[P073] Atrophic dermatofibroma

( Ji Su Lee ),( Hyun-sun Park ),( Soyun Cho ),( Hyun-sun Yoon ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Atrophic dermatofibroma is an uncommon variant of dermatofibroma. Since it is apart from the classical presentation of dermatofibroma, it is often misdiagnosed. A 22-year-old female presented with a single atrophic and depressed lesion on her right posterior thigh since 4 years. There was no history of trauma or injury at the site. A punch biopsy was done under the diagnosis of anetoderma or panniculitis. Histopathological examination revealed a well-defined fibrohistiocytic dermal tumor with epidermal hyperplasia. There was a proliferation of spindle cells in haphazard arrangement in the dermis. The thickness of the involved dermis was less than 50% of adjacent dermis. Atrophic dermatofibromas represent approximately 2% of all dermatofibromas and are clinically presented as flat or dimpled atrophic plates, or slightly raised oval plaques which become depressed by manual compression. In many cases, atrophic dermatofibroma is initially misdiagnosed as anetoderma, resolving panniculitis, atrophic scarring, morphea and localized lipoatrophy. Histo-pathologically, atrophic dermatofibroma presents a reduction of at least 50% of the thickness of the dermis relative to the surrounding dermis. This histologic feature explains the dimpled or depressed appearance observed in atrophic dermatofibroma. Atrophic dermatofibroma should be considered in the differential diagnosis of atrophic, depressed lesions like our case.

Clinico-dermoscopic features of atypical dermatofibroma

( Haneul Oh ),( Byeong Geun Park ),( Jae Yeong Jeong ),( Tae Jun Park ),( Hwa Jung Ryu ),( Il-hwan Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize, but in some cases its differentiation from atypical dermatofibroma may be difficult. Dermoscopy, which is widely used in recent years, may be helpful in early detection of atypical dermatofibroma. Objectives: To describe the clinical and dermoscopic features of atypical dermatofibroma and to differentiate from typical type. Methods: We retrospectively searched the database of patients from Department of Dermatology, Korea University Ansan Hospital from 2010 to 2019, who had skin biopsy or excision operation with the resulting pathology report of typical and atypical dermatofibroma. Results: Of the 220 patients diagnosed with dermatofibroma, 20 (9.1%) cases were identified as atypical deramtofibroma. In comparison of clinical features, the atypical type was not significantly different from the typical type. However, dermoscopy findings of atypical dermatofibroma showed several distinct features. Peripheral homogeneous pigmentation and central white network pattern was the most common finding, which is only found in 6% of the typical dermatofibroma. Conclusion: Atypical dermatofibroma is clinically difficult to distinguish from the typical counterpart and biopsy is essential for diagnosis. If dermatofibroma is suspected and exhibits uncommon dermoscopy findings, it may be an atypical type and should be treated with caution when treating because of the tendency to recur and metastasis.

Letter to the Editor : Dermatofibroma on the Lip

( Woo Seok Jeon ),( Ji Hyun Lee ),( Tae Yoon Kim ) 대한피부과학회 2014 大韓皮膚科學會誌 Vol.52 No.12

Dermatofibroma (benign fibrous histiocytoma) can occur at various sites on the body surface with a predilection for the extremities1. However, involvement of the oral mucosa, especially of the lip, is very uncommon1. To our knowledge, only seven cases of dermatofibroma on the lip have been reported in the English literature (Table 1), and it has been rarely reported in the Korean literature2. Here, we report a case of a dermatofibroma on the upper lip. A 32-year-old woman presented with solitary nodule on the upper lip. She had an accidental lip biting injury 1 year previously. Several weeks after the minor trauma on the upper lip, she noticed an asymptomatic slow-growing solitary nodule at the bite site. Physical examination revealed a 7-mm, fixed rubbery nodule on the upper lip (Fig. 1A). The lesion was initially suspected as a mucocele or traumatic fibroma. Excisional biopsy was performed. Histologically, hyperplastic epidermis and a poorly circumscribed dermal tumor, which are separated by a Grenz zone from the epidermis, were observed (Fig. 1B). The tumor consisted of fibroblast-like spindle cells and histiocytes arranged in storiform pattern that intermingled with collagen fibers (Fig. 1C). Immunohistochemical staining for CD34, CD68, and factor XIIIa was performed. CD34 was negative in the fibroblastic spindle tumor cells and positive in vessels (Fig. 1D) CD68 was positive in the fibroblasts and histiocytes (Fig. 1E); and factor XIIIa was focally positive in the histiocytes (Fig. 1F). These findings were consistent with dermatofibroma. Dermatofibroma arising on the lip is very rare; therefore, it can preclude accurate clinical diagnosis. On the basis of this case, we suggest that dermatofibroma should be considered in the differential diagnosis of a nonulcerative nodule on the lip. One previously reported case was also associated with a history of trauma3. The pathogenesis of dermatofibroma has been controversial, as a reactive or inflammatory trigger by mechanical stimuli may contribute to its development4. Our case indicated the influence of a preceding traumatic episode, which tends to support the view that the disease arises from a reactive rather than a neoplastic process. However, it is still unclear whether dermatofibroma is a true neoplasm or a reactive hyperplasia. Simple excision is the definite treatment of dermatofibroma5; however, careful clinical follow-up is recommended because facial dermatofibroma has a high recurrence rate5.

