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Wakefield CB, Mertens F, Fletcher CDM, Anderson WJ. Clinicopathologic and molecular study of superficial CD34-positive fibroblastic tumours mimicking atypical fibrous histiocytoma (dermatofibroma). Histopathology 2024. [PMID: 39044682 DOI: 10.1111/his.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
AIMS Superficial CD34-positive fibroblastic tumour (SCD34FT) is an uncommon but distinctive low-grade neoplasm of the skin and subcutis that shows frequent CADM3 expression by immunohistochemistry (IHC). In this study, prompted by an index case resembling 'atypical fibrous histiocytoma (FH)' that was positive for CADM3 IHC, we systematically examined a cohort of tumours previously diagnosed as 'atypical FH' by applying CADM3 and fluorescence in situ hybridization (FISH) for PRDM10 rearrangement, to investigate the overlap between these tumour types. METHODS AND RESULTS Forty cases of atypical FH were retrieved, including CD34-positive tumours (n = 20) and CD34-negative tumours (n = 20). All tumours were stained for CADM3. All CADM3-positive tumours were evaluated by FISH to assess for PRDM10 rearrangement. Eleven CD34-positive tumours (11/20, 55%) coexpressed CADM3 and were reclassified as SCD34FT. None (0/20) of the CD34-negative atypical FH were CADM3-positive. Reclassified SCD34FT (10/11) arose on the lower extremity, with frequent involvement of the thigh (n = 8). Features suggestive of atypical FH were observed in many reclassified cases including variable cellularity, spindled morphology, infiltrative tumour margins, collagen entrapment, epidermal hyperpigmentation, and acanthosis. Variably prominent multinucleate giant cells, including Touton-like forms, were also present. An informative FISH result was obtained in 10/11 reclassified tumours, with 60% (6/10) demonstrating PRDM10 rearrangement. CONCLUSION A significant subset of tumours that histologically resemble atypical FH, and are positive for CD34, coexpress CADM3 and harbour PRDM10 rearrangement, supporting their reclassification as SCD34FT. Awareness of this morphologic overlap and the application of CADM3 IHC can aid the distinction between SCD34FT and atypical FH.
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Affiliation(s)
- Craig B Wakefield
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Fredrik Mertens
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christopher D M Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Hussein MRA, Abdelwahed Hussein TMR. Dermatofibromas with Aberrant Expression of CD34 Protein: A Systematic Review and a Reappraisal of Clinicopathological Features and Histogenesis. Diagnostics (Basel) 2023; 13:diagnostics13020185. [PMID: 36672995 PMCID: PMC9857706 DOI: 10.3390/diagnostics13020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/18/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Dermatofibromas (DFs) are benign fibrohistiocytic lesions that usually do not express CD34 protein. This study aimed to analyze the literature concerning the immunohistological and ultrastructural features of DFs. It also related these features to the histogenesis of these lesions. METHODS This study included a PubMed literature search for studies addressing the clinicopathological, ultrastructural, and immunohistochemical features of DFs. It also presented some current cases of CD34-negative DFs and a subset of these lesions with aberrant expression of this protein. RESULTS Analysis of the PubMed literature revealed that DFs with an aberrant expression of CD34 are rare tumors that commonly affect the extremities of adult females. Separating these tumors from dermatofibrosarcoma protuberans (DFSP, CD34-positive tumors) requires using a large panel of immunostains. Ultrastructurally, DFs are composed of diverse cell types, including cells with histiocytic, myofibroblastic, and fibroblastic features. An analysis of the DFs described by this study revealed that cases with an aberrant expression of CD34 protein had slightly high mean age and male sex predominance when compared to CD34-negative cases. The former commonly affected the extremities. There was no evidence of local recurrence or distant metastasis on follow-up. CONCLUSIONS DFs have the potential to express CD34 protein, defining a rare aberrant phenotype, which was not associated with any differences in the outcome as compared to CD34-negative DFs.
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Nishimoto A, Ansai S, Akaishi S, Dohi T, Ogawa R. Keloidal dermatofibroma: Clinicopathological comparison of 52 cases with a series of 2077 other dermatofibromas. J Dermatol 2022; 50:485-493. [PMID: 36377307 DOI: 10.1111/1346-8138.16638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
Dermatofibroma is a common benign skin lesion with a contested etiology: some believe it is a neoplasm while others propose minor injuries initiate it. Many dermatofibroma variants have been described, including keloidal dermatofibroma, which is unusual by bearing keloidal collagen. Keloidal dermatofibroma was first described in 1998 and only 15 cases have been reported. Since keloids are driven by skin injuries, the existence of keloidal dermatofibroma has been suggested to support the injury hypothesis of dermatofibroma etiology. To better understand keloidal dermatofibroma characteristics and gain clues regarding dermatofibroma etiology, consecutive keloidal dermatofibroma cases (n = 52) and dermatofibroma without keloidal collagen (n = 2077) that were histopathologically diagnosed in 2016-2019 were identified from the records of a Japanese dermatopathology laboratory and compared in terms of demographic, clinical, and histopathological characteristics by univariate analyses. Compared to other dermatofibromas, keloidal dermatofibromas occurred more frequently on the forearm and hand (P < 0.0001 and 0.0019), especially the wrist dorsum, and in the superficial skin layer (P < 0.0001). Keloidal dermatofibromas also demonstrated more cellularity and hemorrhage (both P < 0.0001). Correlation analyses between keloidal collagen amount and keloidal dermatofibroma size (a proxy of time-since-onset) did not support the notion that keloidal collagen deposition and keloidal dermatofibroma formation are triggered simultaneously. Recent injury, as indicated by fresh hemorrhage, was equally common in putatively older and younger keloidal dermatofibromas. Thus, keloidal collagen in keloidal dermatofibromas could be due to injury to preexisting dermatofibromas, which suggests that the keloidal dermatofibroma entity does not prove the injury hypothesis. Commonalities between keloids and keloidal dermatofibromas suggest a link between genetics, provocative events that induce myofibroblast differentiation, and keloidal collagen production.
