Dermatofibroma, histiocytoma, DF
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
- Histiocytoma, dermatofibroma lenticulare, fibrome en pastille, hard fibroma.
Mostly women in young adulthood, but also older people. The prevalence is around 50%. Histiocytomas are often not immediately presented to dermatologists
In addition to dermatofibroma vulgaris, there are several subtypes that can be primarily differentiated dermatopathologically:
Ossifying, sclerosing, desmoplastic, myxoid, xanthomatous, haemosiderotic
Deep infiltrating, facial area
Cellular architecture / typology:
Cell-rich (high recurrence rate, in males on legs), granular cell-containing, neurothekeoma, DF with monster cells, epithelioid cellular, pseudosarcomatous, metastatic,
- It is unclear whether this is a neoplasm or a skin reaction pattern. However, dendritic cell markers are indeed found, suggesting a relationship with the non-Langerhans cell histiocytoses. Since certain histiocytoma types tend to recur, this may also postulate the neoplasia.
- Ictus reaction
- Ruptured cyst
- There is a subsequent inflammatory connective tissue reaction
- Mostly on the lower extremity, a red/brown, sharply demarcated, lenticular nodule is seen
- If the skin lesion is fixed between the thumb and index finger, the nodule sinks (Fitzpatrick's sign)
- Unusually large dermatofibromas are called giant dermatofibromas
- Dermatoscopic pattern:
- Brown, rather light pigment network in the periphery of the lesion. No sharp demarcation against the surrounding skin. A scar is found in the centre of the lesion, which may be bizarre and irregularly configured. With polarisation, "shiny white lines" are found.
- Papular changes with pigment network should be excised if uncertain, no prolonged observation period recommended. Unfortunately, dermatofibromas have already turned out to be melanomas several times - deep-threshold excisions are useful and should also always be covered by the insurance company.
Extremities, especially legs, are the most frequent localisation. Dermatofibromas are rare on the face (separate subtype).
- Thickened (acanthotic) epidermis
- No sharp border to side and base
- No capsule
- Diffuse collections of spindle cells, some containing lipid or haemosiderin
- Subtypes: Cellular, Aneurismal, Epithelioid, Atypical, Lipid-containing, Cholesterol-containing, Palisade DF (see also at Classification).
- May bleed in trauma
- Differential diagnosis of amelanotic melanoma may be missed for a long time, there are known legal cases on this
Does not start, but persists for a long time.
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