Is it necessary to distinguish atypical dermatofibroma from the typical type?

( Jung Jin Shin ),( Ji Hyun Park ),( Jae Beom Park ),( Hee Won Jang ),( Hwa Jung Ryu ),( Sang Wook Son ),( Il Hwan Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Dermatofibroma is a common benign skin neoplasm. However, atypical dermatofibroma is a rare variant with more aggressive nature and requires complete excision due to its tendency to recur and ability to metastasize. Objectives: This study was done to evaluate the clinical and pathological features of atypical dermatofibroma and its difference from the typical form. Methods: We retrospectively searched the database of patients from Korea University Ansan Hospital from January 2005 to August 2015, who had skin biopsy or excision operation with the resulting pathology report of atypical dermatofibroma. Analysis of the clinical demographics and pathology was done. Results: 22 patients were distinguished as atypical dermatofibroma of the total 240 patients diagnosed with dermatofibroma. Clinical demographics was variable and was not vastly different from dermatofibroma. Pathology review showed atypical pleomorphic, spindle cells with multinucleated cells. Immunohistochemical stains with CD34/68 varied. On follow up, no recurrence occurred in patients treated with complete excision. Conclusion: Atypical dermatofibroma is clinically difficult to distinguish from the typical counterpart and biopsy is essential for diagnosis. It should be treated with more precaution due to its tendency to recur and metastasize. Although it is a poorly recognized variant, the potential to be mistaken for malignant proliferation and unnecessary treatment is enough to garner more attention.

피부섬유종의 면역조직화학적 연구

윤성재 ( Yun Seong Jae ),박경호 ( Park Gyeong Ho ),성환태 ( Seong Hwan Tae ),이동윤 ( Lee Do Yun ),한정호 ( Han Jeong Ho ),이일수 ( Lee Il Su ) 대한피부과학회 2004 대한피부과학회지 Vol.42 No.3

N/A Background: Dermatofibromas are common benign tumors which occur in the skin. They have been divided into fibrous lesions, composed entirely or almost entirely of fibroblasts and collagen, and cellular lesions composed to a significant degree of phagocytic cells with the appearance of histiocytes. A cellular variant characterized by increased cellularity, storiform arrangement, larger size, and location in the deep dermis, often with extension into the superficial subcutaneous tissue may be difficult to differentiate from dermatofibrosarcoma protuberans. There is an incessant controversy over the histogenesis of dermatofibromas, although many authors consider that these tumors derive from primitive mesenchymal cells. The recent development in immunohistochemical staining technology and ultrastructural study revealed various cellular proliferation in the lesion, including fibroblast, histiocyte and myofibroblast. Objective: Our purpose was to study by immunohistochemistry the differences between fibrous and cellular dermatofibromas and to find the relationship between the myofibroblast and the histogenesis of dermatofibroma. Methods: We will select 36 cases of dermatofibromas which include 27 fibrous and 9 cellular types. We have studied the immunophenotype of 36 dermatofibromas using antibodies against vimentin, smooth muscle actin, desmin, CD34, factor XⅢa, CD68 and MMP 11. Results: All dermatofibromas were positive for vimentin, smooth muscle actin, and factor XⅢa, but negative for desmin and CD34. All cellular type were positive for CD68, but 24/27 of the fibrous type were positive for CD68. MMP 11 was positive in 6/9 of the cellular type and 25/27 of the fibrous type. The degree of staining for vimentin, factor XⅢa, CD68, and MMP 11 was not different in both types. But the degree of staining for smooth muscle actin in the fibrous type was higher than in the cellular type. Conclusion: The differences in the degree of staining for smooth muscle actin and the positivity for CD68 suggest the possibility of a different differentiation of dermatofibroma between cellular and fibrous types. the prominent vimentin and smooth muscle actin immunoreactivity and desmin non-reactivity may suggest that the myofibroblast may play a role, in part, for developing dermatofibromas. Further investigations with ultrastructural study using electron microscopy and double/triple immunohistochemical staining would be necessary. (Korean J Dermatol 2004;42(3):256~263)