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Affiliation(s)
- Akana Nishimoto
- Department of Plastic and Reconstructive Surgery Nippon Medical School Musashi‐Kosugi Hospital Kawasaki Kanagawa Japan
| | - Shin‐ichi Ansai
- Department of Dermatology Nippon Medical School Musashi‐Kosugi Hospital Kawasaki Kanagawa Japan
| | - Satoshi Akaishi
- Department of Plastic and Reconstructive Surgery Nippon Medical School Musashi‐Kosugi Hospital Kawasaki Kanagawa Japan
| | - Teruyuki Dohi
- Department of Plastic, Reconstructive and Aesthetic Surgery Nippon Medical School Hospital Tokyo Japan
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery Nippon Medical School Hospital Tokyo Japan
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4
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Ru YX, Xue-Bin Z, Yan XL, Shu-Xu D, Yongqiang Z, Ying L, Jing L, Eyden B. Lipogenic stromal cells as members of the foam-cell population in human atherosclerosis: Immunocytochemical and ultrastructural assessment of 6 cases. Ultrastruct Pathol 2022; 46:285-301. [PMID: 35352612 DOI: 10.1080/01913123.2022.2059042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yong-Xin Ru
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, Shi, China
| | - Zhang Xue-Bin
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, Shi, China
| | - Xiao-Ling Yan
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, Shi, China
| | - Dong Shu-Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, Shi, China
| | - Zhang Yongqiang
- Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, Shi, China
| | - Li Ying
- Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, Shi, China
| | - Liu Jing
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, Shi, China
| | - Brian Eyden
- Department of Histopathology, Christie NHS Foundation Trust, Manchester, UK
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Cutaneous Fibrous Histiocytomas, Ossifying-Variant with Osteoclast-like Giant Cells and Granular Cell-Variant: A Series of Two Unusual Cases with Emphasis on the Differential Diagnosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12062977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ossifying variant and the granular cell variant are rare subtypes of cutaneous fibrous histiocytoma (CFH), characterized by islands of mature metaplastic bone tissue rimmed by multinucleated osteoclast-like giant cells and by large-sized cells with granular cytoplasm and mildly hyperchromatic nuclei with inconspicuous nucleoli, respectively. We herein present two cases of these unusual CFH variants in a 37-year-old woman and in a 38-year-old man, respectively. The main differential diagnoses, including both benign and malignant lesions, are also discussed.
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Torre-Castro J, Moya-Martínez C, Núñez-Hipólito L, Mendoza-Cembranos MD, Eraña-Tomás I, Jo-Velasco M, Saus C, Solares J, Requena L, Santonja C. Three additional cases of non-neural granular cell tumor with novel immunohistochemical findings. J Cutan Pathol 2020; 47:1026-1032. [PMID: 32643817 DOI: 10.1111/cup.13801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-neural granular cell tumor (NNGCT) is an uncommon neoplasm of controversial histogenesis and its histopathologic differential diagnosis includes, in addition to conventional GCT, other dermal tumors that may exhibit granular cell change. METHODS Three patients with a diagnosis of NNGCT were identified in the authors' files. Hematoxylin and eosin-stained sections and immunohistochemical studies were performed. RESULTS Histopathological study of the three lesions showed dermal proliferation of granular cells arranged in thick fascicles between collagen bundles. The lesions showed positivity for Factor XIIIa, CD163, CD68, NKIC3, vimentin, ALK, fascin, and cyclin D1. CONCLUSION To our knowledge, positivity for cyclin D1 has not been reported to date in NNGCT. In borderline cases, where the diagnosis is unclear despite histopathologic and immunohistochemical findings, positivity for cyclin D1 may favor the diagnosis of NNGCT. Further investigations to assess the differentiation of this rare neoplasm are needed.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Cristina Moya-Martínez
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Lucía Núñez-Hipólito
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Itziar Eraña-Tomás
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Margarita Jo-Velasco
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carles Saus
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Julia Solares
- Department of Pathology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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7
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Macarenco RS, Filippi RZ, D'Almeida Costa F, Jesus-Garcia R. Leiomyosarcoma of the great saphenous vein (vena saphena magna) with granular cell change: Report of a superficial neoplasm. J Cutan Pathol 2017; 45:141-145. [PMID: 29068077 DOI: 10.1111/cup.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
The great saphenous vein (GSV) corresponds to the main superficial large-caliber vessel affected by leiomyosarcoma (LMS). Given its superficial location and because signs of vascular origin may not be clinically apparent, LMS of the GSV may be misinterpreted clinically as superficial nonvascular soft tissue mass. Herein, we report a case on the distal portion of the right GSV of a 57-year-old man. The histopathological recognition of a large-caliber vein-associated LMS (with granular cell change) in an incisional biopsy specimen was crucial to guide radiological evaluation and confirmation of a superficial vascular LMS before surgical treatment. Recognizing this entity in small biopsies is important as its surgical treatment and prognosis differ substantially from nonvascular superficial (ie, subcutaneous and dermal) LMSs. In addition, because vascular LMSs can involve long vessel segments, underestimation of extent of disease is a risk. To the best of our knowledge, granular cell change has not been documented in LMS of the GSV.
