Archives of Dermatology

1990

DOI: 10.1001/archderm.126.4.506

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Cholesterotic fibrous histiocytoma. Its association with hyperlipoproteinemia

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Cited by 19 publications

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“…Several distinctive variants of clinical or pathologic relevance have been described (1,2), including cellular FH (1-3), aneurysmal (angiomatoid) FH (4), atypical (pseudosarcomatous) FH or dermatofibroma with "monster cells," palisading FH, epithelioid FH, atrophic FH, ossifying FH and FH with osteoclast-like giant cells (5), cholesterotic FH associated with hyperlipoproteinemia (6), and lipidized "ankle-type" FH, which is not associated with hyperlipidemia (1). Although characterized by their potential for local recurrence, especially if incompletely excised, cellular and aneurysmal FH were not known, until recently, to be capable of metastatic dissemination.…”

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confidence: 99%

Metastasizing Fibrous Histiocytoma of the Skin: A Clinicopathologic and Immunohistochemical Analysis of Three Cases

³

et al. 2000

Modern Pathology

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The clinicopathologic and immunohistochemical features of three metastasizing fibrous histiocytomas of the skin are presented. The first patient had a 1.3-cm nodule in the right thigh, with right inguinal lymph node metastases 19 years later. The second patient, who had a 3-cm nodule excised from his left thigh and inguinal lymph node metastasis after 4 months, had a favorable outcome 14 years after local radiotherapy and chemotherapy. The third had a 2-cm nodule in his neck, which recurred 16 months later. Four months later, cervical lymph node metastases were found. The patient was alive and well 26 months after initial surgery. All three primary skin tumors involved the dermis and subcutis, appeared well-delineated but nonencapsulated, were associated with some degree of epidermal hyperplasia, and showed features of aneurysmal/atypical or cellular fibrous histiocytoma. The number of mitoses ranged from 6 to 11 per 10 high-power fields. Recurrences and metastases showed morphologic features similar to primary lesions. Tumor cells were positive, at least focally, for CD 68, Ki-M1p, and Factor XIIIa, and occasionally for smooth muscle actin. Desmin, CD 34, S-100 protein, and cytokeratin stainings were negative. Primary neoplasms, recurrences, and metastases showed a Mib-1 labeling index of 10% or less. Cellular, aneurysmal, and atypical (pseudosarcomatous) fibrous histiocytomas of the skin can metastasize, yet they often show a protracted clinical course. Risk factors for metastatic dissemination include large size, high cellularity, aneurysmal changes, marked cellular pleomorphism, high mitotic activity, tumor necrosis, and repeated local recurrences. (4) reported a case of aneurysmal FH of the neck, which metastasized to regional lymph nodes after repeated recurrences. In 1996, Colome-Grimmer and Evans (7) reported two patients with metastasizing cellular FH. In both cases, the tumor metastasized to regional lymph nodes and lungs, in one case after repeated recurrences. Two potential additional cases of metastasizing dermatofibroma have been found in the literature (8, 9). In the present study, we analyzed the clinicopathologic and immunohistochemical features of two cellular and one aneurysmal/atypical (pseudosarcomatous) FH of the skin, which had metastasized to regional lymph nodes. Most FHs of the skin are benign lesions. However, our results indicate that in rare instances, cellular, aneurysmal, and atypical variants of cutaneous FH may metastasize and could as a consequence be considered lowgrade sarcomas.

“…Several distinctive variants of clinical or pathologic relevance have been described (1,2), including cellular FH (1-3), aneurysmal (angiomatoid) FH (4), atypical (pseudosarcomatous) FH or dermatofibroma with "monster cells," palisading FH, epithelioid FH, atrophic FH, ossifying FH and FH with osteoclast-like giant cells (5), cholesterotic FH associated with hyperlipoproteinemia (6), and lipidized "ankle-type" FH, which is not associated with hyperlipidemia (1). Although characterized by their potential for local recurrence, especially if incompletely excised, cellular and aneurysmal FH were not known, until recently, to be capable of metastatic dissemination.…”

mentioning

confidence: 99%

Metastasizing Fibrous Histiocytoma of the Skin: A Clinicopathologic and Immunohistochemical Analysis of Three Cases

