The first comprises constant clinical, histopathological, and immunohistochemical features that are always present in every case, and the combination of which is necessary for the diagnosis. The second set helps to avoid missing cases and includes variable features that may be present in some cases, and to which any emerging finding could be added. Although different therapeutic options have been used, either as single agents or in combinations, there is no standard therapy for primary cutaneous aggressive epidermotropic CD8(+) T-cell lymphoma and the tumor still represents a therapeutic challenge with very poor prognosis.     

Melanoma associated with a dermatofibroma

BACKGROUND: Dermatofibromas are common benign cutaneous fibrohistiocytic neoplasms, whereas melanomas are potentially aggressive malignancies. Differentiating these two entities can occasionally be difficult. METHODS: We report the case of a 56-year-old female presenting with a firm pink papule on the left thigh. RESULTS: Histopathology revealed atypical melanocytes in the epidermis and papillary dermis with numerous mitotic figures and intraepidermal pagetoid spread. Within the dermis was a poorly demarcated collection of epithelioid and spindled cells with intermixed keloidal collagen. The atypical melanocytes stained for MART-1 and S-100, whereas the underlying fibrohistiocytic tumor took up factor XIIIa immunostain, confirming the diagnosis of invasive malignant melanoma occurring in association with a dermatofibroma. CONCLUSIONS: This case emphasizes the role of immunohistochemical stains in correctly diagnosing melanocytic and histiocytic neoplasms.     

Dermatofibroma with diffuse eosinophilic infiltrate

Dermatofibroma, a common form of benign fibrous histiocytoma, is characterized by the presence of different cell types consisting of fibroblastic, histiocytic, and even multinucleated cells. Dermatofibromas are always accompanied by an inflammatory lymphoid cell reaction, including B cells and T cells at their border. To our knowledge, however, there is no report of an infiltration of eosinophils within this tumor. We describe a dermatofibroma on the pretibial region of an 8-year-old boy. Microscopic examination revealed a diffuse eosinophilic infiltration within the dermatofibroma, which was typically composed of histiocytic cells and mature collagen. The diagnosis of dermatofibroma was confirmed by demonstrating the immunoreactivity of tumor cells to an anti-factor XIIIa antibody.     

Sweet's syndrome: a spectrum of unusual clinical presentations and associations

BACKGROUND: Sweet's syndrome (SS) is the prototypic neutrophilic dermatosis. First described in 1964, the characterization of new clinical associations, unique histopathological findings and clinical variants have stimulated much interest and discussion recently. However, the prevalence of these unusual variants and clinical associations within a single cohort of patients, has not been described. OBJECTIVES: To describe and evaluate the prevalence of unusual clinical and histopathological features, as well as the clinical associations of SS seen in patients from the National Skin Centre, Singapore. METHODS: This is a retrospective study of all consecutive cases of SS seen at our centre over a 5.5-year period (June 1999-December 2004). Data on associated systemic diseases was obtained from the medical records and matched with information from the National Cancer Registry, Singapore. Patients not actively followed up for more than 3 months were contacted for their updated health status. RESULTS: Thirty-seven patients were identified. Ten (27%) had non-idiopathic SS. These were associated with haematological disorders, connective tissue disorders, infections or a drug. Twenty-nine patients (78%) had at least one atypical clinical or histopathological feature. Atypical clinical features included bullous lesions, SS with hand involvement or neutrophilic dermatoses of the hands and the concomitant existence of subcutaneous SS with pyoderma gangrenosum. SS was the presenting feature in three patients with infections caused by atypical organisms, including Mycobacterium chelonae, Penicillium species and Salmonella type D. Unique histopathological variants included subcutaneous SS and lesions containing an admixture of mature and immature neutrophils. Subcutaneous neutrophilic inflammation seemed to be more common in patients with an underlying haematological disorder. This group of patients also had a lower mean haemoglobin level. CONCLUSIONS: Unusual clinical and histopathological variants of SS described in the literature are similarly encountered in our cohort of patients, with some features being more common than others. We highlight and discuss some unique clinical and histopathological observations seen in our patients with SS.     