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Affiliation(s)
- Ricardo S Macarenco
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Renee Z Filippi
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Reynaldo Jesus-Garcia
- Orthopedic Oncology Department, Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia Família Dayan Daycoval, São Paulo, Brazil
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A Rare Case of a Primary Cutaneous Desmoplastic Atypical Granular Cell Tumor. Am J Dermatopathol 2017; 39:e50-e53. [DOI: 10.1097/dad.0000000000000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Rawal YB, Dodson TB. S-100 Negative Granular Cell Tumor (So-called Primitive Polypoid Non-neural Granular Cell Tumor) of the Oral Cavity. Head Neck Pathol 2016; 11:404-412. [PMID: 27709427 PMCID: PMC5550384 DOI: 10.1007/s12105-016-0760-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
Four cases of cutaneous S-100 negative granular cell tumor were described in 1991. Until now, only 3 cases of oral involvement have been documented in English literature. Two additional cases of oral S-100 negative granular cell tumor are described. Immunohistochemical markers were applied to exclude other lesions that may show the presence of granular cells. The clinical findings were correlated with the histopathological and immunohistochemical features to arrive at the appropriate diagnosis. S-100 negative granular cell tumors are erythematous polypoid masses commonly mistaken for granulation tissue or a pyogenic granuloma. Any part of the oral cavity may be affected. Histopathologically, the lesions consist of sheets, nests, and fascicles of granular cells that are S-100 negative. The granular cells are non-reactive to SMA, HMB45, Melan A, and CD163. The intracytoplasmic granules are diffusely and strongly positive to NKI/C3. The cell lineage of the S-100 negative granular cell tumor is obscure. Absence of staining with CD163 excludes a histiocytic lineage. Absence of staining with S-100 excludes a neural origin. Absence of staining with S-100 and key melanoma markers HMB45 and Melan A also excludes a melanocytic origin. In this context, positive reactivity with NKI/C3 is indicative of presence of intracytoplasmic lysosomal granules only. Greater awareness of this lesion in the oral cavity will result in better characterization of its biologic potential.
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Affiliation(s)
- Yeshwant B. Rawal
- 0000000122986657grid.34477.33Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, B-204 Magnuson Health Sciences Center, 1959 NE Pacific Street, Box 357133, Seattle, WA 98195 USA
| | - Thomas B. Dodson
- 0000000122986657grid.34477.33Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, B-204 Magnuson Health Sciences Center, 1959 NE Pacific Street, Box 357133, Seattle, WA 98195 USA
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10
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Abstract
Classic granular cell tumor is a mesenchymal neoplasm that commonly occurs on the skin, but is not infrequently found in the oral cavity, primarily on the dorsal tongue. Diagnosis is usually straightforward with hematoxylin and eosin stained slides. Immunohistochemical studies on classic granular cell tumor shows positive immunostaining for S-100 and vimentin, while CD68 is variably positive. We report a case of otherwise unremarkable oral granular cell tumor that was immunohistochemically negative for S-100, and positive for vimentin and CD68, and discuss the differential diagnosis. The results of the immunohistochemical studies in our case are compared with those of classic S-100 positive oral granular cell tumors, as well as cutaneous and oral S-100 negative granular cell tumors. Classic S-100 positive granular cell tumors and S-100 negative granular cell tumors of the oral cavity can only be distinguished by immunohistochemical studies; however, the necessity of this distinction is unclear, as both are benign lesions in which recurrence is unlikely.
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Abstract
Dermatofibroma ("fibrous histiocytoma") is a common soft tissue lesion with many variants based on a great variety of architectural patterns, cellular morphology and stromal reactions. The coexistence of 2 or more patterns within a single lesion is well known and causes diagnostic difficulties. We report a case of an unusual histologic presentation of a solitary sclerotic and epithelioid dermatofibroma in a 48-year-old woman.