비전형적 피부섬유종의 임상적 특징과 더모스코피 소견에 관한 연구

오하늘 ( Haneul Oh ),문혜림 ( Hye-rim Moon ),유화정 ( Hwa-jung Ryu ),김일환 ( Il-hwan Kim ) 대한피부과학회 2021 대한피부과학회지 Vol.59 No.5

Background: Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize; however, in some cases, it is difficult to differentiate it from atypical dermatofibroma. Atypical dermatofibroma is a rare variant of a more aggressive nature and requires complete excision due to its tendency to recur. Objective: To describe the clinical and dermoscopic features of dermatofibromas with special emphasis on the characteristics of atypical subtypes and to differentiate them from typical subtypes on the basis of results. Methods: We retrospectively searched the databases of patients of Korea University Ansan Hospital from January 2010 to December 2019 who underwent skin biopsies or excision surgeries and had pathological reports of dermatofibroma. Analyses of the clinical characteristics (age, sex, number of lesions, anatomical site) and dermoscopic patterns were performed. Results: Dermoscopic patterns were analyzed in 148 cases of dermatofibroma; peripheral delicate pigment networks and central white scar-like patches were the most common patterns found in 45 cases (30.4%). In eight cases of atypical dermatofibroma, three cases (37.5%) showed peripheral homogenous areas and central white networks, followed by multiple white scar-like patches in 2 cases (25.0%), peripheral delicate pigment networks, and central white scar-like patches in 2 cases (25.0%). Dermoscopy revealed a statistically significant difference in the peripheral homogenous area and the central white network pattern between the two groups. Conclusion: In this study, we analyzed the dermoscopic findings of 148 patients with dermatofibroma and found that the peripheral homogenous area and central white network patterns were significantly more in atypical dermatofibroma. (Korean J Dermatol 2021;59(5):341∼347)

Clinicodermoscopic features of atypical dermatofibroma compared with typical type

( Haneul Oh ),( Tae Jun Park ),( Bo Young Kim ),( Chang Min Kim ),( Hwa Jung Ryu ),( Hye Rim Moon ),( Il-hwan Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Dermatofibroma is a common benign skin neoplasm that is usually easy to recognize, but in some cases its differentiation from atypical dermatofibroma may be difficult. Objectives: To describe the clinical and dermoscopic features of atypical dermatofibromas and to differentiate from typical type according to the above features. Methods: We retrospectively searched the database of patients from Korea University Ansan Hospital from January 2010 to July 2018, who had skin biopsy or excision operation with the resulting pathology report of typical and atypical dermatofibroma. Analysis of the clinical demographics (age, gender, anatomical site etc.) and dermoscopic features was done. Results: Of the 240 patients diagnosed with dermatofibroma, 19 (7.9%) were identified as atypical deramtofibroma. In comparison of clinical features, the atypical type was not significantly different from the typical type. However, dermoscopy findings of four patients with atypical dermatofibroma were analyzed, and These dermoscopic findings are patterns that appear below 6% in typical types. Conclusion: Atypical dermatofibroma is clinically difficult to distinguish from the typical counterpart and biopsy is essential for diagnosis. If dermatofibroma is suspected and exhibits rare dermoscopy findings, it may be an atypical type and should be treated with caution when treating because of the tendency to recur and metastasis.

