Dermatofibroma: Difference between revisions

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~~#redirect~~ [[~~Non~~-~~malignant_skin_disease#Dermatofibroma~~]]

{{ Infobox diagnosis

| Name = {{PAGENAME}}

| Image = SkinTumors-P9280848.jpg

| Width =

| 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)

| 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]]

| Stains =

| IHC =

| EM =

| Molecular =

| IF =

| Gross =

| Grossing =

| Site = [[skin]]

| Assdx =

| Syndromes =

| Clinicalhx = previous trauma

| Signs =

| Symptoms =

| Prevalence = common

| Bloodwork =

| Rads =

| Endoscopy =

| Prognosis = benign

| Other =

| ClinDDx =

}}

'''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]].<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==

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]].

*[[Dermal scar]].

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)].

*[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===

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>

===Epithelioid cell histiocytoma===

Features:

*Epithelioid cells.

*No lesional cells in epidermis.

DDx:

*[[Melanocytic lesions]] - esp. [[malignant melanoma]].

==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>

Image:

*[http://pathinfo.wikia.com/wiki/File:CD34.DFSP.100x.jpg DFSP - CD34 (wikia.com)].

==Sign out==

<pre>

SKIN LESION, LEFT SHOULDER, EXCISION:

- DERMATOFIBROMA.

</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===

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==

[[Category:Diagnosis]]

@@ Line 1: / Line 1: @@
-#redirect [[Non-malignant_skin_disease#Dermatofibroma]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = SkinTumors-P9280848.jpg
+| Width      =
+| 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)
+| 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]]
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      =
+| Grossing   =
+| Site       = [[skin]]
+| Assdx      =
+| Syndromes  =
+| Clinicalhx = previous trauma
+| Signs      =
+| Symptoms   =
+| Prevalence = common
+| Bloodwork  =
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    =
+}}
+'''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]].<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==
+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]].
+*[[Dermal scar]].
+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)].
+*[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===
+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>
+===Epithelioid cell histiocytoma===
+Features:
+*Epithelioid cells.
+*No lesional cells in epidermis.
+DDx:
+*[[Melanocytic lesions]] - esp. [[malignant melanoma]].
+==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>
+Image:
+*[http://pathinfo.wikia.com/wiki/File:CD34.DFSP.100x.jpg DFSP - CD34 (wikia.com)].
+==Sign out==
+<pre>
+SKIN LESION, LEFT SHOULDER, EXCISION:
+- DERMATOFIBROMA.
+</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===
+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]]

Dermatofibroma: Difference between revisions

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