³

et al. 2000

Modern Pathology

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The clinicopathologic and immunohistochemical features of three metastasizing fibrous histiocytomas of the skin are presented. The first patient had a 1.3-cm nodule in the right thigh, with right inguinal lymph node metastases 19 years later. The second patient, who had a 3-cm nodule excised from his left thigh and inguinal lymph node metastasis after 4 months, had a favorable outcome 14 years after local radiotherapy and chemotherapy. The third had a 2-cm nodule in his neck, which recurred 16 months later. Four months later, cervical lymph node metastases were found. The patient was alive and well 26 months after initial surgery. All three primary skin tumors involved the dermis and subcutis, appeared well-delineated but nonencapsulated, were associated with some degree of epidermal hyperplasia, and showed features of aneurysmal/atypical or cellular fibrous histiocytoma. The number of mitoses ranged from 6 to 11 per 10 high-power fields. Recurrences and metastases showed morphologic features similar to primary lesions. Tumor cells were positive, at least focally, for CD 68, Ki-M1p, and Factor XIIIa, and occasionally for smooth muscle actin. Desmin, CD 34, S-100 protein, and cytokeratin stainings were negative. Primary neoplasms, recurrences, and metastases showed a Mib-1 labeling index of 10% or less. Cellular, aneurysmal, and atypical (pseudosarcomatous) fibrous histiocytomas of the skin can metastasize, yet they often show a protracted clinical course. Risk factors for metastatic dissemination include large size, high cellularity, aneurysmal changes, marked cellular pleomorphism, high mitotic activity, tumor necrosis, and repeated local recurrences. (4) reported a case of aneurysmal FH of the neck, which metastasized to regional lymph nodes after repeated recurrences. In 1996, Colome-Grimmer and Evans (7) reported two patients with metastasizing cellular FH. In both cases, the tumor metastasized to regional lymph nodes and lungs, in one case after repeated recurrences. Two potential additional cases of metastasizing dermatofibroma have been found in the literature (8, 9). In the present study, we analyzed the clinicopathologic and immunohistochemical features of two cellular and one aneurysmal/atypical (pseudosarcomatous) FH of the skin, which had metastasized to regional lymph nodes. Most FHs of the skin are benign lesions. However, our results indicate that in rare instances, cellular, aneurysmal, and atypical variants of cutaneous FH may metastasize and could as a consequence be considered lowgrade sarcomas.

“…Gibson et al reported three cases of necrobiosis lipoidica with cholesterol clefts on the background of severe diabetes mellitus [2]. Hunt et al reported a woman with a fibrous histiocytoma that showed cholesterol deposition in the setting of type IIB hyperlipidemia [9]. Histopathologically, these disorders show lipid-rich foam cells or macrophages on the background of hyperlipidemia or diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Crystal Deposition in Basal Cell Carcinoma: An Investigation of 4 Cases

et al. 2015

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Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. However, no cases of cholesterol crystal involvement in cutaneous cancer have been reported. We report four cases of basal cell carcinoma with cholesterol crystal deposition, and discuss the mechanism(s) of the condition. Disease duration, anatomical site, histopathological features, and serum lipid profiles were investigated. The median disease duration was 3.5 years, and the sites of the lesions were the scrotum (one patient) and the nose (three patients). Histopathologically, there was necrotized tissue around the clefts. In addition, we detected frequent apoptotic cells around the cholesterol clefts in two of the patients by using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Serum lipid levels were slightly elevated in two of the patients. In conclusion, cholesterol crystal deposition in basal cell carcinoma was considered to relate to a long disease duration with a tumor in a region that was subject to external irritation. Histopathologically, apoptotic cells around the cholesterol clefts indicated that lipids from the tumor cell membranes were one of the causes of cholesterol crystal deposition.

“…Furthermore, we could find only 3 definitive reports of cholesterotic fibrous histiocytoma associated with hyperlipoproteinemia. The first report was published by Hunt et al [ 1 ] in 1990, followed by the reports by Yu et al [ 2 ] and Takahashi et al [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Cholesterotic Fibrous Histiocytoma in a Patient with Metabolic Syndrome

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,

²

2017

Case Rep Dermatol

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Among the many variants of dermatofibroma, dermatofibroma with cholesterol cleft (cholesterotic fibrous histiocytoma) is extremely rare. Here, we describe the case of a 50-year-old male patient with a cholesterotic fibrous histiocytoma on his left lower leg. He presented with a hyperkeratotic nodule 6 mm in diameter with a brown surface on the extensor surface of his left lower leg. The lesion had developed over the course of a few years without any tendency to heal. A skin biopsy performed on the tumor showed histopathological findings compatible with those of dermatofibroma. Interestingly, the lesion included many cholesterol clefts, as well as foamy histiocytes and multinucleated giant cells around them. He had had metabolic syndrome for years. To the best of our knowledge, this is the first report of a cholesterotic fibrous histiocytoma in a patient with metabolic syndrome. We conclude that the altered microenvironment caused by metabolic syndrome, as well as hyperlipoproteinemia itself, may play a role in the pathogenesis of this rare case.

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