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'''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]] | ||