Metastasizing Cellular Dermatofibroma

Colome‐Grimmer, Maria; Evans, Harry L.

doi:10.1097/00000478-199611000-00007

Cited by 86 publications

(41 citation statements)

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“…In most cases, there is a long delay (range, 4 to 228 months; median, 40 months) between the excision of the primary skin lesion and the emergence of metastases. Actually, long-term follow-up shows that those metastases, whatever their location, are characteristically slow-growing lesions, which justifies the iterative metastasectomy approach in case of pulmonary involvement (7,8). This is exemplified by Patient 1 of our series in whom a progressive inguinal lymph node enlargement was noticed as long as 13 years before inguinal lymphadenectomy and also by Patient 2 of Colome-Grimmer and Evans's report (7), who survived 8 years after his lung metastases had been detected.…”

Section: Discussionmentioning

confidence: 99%

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

Guillou¹,

Gebhard²,

Salmeron

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.

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Section: Discussionmentioning

confidence: 99%

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

Guillou¹,

Gebhard²,

Salmeron

et al. 2000

Modern Pathology

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“…The neoplastic cells contained enlarged vesicular nuclei, numerous mitoses (up to 50 mitoses in 10 high-power fields), and did not stain positively for CD34, S-100 protein and alpha-smooth muscle actin. The tumor showed multiple chromosomal aberrations including gains of chromosomes 1, 3, 7, 18, 22 and losses of chromosomes 4,5,6,7,8,9,11,12,13,18,19 indicating a marked genomic instability and an aggressive biological behavior (data not shown). Within 1 year the patient developed lung and retroperitoneal metastases and died of the disease.…”

Section: Methodsmentioning

confidence: 97%

“…During the past years a few examples of cellular, aneurysmal, atypical dermatofibromas as well as of dermatofibromas occurring on the face and in deep soft tissues have been reported that metastasized to lymph nodes and the lungs and even caused death of patients in some instances. 1,4,[6][7][8][9][10][11][12][13][14] Morphologically, the primary and the metastatic neoplasms showed classical features of the mentioned variants of dermatofibroma, and so far no predictive mophological features have been identified to separate classical benign dermatofibroma from rare metastasizing dermatofibroma. In this study, we investigated seven cases of malignant dermatofibroma in comparison with 10 examples of classical dermatofibroma and to 1 obvious pleomorphic dermal sarcoma not otherwise specified.…”

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confidence: 99%

Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases

et al. 2013

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Dermatofibroma (cutaneous fibrous histiocytoma) represents a common benign mesenchymal tumor, and numerous morphological variants have been described. Some variants of dermatofibroma are characterized by an increased risk of local recurrences, and there are a few reported metastasizing cases. Unfortunately, an aggressive behavior cannot be predicted reliably by morphology at the moment, and we evaluated the value of array-comparative genomic hybridization (CGH) in this setting. Seven cases of clinically aggressive dermatofibromas were identified, and pathological and molecular features were evaluated. The neoplasms occurred in four female and in three male patients (mean age was 33 years, range 2-65 years), and arose on the shoulder, buttock, temple, lateral neck, thigh, ankle, and cheek. The size of the neoplasms ranged from 1 to 9 cm (mean: 3 cm). An infiltration of the subcutis was seen in five cases. Two neoplasms were completely excised, whereas an incomplete or marginal excision was reported in the remaining cases. Local recurrences were seen in six cases (time to the first recurrence ranged from 8 months to 9 years). Metastases were noted between 3 months and 8 years after diagnosis in six patients. Two patients died of disease, and two patients are alive with disease. Histologically, the primary tumors showed features of cellular dermatofibroma (four cases), cellular/ aneurysmal dermatofibroma (one case), atypical/cellular dermatofibroma (one case), and classical dermatofibroma (one case). Mitotic figures ranged from 3 to 25 per 10 high-power fields, and focal necrosis was present in five cases. Interestingly, malignant transformation from cellular dermatofibroma to an obvious spindle cell/ pleomorphic sarcoma was seen in one primary and in one recurrent neoplasm. Five neoplasms showed chromosomal aberrations by array-CGH, suggesting that these changes may represent an additional diagnostic tool in the recognition of cases of dermatofibroma with a metastatic potential.

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“…DF almost pursues a benign course, with a recurrence rate of less than 2%, although a higher rate of recurrence has been reported for some variants, including the cellular, aneurysmal, and atypical (pseudosarcomatous) forms 14 . A higher rate of recurrence has been noted in the subcutaneous and deep types and in lesions located on the face, in which a recurrence rate of 15% has been reported 6,15 . Also, a local recurrence rate of 19% (four of 21 cases) has been reported in 21 cases from the previous subcutaneous DF series 2 .…”

Section: Discussionmentioning

confidence: 97%

Subcutaneous Dermatofibroma

Jung

Lee

et al. 2011

Ann Dermatol

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Dermatofibroma (DF) is usually confined to the dermis and the overlying epidermis is usually hyperplastic. Although DF with deep subcutaneous extension is commonly encountered, purely subcutaneous DF is uncommon. In this review, we describe a case of a 41-year-old male patient who presented with a painless, subcutaneous, hard papule on the left thigh. After the skin had been incised the lesion was totally removed, and histopathology revealed a subcutaneous dermatofibroma.

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Metastasizing Cellular Dermatofibroma

Cited by 86 publications

References 5 publications

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

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

Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases

Subcutaneous Dermatofibroma

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