Dermatofibroma y metástasis pulmonares. Tratamiento actual

Clinicopathologic Features of Facial Dermatofibromas, a Cohort Study, and a Systematic Review of Literature

BACKGROUND

Dermatofibromas are common skin tumors that typically occur on the extremities and trunk and demonstrate benign behavior, frequent recurrences, and very rare metastasis. Facial dermatofibromas are rare and not well studied . We analyzed clinicopathologic features of facial dermatofibromas.

DESIGN

Considering the rarity of the condition, we conducted a cohort study and a systematic review. We queried medical records of a single tertiary care center for dermatofibromas from January 1, 2000, to July 1, 2021. A systematic review of multiple databases was conducted through October 27, 2021, to include studies reporting facial dermatofibromas. Random-effects meta-analysis was used to estimate pooled odds ratio and proportions with associated 95% confidence interval (CI).

RESULTS

The cohort study identified 2858 cases of dermatofibromas, of which, 23 cases from 18 patients were on the face (1%). The mean age was 52.7 ± 17.8 years. Fifty-six percent of the cases were women. The most common location was the forehead (6 cases). The mean follow-up was 54 months. Forty-four percent of the cases had subcutaneous involvement, and 39% were the cellular type. Margins were positive in 89% of the cases, recurrence rate was 22%, and no metastases were observed. The systematic review included 10 studies (119 patients). Meta-analyses showed that facial dermatofibromas were 2% of all dermatofibromas (95% CI: 1%-3%). The local recurrence rate was 14% (95% CI: 6%-26%). Facial dermatofibromas with subcutaneous involvement were more likely to recur [odds ratio 4.53 (95% CI: 1.12-18.24)]. Before histopathologic examination, clinical differential diagnosis included dermatofibromas in only 9% of the cases (95% CI: 2%-19%).

CONCLUSION

Facial dermatofibromas are rare and are difficult to fully excise. Cellular type and subcutaneous or muscular involvement are common in these cases and tend to have higher local recurrence rate than other nonfacial dermatofibromas. Wider excisions might be necessary for complete excision.

A Clinicohistopathological Analysis of Cutaneous Fibrous Histiocytomas of the Finger

Background:

Cutaneous fibrous histiocytoma (CFH) is a common, benign skin tumor predominantly occurring on the extremities or trunk. However, CFH on the finger is rare.

Objective:

This study was undertaken to examine the clinicohistopathological features of CFH of the finger.

Materials and Methods:

This is a retrospective study of 12 CFHs located on fingers in a tertiary hospital in Korea. All case slides were retrieved from saved files.

Results:

Ages of the CHF of the finger affected individuals ranged from 9 to 48 years with a male-to-female ratio of 1.4:1. Picker's nodule or wart was the most common clinical diagnosis. In only 2 out of the 12 cases was the pre-biopsy diagnosis of CFH ventured. Fibrocollagenous type was the most common histological type. Majority of the cases were mitotically inactive, exhibiting only 0–1 mitoses per high-power field and there was no recurrence. Tumor cells were uniformly CD34 negative.

Conclusion:

Because CFH can resemble malignancies including dermatofibrosarcoma protuberans, a lack of familiarity with the occurrence of CFH of the finger may lead to more aggressive treatment. Dermatologists should include CFH in their differential diagnosis of circumscribed nodules on the fingers to ensure proper management.

Metastasizing "benign" cutaneous fibrous histiocytoma: a clinicopathologic analysis of 16 cases

Cutaneous fibrous histiocytoma (FH) is considered a benign tumor; however, certain types of FH have been shown to have a tendency for local recurrence, and there are rare reported cases of metastasis. In this study, 16 cases of morphologically benign FH with locoregional or distant metastasis were identified in consult files. Pathologic features of primary, recurrent, and metastatic tumors, as well as clinical outcome, were evaluated. Nine were male and 7 were female patients; mean age was 42 years (range, 3 to 68 y). Primary tumors arose on the leg in 5 patients, buttock in 1, trunk in 3, shoulder in 3, neck in 2, and finger in 1. The primary site in 1 case was unknown. Fifteen primary tumors available for review involved the dermis; 6 extended into the superficial subcutis. Tumor size ranged from 1 to 5 cm (median 3.2 cm). Histologically, primary tumors showed characteristic features of FH, being composed in most cases of a polymorphous population of bland spindle and histiocytoid cells in a mixed storiform and fascicular growth pattern with admixed foam cells, multinucleate cells, and inflammatory cells in varying proportions. Histologic variants included 11 cellular (2 with mixed atypical and cellular features), 2 aneurysmal, 1 atypical, and 1 epithelioid type. All tumors showed entrapment of hyalinized collagen bundles. Mitotic activity ranged from <1 to 13/10 HPF. Focal necrosis was seen in 1 primary tumor. Ten patients had local tumor recurrence; 4 patients had multiple local recurrences. Time to first recurrence ranged from 6 weeks to 13 years. The local recurrences of 1 tumor showed increased cytologic atypia, but recurrences were otherwise morphologically similar to primary tumors. Metastases occurred 0 to 180 months after diagnosis (median 17 mo) and involved the lungs (12 patients), lymph nodes (8), soft tissues (6), and liver (1). Five patients developed multiple satellite nodules in the region of the primary tumor. Metastases were morphologically similar to the primary tumors. So far, 6 patients died of disease, with a median time to death of 64 months (range, 10 to 168 mo). Four patients are alive with metastatic disease. Two patients are disease free at last follow-up, and 1 patient died of unrelated disease. Metastasis of morphologically benign cutaneous FH is an extremely rare but clinically aggressive event. Primary tumors tend to be large and cellular, but aggressive behavior cannot be predicted on morphologic grounds alone; however, early or frequent local recurrence may warrant closer clinical follow-up.

[The clinical view through the Archives: the clinical notes of 2009]

The Clinical Notes published in 2009 serve as a resource to reflect on clinical aspects relevant to different clinical entities. Through this review an attempt is likewise made to bring the reader closer to the clinical reality of our environment.