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Haikal F, Maceira JP, Dias EP, Ramos-e-Silva M. Histogenesis of Abrikossoff tumour of the oral cavity. Int J Dent Hyg 2010; 8:53-62. [DOI: 10.1111/j.1601-5037.2009.00392.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Yeh I, Tran DT, Davis TL, Argenyi ZB. An infiltrative variant of non-neural granular cell tumor: a case report. J Cutan Pathol 2009; 36 Suppl 1:46-51. [PMID: 19187104 DOI: 10.1111/j.1600-0560.2008.01214.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermal non-neural granular cell tumors are rare tumors of indeterminate lineage that typically present as well-circumscribed tumors with nuclear pleomorphism and mitotic activity. We describe a dermal non-neural granular cell tumor with a distinctive growth pattern with granular cells interspersed between collagen bundles. This asymptomatic papule arose on the scapula of a 46-year-old woman and consisted of a mixture of epithelioid and spindled granular cells. The immunohistochemical characteristics were similar to those of previously reported dermal non-neural granular cell tumors. Despite mild nuclear pleomorphism and dispersion of lesional cells among collagen bundles, mitoses were not present and Ki-67 staining indicated a low proliferative rate. In addition to being S-100 protein negative and NKI/C3 positive, our case was positive for PGP9.5 and weakly positive for neuron-specific enolase, a staining pattern similar to what has been observed for cellular neurothekeomas. Our case could represent a dermal non-neural granular cell tumor with unique architecture, a granular cellular neurothekeoma or a granular cell dermatofibroma. As both dermal non-neural granular cell tumor and cellular neurothekeoma are of indeterminate lineage, our case with features characteristic of both entities may suggest a common precursor or lineage for dermal non-neural granular cell tumor and cellular neurothekeoma.
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Affiliation(s)
- Iwei Yeh
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195-6524, USA.
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14
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15
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Selected case from the Arkadi M. Rywlin international pathology slide seminar: apocrine gland cysts with hemosiderotic dermatofibromalike stroma. Adv Anat Pathol 2008; 15:172-6. [PMID: 18434769 DOI: 10.1097/pap.0b013e3181709fa7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Primitive Nonneural Granular Cell Tumor (So-called Atypical Polypoid Granular Cell Tumor). Report of 2 Cases With Immunohistochemical and Ultrastructural Correlation. Am J Dermatopathol 2008; 30:156-9. [DOI: 10.1097/dad.0b013e318164101c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Val-Bernal JF, Val D, Garijo MF, Vega A, González-Vela MC. Subcutaneous ossifying lipoma: case report and review of the literature. J Cutan Pathol 2007; 34:788-92. [PMID: 17880585 DOI: 10.1111/j.1600-0560.2006.00704.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lipomas can undergo a variety of changes, one of which is ossification. Ossifying lipoma (OL), independent of bone tissue, is rare. No case has been reported with this heading in the dermatopathological literature. CASE REPORT A 73-year-old woman was referred for a subcutaneous mass on the left scapular region that had been present for more than 22 years. RESULTS The lesion was an OL measuring 8 cm and weighing 75 g. Only 25 cases of OL have been described in soft tissues. Including the present report, locations in order of frequency are the head and neck area (11 cases), the limbs (9 cases) and the trunk (6 cases). Average patient age is 50.9 years (range, 17-81 years). History is measured in years (mean, more than 6 years). Average tumor size is 7.1 cm (range, 0.8-20 cm). The adipose component is usually predominant and the mature bone tissue is irregular in distribution. Bone spicules are surrounded by fibrous tissue bands. Chondrous structures are found in 46.2% of tumors. No recurrences have been reported. CONCLUSIONS OL is rare but has a characteristic gross, radiological and histological appearance. It has the same prognosis as simple lipoma. Excision is the treatment to be chosen.
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Affiliation(s)
- J Fernando Val-Bernal
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Avenida Valdecilla s/n, E-39008 Santander, Spain.
