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Dermpath-India Pathology of Fibrous Histiocytoma (Dermatofibroma) Dr Sampurna Roy MD 2022
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This is a common dermal tumour which usually occurs on the extremities in young adults. Fibrous histiocytoma is regarded as a neoplastic lesion by some authors and an inflammatory or reactive process by others. Gross: These are usually solitary round or ovoid firm nodule, less than 1cm in diameter. Aneurysmal variant may be upto 10 cms in diameter. Dark brown or red in colour. Cream or yellowish cut surface is noted in tumour with abundant lipid. Further reading: Anti-cytokeratin 20 staining of Merkel cells helps differentiate basaloid proliferations overlying dermatofibromas from basal cell carcinoma. Follicular basal cell hyperplasia overlying dermatofibroma. Sebaceous hyperplasia: a clue to the diagnosis of dermatofibroma. Plate-like sebaceous hyperplasia overlying dermatofibroma.
Dermatofibroma may be associated with melanocytic lesions.
Dermatofibroma may occur in patients associated with HIV infection. Multiple eruptive dermatofibromas in three men with HIV infection. Presence of Leishmania organisms in specific and non-specific skin lesions in HIV-infected individuals with visceral leishmaniasis.
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Visit: Epithelioid Fibrous Histiocytoma Visit: Aneurysmal Variant of Dermatofibroma
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Cellular Fibrous Histiocytoma
Characteristic features of cellular variant: - Extends into the subcutis - Mitotic figures are present. - Central necrosis may be present in some cases. - Lesion may recur, if incompletely excised. - Focal smooth muscle actin positive in 60% cases. CD34 is negative Differential diagnosis - Dermatofibrosarcoma protuberans Further reading: Cellular benign fibrous histiocytoma. Clinicopathologic analysis of 74 cases of a distinctive variant of cutaneous fibrous histiocytoma with frequent recurrence. Metastasizing cellular dermatofibroma. A report of two cases.
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Atypical Cutaneous Fibrous
Histiocytoma
This is a variant of cutaneous fibrous histiocytoma (dermatofibroma). Usually presents in middle-aged patients as small nodules occurring on the trunk, limbs , head, neck and vulva. Histologically these are primarily dermal lesions. Superficial involvement of the subcutis may occur. The degree of pleomorphism varied from only focal and minimal or moderate to marked. Number of mitotic figures ranged from 1 to 15 per 10 high power fields. Similar to the cellular and aneurysmal variants of fibrous histiocytoma, atypical fibrous histiocytoma shows a higher tendency to recur locally than ordinary fibrous histiocytoma and may rarely metastasize. Differential diagnosis: Pleomorphic sarcoma ; Atypical fibroxanthoma ; Malignant Fibrous Histiocytoma. Further reading: The value of immunohistochemistry in atypical cutaneous fibrous histiocytoma. Atypical cutaneous fibrous histiocytoma. Atypical 'pseudo sarcomatous' variant of cutaneous benign fibrous histiocytoma: report of eight cases.
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Differential diagnosis of
Dermatofibroma: - Dermatofibrosarcoma protuberans: CD34+ or +/- ; Factor XIIIa negative, monomorphic population of cells, irregularly infiltrative at the periphery, honeycomb pattern of infiltration into the subcutis). Further reading: Dermatofibroma and dermatofibrosarcoma protuberans: an immunohistochemical study reveals distinctive antigenic profiles. Deep penetrating dermatofibroma versus dermatofibrosarcoma protuberans. A clinicopathologic comparison. The pathological distinction between "deep penetrating" dermatofibroma and dermatofibrosarcoma protuberans. CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma. Tenascin differentiates dermatofibroma from dermatofibrosarcoma protuberans: comparison with CD34 and factor XIIIa. - Scar ; - Keloid ; - Some Hemangiomas; - Sclerotic Fibroma; - Dermal Dendrocytoma;
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