Cellular digital fibromas: distinctive CD34-positive lesions that may mimic dermatofibrosarcoma protuberans.
ABSTRACT Digital fibromas are common benign acral tumors typically reported as angiofibromas (AFs) or acquired digital fibrokeratomas (ADFs). Cellular variants are not well recognized.
We collected 14 acral fibrocytic lesions showing a spindle cell morphology from our files, and evaluated CD34, Factor XIIIa, epithelial membrane antigen (EMA), and S100 protein staining of these lesions. We compared the histologic and immunohistochemical features of these cellular fibromas with five digital AFs, five ADFs, and five digital dermatofibromas.
The 14 cellular digital fibromas showed intersecting fascicles of thin delicate bland spindle cells in the superficial reticular dermis with a fibrotic-to-slight myxoid stroma. The spindle cells in all cases stained strongly for CD34, and only scattered stromal cells stained for Factor XIIIa. Five tested cases were negative for EMA and S100 protein. The digital AFs, fibrokeratomas, and dermatofibromas stained predominately for Factor XIIIa, with no or minimal staining for CD34.
These findings suggest that a subset of digital fibromas is characterized by a dense cellular proliferation of CD34-positive spindle cells. Awareness of this variant of digital fibroma and its staining pattern is critical in preventing misdiagnosis as dermatofibrosarcoma protuberans, particularly in superficial biopsies.
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ABSTRACT: The authors report a case of superficial acral fibromyxioma (SAF) in a 74-year-old male who presented with a painless mass in a periungual dorsoradial region of the right thumb. It is a rare benign neoplasm, which was recently described, that arouse on the skin and subcutaneous tissue of the hands and feet, especially in the proximity to the ungual region of male adults. Surgical treatment was performed with the excision in blocks of the margins of the lesion and fragmentation of the nail and nail matrix, according to the literature recommendation. Although there may be local recurrence in 22% of the cases, the patient presents no symptoms, deformities or functional limitations. In addition, there was no sign of tumor recurrence 18 months after the surgery. We are not aware of a similar case report in the Brazilian literatureRevista Brasileira de Ortopedia 04/2013; 48(2):200-203.
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ABSTRACT: Fibroblastic proliferations in the dermis comprise a heterogeneous group of disorders that can pose diagnostic challenges. We sought to study the clinicopathologic features of this tumor. We reviewed the clinicopathologic features of 5 unusual mesenchymal tumors of the digits that, to our knowledge, correspond to an entity not previously described. The patients were 5 men. All cases were located in the digits and were associated with history of trauma. Histopathologically, the neoplasms were located mainly in the reticular dermis. The tumors consisted of solitary nodules composed of fascicles of benign-appearing spindle cells devoid of cytologic atypia. The spindle cells formed short fascicles arranged in a haphazard manner. On immunohistochemistry, the tumor cells expressed vimentin and in 2 cases, CD34. The tumor cells were negative for smooth muscle actin (SMA), desmin, h-caldesmon, epithelial membrane antigen (EMA), S100, CD68, CD99, and beta-catenin. Only 5 cases were studied. Awareness of this entity is of importance to avoid misdiagnosis with other conditions. Based on the immunohistochemical pattern, we believe that these tumors are fibroblastic in origin. The peculiar gross appearance and location of the lesions is clinically quite distinctive and may lead to confusion with other neoplastic and reactive processes.Journal of the American Academy of Dermatology 07/2013; · 5.00 Impact Factor
- Piel 11/2006; 21(9):435-441.