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18
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Tran TA, Hayner-Buchan A, Jones DM, McRorie D, Carlson JA. Cutaneous Balloon Cell Dermatofibroma (Fibrous Histiocytoma). Am J Dermatopathol 2007; 29:197-200. [PMID: 17414448 DOI: 10.1097/dad.0b013e31803328b3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dermatofibroma (DF) or cutaneous fibrous histiocytoma is a common benign skin tumor that exhibits multiple, distinct histologic variants. Although clear cell DF has been described in the literature, balloon cell degeneration causing a clear cell DF phenotype has been not been reported to date. Herein, we describe the clinicopathologic findings of balloon cell DF arising on the heel of a 43-year-old man. Clinically, it presented as enlarging tan-white, ulcerated, firm 1.5 cm nodule, clinically suspected to be pyogenic granuloma. Excisional biopsy revealed a circumscribed fibrous tumor populated by mostly clear and spindle cells. A zonal arrangement separated the varied tumor cells where the most superficial, polypoid area showed large, clear polygonal balloon cells; the mid-dermal zone demonstrated a transition between balloon cells, epithelioid cells, and spindle cells; and the deep dermal zone had storiform arrangement of spindle cells, with the fascicles separated by coarse collagen bundles. A CD10+ > CD68+ > Factor XIIIa+ immunophenotype was identified with negative immunolabeling for S-100 protein, HMB-45, cytokeratin AE1/AE3, desmin, smooth muscle actin, lysozyme, and leukocyte common antigen (LCA). Ultrastructurally, the clear tumor cells were filled with multiple, empty, nonmembrane bound vacuoles of varying size. No recurrence has been described after complete excision and 7 months of follow up. DF with balloon cell change, likely secondary to persistent irritation, should be added to the differential diagnosis of cutaneous primary and metastatic neoplasms showing balloon cell degeneration such as balloon cell melanocytic nevi and renal cell carcinoma, respectively.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Diagnosis, Differential
- Factor XIIIa/analysis
- Heel
- Histiocytoma, Benign Fibrous/chemistry
- Histiocytoma, Benign Fibrous/diagnosis
- Histiocytoma, Benign Fibrous/pathology
- Histiocytoma, Benign Fibrous/surgery
- Humans
- Immunohistochemistry
- Male
- Microscopy, Electron, Transmission
- Neprilysin/analysis
- Skin Neoplasms/chemistry
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Time Factors
- Treatment Outcome
- Vacuoles/ultrastructure
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Affiliation(s)
- Tien Anh Tran
- Department of Pathology, Florida Orlando Hospital, Orlando, FL, USA
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Bhattacharyya I, Summerlin DJ, Cohen DM, Ellis GL, Bavitz JB, Gillham LL. Granular cell leiomyoma of the oral cavity. ACTA ACUST UNITED AC 2006; 102:353-9. [PMID: 16920544 DOI: 10.1016/j.tripleo.2005.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Revised: 07/26/2005] [Accepted: 08/08/2005] [Indexed: 11/20/2022]
Abstract
Granular cytoplasmic change is a reported but uncommon finding in leiomyoma. Leiomyoma in the oral cavity is also uncommon, and granular cell change in oral leiomyomas, to the best of our knowledge, has not been previously reported in the English literature. Two cases of oral leiomyomas with significant granular cell change are presented. These tumors may be confused with the more common granular cell tumor, however, routine histology and immunohistochemistry aided in establishing the diagnosis. Ultrastructural studies were done for one case. Both tumors were immunoreactive for muscle markers, namely, smooth muscle actin and desmin. One of the tumors (case 2) reacted postiviely for HHF-35 and alpha-1 antitrypsin. The tumors were unreactive for S-100 protein, pancytokeratin, myoglobin, and factor VIII related antigen (case 2).
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Abstract
We report on two patients with granular cell atypical fibroxanthoma. Both neoplasms were solitary, light-tan, dome-shaped papules on sun-exposed areas of the head in two elderly white men. Microscopically, these neoplasms showed a dermal proliferation of pleomorphic granular cells with irregular hyperchromatic nuclei, multinucleated cells, and scattered mitoses. Immunohistochemical stains were positive for CD68 and vimentin and negative for Melan-A or human melanoma black (HMB)-45, S-100 protein, pancytokeratin, and actin, consistent with atypical fibroxanthoma. The differential diagnosis of granular cells in neoplasms containing cytological pleomorphism is challenging in view of the many different neoplasms that may present with granular cytoplasm. These include the conventional granular cell tumor and its malignant form, leiomyoma, leiomyosarcoma, dermatofibroma, dermatofibrosarcoma protuberans, and angiosarcoma.
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Affiliation(s)
- Sarah N Rudisaile
- Cutaneous Pathology, WPC Laboratories, Inc., Maryland Heights, MO 63043, USA
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21
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Hong SB, Yang MH, Lee MH, Haw CR. Dermatofibroma‐like Atypical Granular Cell Tumour. Acta Derm Venereol 2005; 85:179-80. [PMID: 15868643 DOI: 10.1080/00015550510036469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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22
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Luz FB, Gaspar AP, Ramos-e-Silva M, Carvalho da Fonseca E, Villar EG, Cordovil Pires AR, Kalil-Gaspar N. Immunohistochemical profile of multicentric reticulohistiocytosis. Skinmed 2005; 4:71-7. [PMID: 15785133 DOI: 10.1111/j.1540-9740.2005.03415.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND There is enough evidence to support the knowledge that multicentric reticulohistiocytosis (MR) is a histiocytic proliferative disorder; however, the type of histiocytes involved is not well established. OBJECTIVE AND METHODS To study the nature of cells present in MR lesions by studying the immunohistochemical profile of three new cases and reviewing 23 cases reported in the literature. RESULTS MR histiocytic cells are positive for vimentin, CD68, and CD45, negative for S-100 protein, CD34, and XIIIa factor, and weak reactors for thrombomodulin. Small activated histiocytes are MAC387 positive. Lymphocytes, mainly CD4+ cells, are found in MR infiltrates. CONCLUSIONS The MR immunophenotypic pattern does not suggest a type I or type II dendrocyte or a Langerhans cell origin. On the other hand, it points to a different cell derived from the monocyte-macrophage line. CD4+ cells may be responsible for activating the proliferation of histiocytic cells. Small histiocytic MAC387+ cells are likely to become the MR multinucleated giant cells.