临床误诊为黑素瘤的其他疾病141例分析

【摘要】 目的 分析141例临床误诊为黑素瘤的病例,提高疾病认识及诊断水平。方法 回顾分析第四军医大学西京皮肤医院2001年11月至2019年9月病理数据库中141例临床初诊为黑素瘤但经组织病理检查排除黑素瘤诊断的患者临床及组织病理资料。结果 误诊为皮肤黑素瘤141例,男64例,女77例,误诊时中位年龄51岁,平均病期103.4个月。皮损主要表现为斑片、丘疹,颜色以黑色为主,组织病理诊断包括色素痣35例,基底细胞癌 29例,脂溢性角化病15例,鲍恩病 7例,甲黑素斑6例,表皮囊肿5例,汗孔瘤、出血及皮肤纤维瘤各4例,其他32例。结论 临床部分疾病表现有黑素瘤特征,容易误诊,需掌握其临床特征,积极进行皮肤镜、皮肤组织病理等辅助检查明确诊断,降低误诊率。     

Typical and atypical dermoscopic presentations of dermatofibroma

Background Dermatofibroma is a common skin neoplasm that is usually easy to recognize, but in some cases its differentiation from melanoma and other tumours may be difficult. Objective To describe the dermoscopic features of dermatofibromas, with special emphasis on the characteristics of atypical patterns, and to calculate pattern frequency according to the patients age and gender, anatomical site and histopathological subtype. Methods Two groups of patients were consecutively seen, one with dermatofibromas that were surgically excised because of clinically and/or dermoscopically equivocal aspects or following patient request, and another with non‐equivocal dermatofibromas. Each lesion was scored for previously reported global dermoscopic patterns and for additional features. Results A typical pattern was observed in 92 of 130 (70.8%) lesions, whereas an atypical pattern, that we named the ‘non Dermatofibroma (DF)‐like’ pattern, was seen in 38 of 130 (29.2%). Atypical dermatofibromas showed features reminiscent of different conditions, such as melanoma in 21(16.2%) cases, vascular tumour in six (4.6%), basal cell carcinoma in five (3.8%), collision tumour in three (2.3%) and psoriasis in three (2.3%). A significant association was found between the ‘melanoma‐like’ pattern/‘vascular tumour‐like’ pattern and males, whereas a trend was observed between the above‐mentioned patterns and hemosiderotic/aneurysmal DFs. ‘Peripheral pigment network and central white scar‐like patch’ pattern was found associated with females and classic histopathological variant of DF. Conclusion Dermatofibromas may display different morphological faces. The typical dermoscopic patterns allow a confident diagnosis, whereas a full surgical excision is always recommended in all doubtful cases.     

Atypical Spitz tumour: a 'chameleon' lesion

It is a common experience that many Spitz naevi deviate from the idealized or stereotypical representation found in the literature, often causing considerable difficulties in distinguishing them from melanoma. The diagnostic term 'atypical Spitz naevus' is used to describe lesions that deviate from the typical appearance of Spitz naevi and which have an uncertain biological significance and prognosis. The term 'Spitz tumour' has been proposed for these lesions, as the term 'naevus' indicates a lesion that is completely benign and presents no risk to the patient. We present a case of atypical Spitz tumour with peculiar atypical clinical and dermatoscopic features. The difficulty in managing this Spitz tumour was aggravated by the clinical diagnosis. In fact, the lesion appeared as a benign and nonmelanocytic lesion, a pigmented dermatofibroma. Our case underlines the difficulties present in the controversial chapter of spitzoid melanocytic lesions. The atypical Spitz tumour is a 'chameleon' lesion that can mimic not only melanocytic, but also nonmelanocytic lesions.