A 5-year-old, otherwise healthy, female presented to the dermatology clinic with a 1-year history of a raised lesion on her right upper chest ( Figure 1). Her parents originally believed it was a mosquito bite; however, it continued to enlarge over time. While occasionally tender, no bleeding, crusting, or discharge from this solitary lesion was reported.Physical examination revealed a 2.0-cm by 1.5-cm rubbery, smooth, mobile tumor with overlying telangiectasias and erythema on the right chest. The tumor was nontender; neither tent sign nor punctum was visible. A skin biopsy and subsequent excision revealed a well-demarcated dermal tumor composed of mononuclear histiocytes and osteoclast-like giant cells arranged in a plexiform pattern on hematoxylin and eosin (H&E)-stained sections. (Figure 2A).Throughout the specimen, no necrosis or cellular pleomorphism was appreciated ( Figure 2B). The lesional cells were highlighted with vimentin and CD68 ( Figure 2C). MITF, S-100, and pancytokeratin stains were negative. Smooth muscle actin highlighted small vascular channels but was negative in the lesional cells. Between the plexifom collections of histocytes, a collagen stroma was noted, which showed some areas of sclerosis. These features established the diagnosis of plexiform fibrohistiocytic tumor. In the excisional specimen, the tumor extended to the margins, and re-excision did not show any residual lesion. | ME THODSA review of previously published literature was performed to identify case reports, case series, reviews, and retrospective studies that described novel cases of plexiform fibrohistiocytic tumor (PFT).Using the National Center for Biotechnology Information PubMed tool, the search was narrowed using the key terms of "plexiform," "fibrohistiocytic," and "tumor." The inclusion criteria included the aforementioned study types whose individual cases demonstrated histologic evidence of PFT diagnosis, namely histiocytes and giant cells arranged in a plexiform pattern of dermal tumor nodules.Exclusion criteria included studies published in a language other than English and lack of appropriate histologic diagnostic features.Tumors occurring in adults were included as well for completeness. AbstractPlexiform fibrohistiocytic tumor (PFT) is a rare neoplasm of mesenchymal origin that can be identified by its propensity for children and adolescents combined with a characteristic histologic arrangement of histiocytes and osteoclast-like giant cells whorled within tumor islands. A 5-year-old female presented with a raised, intermittently tender, and slowly enlarging tumor on her chest, which was histologically confirmed to be a PFT. We present this case along with a comprehensive review of PFT cases reported in the literature to describe the demographic, histologic, and rarely metastatic behavior of this entity. It is important to include PFT on the differential diagnosis of an enlarging tumor in the pediatric population. K E Y W O R D Sdermatopathology, lumps/bumps, neoplasms-benign

Fat-soluble vitamins exhibit numerous routes of immune modulation and specifically alter a variety of pathways in psoriasis pathology. Psoriasis, a chronic immune-mediated disease, often requires a combination of topical, oral, and occasionally, subcutaneous or intravenous therapies making disease management complex. With the complexity of treatment, patient adherence is reduced. Vitamin supplementation as an adjunctive treatment would minimize potential adverse effects from systemic medication, increase patient adherence and decrease overall cost. While vitamin A and D are effective topically, oral supplementation is not currently a mainstay of therapy although data exists to support such supplementation. Data on vitamin E and K implicate the significant role each has in the alteration of the inflammatory cascade responsible for psoriasis. Research showing fat-soluble vitamin deficiency in psoriasis exists and presents greater evidence for oral vitamin treatment in addition to first-line therapies. This review presents the mechanism of action in psoriasis of each fat-soluble vitamin and the data on the efficacy of oral fat-soluble vitamin supplementation in psoriasis and systemic inflammation. We also present fat-soluble vitamin deficiency data shown in psoriasis patients. With the evidence of their targeted mechanism of action, efficacy data with oral supplementation, and evidence of deficiency in patients, oral fat-soluble vitamins should be considered as an adjunct to therapy in psoriasis patients.

No abstract