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23
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Basile JR, Woo SB. Polypoid S-100-negative granular cell tumor of the oral cavity: a case report and review of literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:70-6. [PMID: 12847447 DOI: 10.1016/s1079-2104(03)00097-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is a report of a case of an S-100-negative polypoid granular cell tumor arising in the lower lip of a 4-year-old patient that may represent the entity primitive polypoid granular cell tumor. Unlike the usual granular cell tumors arising in the tongue or buccal mucosa, such lesions are not S-100 positive and can exhibit mitoses and cytologic atypia, features that may suggest a low-grade mesenchymal malignancy necessitating aggressive therapy. However, this is in fact a nonaggressive neoplasm that is not associated with significant morbidity and therefore should be treated with simple excision.
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Affiliation(s)
- John R Basile
- Department of Oral Medicine and Diagnostic Sciences, Harvard Dental School, Harvard University, Boston, MA 02115, USA
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24
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Bruecks AK, Trotter MJ. Expression of Desmin and Smooth Muscle Myosin Heavy Chain in Dermatofibromas. Arch Pathol Lab Med 2002; 126:1179-83. [PMID: 12296754 DOI: 10.5858/2002-126-1179-eodasm] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background.—The histopathologic features of dermatofibroma vary remarkably, and this diversity may occasionally cause problems in differentiating between benign and malignant mesenchymal lesions, including smooth muscle neoplasms. Immunohistochemical stains are sometimes necessary to clarify the histogenesis of a lesion.
Objective.—To evaluate dermatofibromas for expression of desmin and smooth muscle myosin heavy chain (SM-MHC) antigens, which are commonly used as evidence of smooth muscle differentiation.
Methods.—We studied 100 consecutive cases of dermatofibroma using hematoxylin-eosin–stained sections and immunoperoxidase staining with antibodies against desmin, SM-MHC, and smooth muscle actin.
Results.—We found focal positivity for desmin in 9 cases, and in 2 of these cases, at least 10% of lesional cells showed strong expression. We found focal staining for SM-MHC in 10 cases, and in 2 of these cases, at least 10% of the lesional cells were positive. Regions positive for desmin and/or SM-MHC did not show definite histologic features of myogenous differentiation on hematoxylin-eosin–stained sections. All dermatofibromas expressing desmin and SM-MHC were also strongly positive for smooth muscle actin.
Conclusions.—About 10% of dermatofibromas show focal expression of desmin and SM-MHC, and this expression may be present in up to 10% to 15% of lesional cells. Thus, in dermal spindle cell lesions, focal expression of these muscle antigens, like that of smooth muscle actin, is not diagnostic of a smooth muscle tumor.
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Affiliation(s)
- Andrea K Bruecks
- Department of Pathology and Laboratory Medicine, Calgary Laboratory Services, University of Calgary, Alberta, Canada.
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25
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Maire G, Pédeutour F, Coindre JM. COL1A1-PDGFB gene fusion demonstrates a common histogenetic origin for dermatofibrosarcoma protuberans and its granular cell variant. Am J Surg Pathol 2002; 26:932-7. [PMID: 12131162 DOI: 10.1097/00000478-200207000-00013] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Granular cell variant of dermatofibrosarcoma protuberans is very rare with only one report of two cases. We report a new case in which we demonstrated the presence of the dermatofibrosarcoma protuberans-specific COL1A1-PDGFB fusion from paraffin-embedded tissue. This case analysis demonstrated the utility of molecular genetics as a powerful tool for the diagnosis of atypical forms of dermatofibrosarcoma protuberans.
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Affiliation(s)
- Georges Maire
- UF Recherche clinique 0952 and Laboratoire de Cytogénétique, Université de Bordeaux II and Institut Bergonié, France
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26
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Mentzel T, Kutzner H, Rütten A, Hügel H. Benign fibrous histiocytoma (dermatofibroma) of the face: clinicopathologic and immunohistochemical study of 34 cases associated with an aggressive clinical course. Am J Dermatopathol 2001; 23:419-26. [PMID: 11801774 DOI: 10.1097/00000372-200110000-00006] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thirty-four cases of fibrous histiocytoma (dermatofibroma) arising on the face are reported. These neoplasms occurred frequently in females (24 female, 10 male) and showed a broad age range (12 to 85 years; mean: 43.6 years, median: 41 years). The neoplasms originated on the forehead (nine cases), the cheek (eight cases), the eyebrow (four cases), the temporal region (three cases), the nose (two cases), and the ear (one case); in seven cases the location face was given only. Five of 27 cases with follow-up information (median: 5 years) recurred locally; in one case four recurrences were excised within 8 years. The majority of cases extended into the subcutis and deep soft tissue including striated muscle (50% of cases). Histologically, only the minority of cases was composed entirely of histiocytoid and spindle-shaped tumor cells arranged in a storiform growth pattern. In many cases cellular fascicles and bundles of spindle-shaped tumor cells were noted in addition to classical morphological features of fibrous histiocytoma. A moderate mitotic rate (mean: 2.97 mitoses in 10 HPFs) was observed, and in few cases increased atypia was evident. Frank tumor necrosis and/or vascular invasion were not identified. Immunohistochemical studies revealed Factor XIIIa positivity in 13 out of 17, focal CD68 positivity in 6 out of 10, and alpha-smooth muscle actin positivity in 16 out of 19 cases tested. These lesions should be distinguished from dermatofibrosarcoma protuberans, including its fibrosarcomatous variant, leiomyosarcoma, and low-grade myofibroblastic sarcoma. Cases of fibrous histiocytoma of the face have to be excised with wider margins in comparison with examples of classical fibrous histiocytoma occurring on the extremities because of diffuse infiltration, involvement of deeper structures, and an increased rate of local recurrences.