A case of lipidized dermatofibroma diagnosis with hyperlipidemia

( Dong Won Lee ),( Dae Yeon Kim ),( Tae Hyung Ryu ),( In Hyuk Kwon ),( Jae Eun Choi ),( Hyo Hyun Ahn ),( Young Chul Kye ),( Soo Hong Seo ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Lipidized dermatofibroma is a subtype of dermatofibroma and rarely observed relatively. The tumor develops preferentially on the lower limbs, especially around the ankle, and shows relatively large size compared with those of typical dermatofibroma. A 41 year old male presented with a enlarging yellowish tender pigmented nodule on the left shin. The patient reported a history of trauma on the left shin 2 years ago and has no pre-diagnosed underlying disease. In a histopathological finding, a dermal foamy histiocytes collection was observed, which was then diagnosed as Lipidized dermatofibroma. We practiced a laboratory test, the LDL-cholesterol rose to 181mg/dL. He was referred to the Internal medicine department and diagnosed as Hyperlipidemia and a medication for down-regulate serum lipid was prescribed. According to the few studies, hyperlipidemia is not a direct cause to dermatofibroma’s lipidization. In one retrospective study, age, location, serum cholesterol level had no correlation with lipidized dermatofibroma.. The patient complained of increase-in-size and tenderness. We suggest the possibility that hyperlipidemia have contributed to progression of pre-existed lesion. Lipidized dermatofibroma is relatively rare, so all of the studies are approached retrospectively. Therefore, we may consider conducting a laboratory test to discover whether hyperlipidemia is observed in patients with lipidized dermatofibroma.

피부섬유종의 더모스코피 소견과 조직학적 아형의 상관관계에 관한 연구

황수란 ( Su Ran Hwang ),우수한 ( Soo Han Woo ),이진호 ( Chin Ho Rhee ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.10

Background: Dermoscopic features may be useful in verifying the clinical diagnosis and increasing the diagnostic accuracy of dermatofibroma. There have been no systematic analyses of the dermoscopic features of dermatofibroma in Koreans or studies regarding the correlation between dermoscopic features and histologic subtypes. Objective: To investigate the dermoscopic features of dermatofibroma in Koreans and to explore the relationship between the dermoscopic features and histologic subtypes of dermatofibroma. Methods: The study included 83 lesions from 61 patients with dermatofibroma. Dermoscopic examination was performed via hand-held polarized dermoscopy at 10× magnification. Images were documented using a digital camera with a 3-fold optical zoom. Results: The main dermoscopic structures were pigment network (63.9%), white scar-like patch (53.0%), and homogeneous area (50.6%). The frequency of homogeneous area (50.6%), scale (50.6%), ring-like structure (36.1%), exophytic papillary structure (7.2%), and telangiectasia (6.0%) was significantly higher, and globule-like structure (20.5%) and erythema (8.4%) was significantly lower in Koreans than in Caucasians (p<0.05). Eleven dermoscopic patterns including a peripheral delicate pigment network and central white scar-like patch (28.9%) and total delicate pigment network (15.7%) were observed and there was no significant difference compared to Caucasians. Seven histologic types were observed; however, the correlation between dermoscopic features and histologic subtypes was not significant. Conclusion: The most common pattern of dermatofibroma was pigment network and central white scar-like patch in both Koreans and Caucasians. A correlation between dermoscopic features and histologic subtypes in dermatofibroma was not found. These results may be helpful in clinically diagnosing dermatofibroma, especially in Koreans. (Korean J Dermatol 2014;52(10):681∼691)

[P067] A case of dermatofibroma on scalp

( Yu Jin Jeon ),( Dae Young Oh ),( Young Min Jo ),( Jae Hwa Kim ),( Joong Sun Lee ),( Dae Won Koo ),( Kyung Eun Jung ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Dermatofibroma is a benign tumor of unknown etiology that has a predilection for the lower legs of women. Any age may be affected, but typically dermatofibroma appear in the 20s and 30s. The lesion is characterized by an asymptomatic papule or nodule with domed surface and variable colors such as skin-colored, pink, brown and dark chocolate brown. It commonly occurs at legs, arms, and trunk and the lesion is solitary at most cases. A 39-year-old woman presented with a solitary pink colored papule on scalp of occipital area of 2 month in duration. She had no history of trauma or contact chemical irritants. There has been no change on the skin lesion on scalp for 2 months. Histopathologic examination of the lesion on the scalp revealed whirling fascicles of spindle cells with small amounts of pale blue cytoplasm and elongated nuclei and hyperplastic overlying epidermis, which was supportive for dermatofibroma. She didn`t want to get surgical removal because the lesion is stable and asymptomatic, so we decided to observe her regularly. There have been numerous reports about dermatofibroma on the extremities and trunk. However, this is a rare case of dermatofibroma occurred on the scalp. Additionally, dermatologists should be aware that dermatofibroma is not usually an indication of surgical removal, as the resulting scar is often less cosmetically acceptable.