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Affiliation(s)
- T Mentzel
- Department of Dermatohistopathology, Friedrichshafen, Germany.
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27
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Abstract
BACKGROUND There have been several reports in the literature of dermatofibromas with granular cells. Here we report a granular cell tumor with the architecture of a dermatofibroma. This is the first report of this histological variant of granular cell tumor. The lesion was a 2.5-cm oval, hyperpigmented plaque present for "years" on the back of a 60-year-old African-American woman. METHODS The specimen was processed using formalin fixation and paraffin embedding. Tissue sections were stained with hematoxylin and eosin. Immunohistochemical studies were performed with antibodies directed against S-100 protein, neuron-specific enolase, and factor XIIIa. RESULTS Histopathologic examination revealed granular cells, some of which were spindle shaped, distributed singly and in small groups between collagen bundles resembling a dermatofibroma. Immunohistochemical studies showed the tumor cells to be positive for S-100 and neuron-specific enolase and negative for factor XIIIa. CONCLUSION The immunohistochemical findings support the diagnosis of a granular cell tumor with a dermatofibroma-like pattern.
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Affiliation(s)
- S D Cheng
- The Ohio State University, University Medical Center, Columbus, USA
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28
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Zelger BG, Sidoroff A, Zelger B. Combined dermatofibroma: co-existence of two or more variant patterns in a single lesion. Histopathology 2000; 36:529-39. [PMID: 10849095 DOI: 10.1046/j.1365-2559.2000.00901.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Based on a series of 25 cases, we define and characterize combined dermatofibroma, a tumour comprising two or more variant patterns of dermatofibroma in a single lesion. METHOD AND RESULTS Dermatofibroma may present with a wide variety of architectural, cellular or stromal peculiarities. Architectural peculiarities include deep penetration, atrophy, collarette formation, fascicular to plexiform architecture, massive haemorrhage, prominent haemangiopericytoma-like vascularity and palisading; cellular peculiarities the presence of epithelioid cells, clear cells, granular cells, prominent myofibroblastic differentiation and atypical giant cells ('monster cells'); or stromal peculiarities such as prominent sclerosis, mucin, haemosiderin and cholesterotic deposits. In combined dermatofibromas two or more of these features are seen in complex or inhomogenous combination such as the silhouette of a deep penetrating dermatofibroma with an 'ordinary' storiform pattern in the upper and granular cell differentiation in the lower part of the lesion; or a dermatofibroma with ordinary features in the upper, prominent sclerosis in the middle and clear cells in the lower portion of the lesion; or the characteristic epidermal collarette and cells of epithelial cell histiocytoma with a plexiform ('neurothekeoma-like') architecture surrounded by a myxoid stroma with spindle-shaped to stellate cells. Clinically, these lesions preferentially occur on the lower extremities of young to middle-aged females, frequently with the diagnosis of a fibrohistiocytic lesion. Apart from one recurrence follow-up was uneventful in all other cases. Immunohistochemically, lesions are consistently positive with KiM1p, variably positive for factor XIIIa, smooth muscle specific actin and with KP1 (CD68), NK1C3 and E9. CONCLUSION Recognition of combined dermatofibroma allows the histopathologist to apply a confident benign label to unusual lesions which might otherwise elude diagnosis, or tempt description of 'new' entities and to avoid a misdiagnosis of malignancy.
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Affiliation(s)
- B G Zelger
- Departments of Pathology, Dermatology, University of Innsbruck, Austria
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29
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Rudolph P, Schubert C, Zelger BG, Zelger B, Parwaresch R. Differential expression of CD34 and Ki-M1p in pleomorphic fibroma and dermatofibroma with monster cells. Am J Dermatopathol 1999; 21:414-9. [PMID: 10535568 DOI: 10.1097/00000372-199910000-00002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pleomorphic fibroma (PF) and dermatofibroma with monster cells (DFMC) are characterized by the presence of numerous cells with large atypical nuclei. Despite cytologic similarities, the two entities are likely to be unrelated, but their histogenesis is poorly understood. In this study, we examined six cases of PF and eleven cases of DFMC by immunohistochemistry using antibodies against vimentin, alpha-smooth muscle actin, S-100 protein, CD34, factor XIIIa, and the pan-monocytic marker Ki-M1p. Strong vimentin expression was seen in all tumors, whereas none of them expressed S-100 protein. PF consistently exhibited CD34 staining but appeared to be depleted of Ki-M1p positive cells compared with the surrounding normal skin. Conversely, all cases of DFMC contained numerous Ki-M1p positive cells including atypical multinucleate cells, but virtually no CD34 reactivity was observed. A weak staining for alpha-smooth muscle actin was occasionally seen in a subset of the cells of both entities. Our results indicate that PF and DFMC are histogenetically distinct entities that may arise from two different types of dermal dendritic cells defined by their reactivity for CD34 and Ki-M1p, respectively. Immunohistochemistry using these two antibodies permits an easy and reliable discrimination between PF and DFMC.
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Affiliation(s)
- P Rudolph
- Department of General Pathology, University of Kiel, Germany
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30
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Wick MR, Ritter JH, Lind AC, Swanson PE. The pathological distinction between "deep penetrating" dermatofibroma and dermatofibrosarcoma protuberans. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1999; 18:91-8. [PMID: 10188848 DOI: 10.1016/s1085-5629(99)80014-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In selected cases, the clinicopathological distinction between deep penetrating dermatofibroma (DPDF), which involves the subcutis, and dermatofibrosarcoma protuberans (DFSPs) may be challenging. In most instances, attention to the cytological constituency of the lesions and the overall architecture is sufficient to make this separation. DPDF is typified by cellular heterogeneity, including giant cells and lipidized histiocytes; when it extends into the hypodermis, it does so either using the interlobular subcuticular fibrous septa as scaffolds or in the form of broad pushing fronts of tumor. In contrast, DFSP is a cytologically monotypical tumor, which entraps subcutaneous adipocytes diffusely or grows in stratified horizontal plates in the hypodermis. In the minority of cases where conventional morphological analysis of optimal biopsy specimens is diagnostically indeterminate, immunostaining for CD34 and factor XIIIa (FXIIIa) is helpful; it is also often necessary when a poorly-representative sample of the lesion has been obtained by the clinician. Characteristically, DF is diffusely FXIIIa-reactive and CD34-negative, whereas DFSP manifests the converse of those findings. Other markers such as Ki-M1p, mutant p53 protein, and metallothionein may also provide adjuvant diagnostic information in this context, as may the observation of abnormalities in chromosomes 17 and 22 by direct karyotypic analysis.
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Affiliation(s)
- M R Wick
- Division of Surgical Pathology, Washington University Medical Center, St. Louis, MO 63110-1094, USA
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31
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Zelger BG, Steiner H, Kutzner H, Maier H, Zelger B. Cellular 'neurothekeoma': an epithelioid variant of dermatofibroma? Histopathology 1998; 32:414-22. [PMID: 9639116 DOI: 10.1046/j.1365-2559.1998.00406.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Cellular neurothekeoma is a rare benign cutaneous neoplasm with conflicting opinions regarding its histogenetic origin (nerve sheath, smooth muscle, myofibroblasts) as well as its relation to myxoid neurothekeoma (nerve sheath myxoma). The present series describes 15 cases whose clinicopathological features indicate a relationship to dermatofibroma. METHODS AND RESULTS In this retrospective clinicopathological study, the lesions preferentially occurred in adolescents to young adults on the upper half of the body, often clinically diagnosed as some kind of fibrohistiocytic tissue response. Besides characteristic whorled nests to fascicles of palely eosinophilic epithelioid cells, all lesions showed variable clues pointing to dermatofibroma: acanthosis, ill-defined storiform periphery, peripherally accentuated prominent sclerosis and lymphocytic demarcation/infiltration. Immunohistochemically, all cases were positive with NK1C3 (CD57), KiM1p and proliferating cell nuclear antigen, seven were positive for neurone specific enolase, five for factor XIIIa, six for smooth muscle specific actin and three for E9, an antimetallothionein marker. These findings are similar to those of conventional dermatofibromas, the variability of the profile being best explained by time cycle and function dependent changes. Ultrastructurally, two cases showed microfilaments, attachment plaques, prominent pinocytosis and focal remnants of basal lamina. A careful study of the data and photomicrographs from the literature reveals that in many cases similar conclusions could be reached. Obvious discrepancies are most likely due to the confusion with myxoid neurothekeoma, a well circumscribed, more spindly and myxoid, S100 positive lesion of Schwannian origin. CONCLUSION The appearance of dermatofibromas is markedly influenced by architectural, e.g. in deep penetrating dermatofibroma, and/or cellular/stromal criteria, e.g. in epithelioid cell histiocytoma or sclerosing dermatofibroma. Cellular neurothekeoma seems to be a variant of dermatofibromas with both architectural and cellular/stromal peculiarities, i.e. plexiform pattern, epithelioid cytology and stromal sclerosis.
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Affiliation(s)
- B G Zelger
- Department of Pathology, University of Innsbruck, Austria
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