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hard&#44; round&#44; elevated lesion that had been growing slowly on his lower lip for 2 years and measured 5<span class="elsevierStyleHsp" style=""></span>mm in diameter at the time of first consultation&#46; The surface of the lesion was erythematous and shiny&#46; The patient was otherwise asymptomatic&#46; Curettage was performed&#46; Histology showed a circumscribed&#44; nonencapsulated nodule in the superficial dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The nodule had a plexiform architecture &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; and did not make contact with the epidermis&#46; Some cells had an epithelioid appearance with abundant eosinophilic cytoplasm&#44; blurred cell borders&#44; vesicular nuclei&#44; and inconspicuous nucleoli&#46; Other cells were delicate and spindle-shaped&#44; with hyperchromatic nuclei&#46; No pleomorphism&#44; mitoses&#44; or necrosis were observed&#46; The stroma was myxoid with areas of collagen appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a><span class="elsevierStyleHsp" style=""></span>C&#41;&#46; The epidermis showed mild hyperpigmentation of the basal layer&#44; hyperkeratosis&#44; and pagetoid dyskeratosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Immunohistochemistry was diffusely positive for vimentin and MiTF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41; and focally positive for claudin-1 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; The tumor cells were negative for S100&#44; Melan-A&#44; NSE&#44; EMA&#44; GLUT1&#44; actin&#44; and CD34&#46; Numerous CD68<span class="elsevierStyleSup">&#43;</span> and CD163<span class="elsevierStyleSup">&#43;</span> cells were observed between the nests &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; A diagnosis of BCPHTPCN was made&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Perineurioma is a tumor formed of perineural cells arranged in whorls in a hyalinized or myxoid collagen stroma&#46; Although immune expression of EMA is typical&#44; these tumors are frequently positive for claudin-1&#44; GLUT1&#44; and CD34&#44; and almost always negative for protein S100&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Cellular neurothekeoma is a tumor of uncertain histogenesis&#44; with a lobulated architectural pattern&#46; It is formed of epithelioid and&#47;or spindle-shaped cells in a predominantly myxoid stroma&#46; It is usually positive for vimentin&#44; NKI-C3&#44; NSE&#44; MiTF1&#44; and PGP9&#46;5&#44; and sometimes for actin and CD68 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> In 2013&#44; Requena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> described BCPHTPCN as a tumor with mixed features of perineurioma and cellular neurothekeoma&#44; with a plexiform architectural pattern&#46; The original series consisted of 9 cases in which the perioral region was affected&#44; as found in our case&#46; However&#44; Yamada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> subsequently reported a case affecting the nose&#44; and Linos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> described one on the left ankle&#46; To date&#44; all reported patients have been adults aged between 30 and 76 years&#44; with no gender difference&#46; Clinically the tumor presents as a solitary papule or nodule covered by skin of normal appearance<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; the histopathology findings have also been similar in all the lesions&#44; with the exception of the case presented by Linos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> in which the plexiform architecture was not observed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The tumor in our patient showed all the typical morphological characteristics and was diffusely positive for MiTF1 &#40;specific to neurothekeoma&#41; and focally positive for claudin-1 &#40;commonly observed in perineurioma&#41;&#46; However&#44; other markers frequently used for the diagnosis of these tumors&#8212;NSE&#44; S100&#44; EMA&#44; GLUT1&#44; actin&#44; and CD34&#8212;were negative&#46; Staining for CD68 and CD163 was positive in numerous cells distributed between the nests of the tumor&#46; This finding was described in 2 of the cases presented by Requena et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> but only affected a few stromal histiocytes&#46; In all cases of BCPHTPCN published to date &#40;including our case&#41;&#44; protein S100&#44; melanoma markers &#40;HMB45&#44; Melan-A&#44; SOX10&#41;&#44; and smooth muscle markers &#40;actin&#44; desmin&#41; have been negative&#46; MiTF1&#44; S100A6&#44; and PGP9&#46;5 have been strongly positive in those cases in which they were studied&#46; NKI&#47;C3&#44; EMA&#44; NSE&#44; CD34&#44; claudin-1&#44; GLUT1&#44; and CD68 have shown more variable results in BCPHTPCN&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; BCPHTPCN is a recently described tumor that shows a preference for the perioral region&#44; and whose pathology findings are a hybrid between perineurioma and cellular neurothekeoma&#46; Immunohistochemistry is variable&#44; but important findings include positivity for S100A6&#44; MiTF&#44; NKI&#47;C3&#44; PGP9&#46;5&#44; EMA&#44; and NSE&#46; In our case&#44; we draw particular attention to the presence of numerous CD68<span class="elsevierStyleSup">&#43;</span> and CD163<span class="elsevierStyleSup">&#43;</span> cells between the tumor nests&#46; This peculiar trait has been reported previously in 2 patients&#44; but as a less intense feature&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Given the variability of the immunohistochemistry findings and&#44; in general&#44; the low levels of expression of typical neural markers in this neoplasm&#44; we consider the clinical and morphological features to be key elements in reaching the diagnosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Are&#225;n C&#44; C&#243;rdoba A&#44; Requena L&#44; &#193;lvarez ML&#46; Tumor benigno cut&#225;neo plexiforme h&#237;brido de perineuroma y neurotecoma celular&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;607&#8211;610&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; In the superficial dermis&#44; a circumscribed nonencapsulated nodule is observed that does not make contact with the epidermis&#46; Hematoxylin and eosin &#40;H&#38;E&#41;&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;2&#46; B&#44; Plexiform architectural pattern&#46; The neoplastic cells form round and irregular nests in a predominantly myxoid stroma&#46; No neural or vascular structures are visible within these nests&#46; H&#38;E&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; The majority of the neoplastic cells have ovoid nuclei with inconspicuous nucleoli and eosinophilic cytoplasm with poorly defined borders&#46; These cells are intimately associated with distinct spindle-shaped cells with delicate&#44; elongated&#44; hyperchromatic nuclei&#46; D&#44; Diffuse positivity for MiTF in the nuclei of the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; E&#44; Focal positivity for claudin-1 in the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; F&#44; Positivity for CD163 in numerous interstitial cells between the nests&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BCPHTPCN&#44; benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma&#59; EMA&#44; epithelial membrane antigen&#59; GLUT-1&#44; glucose transporter 1&#59; HPF&#44; high-power fields&#59; MiTF&#44; microphthalmia-associated transcription factor&#59; NKI&#47;C3&#44; lysosomal membrane-associated glycoprotein 3&#59; S100&#44; protein S100&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site Affected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Capsule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immunohistochemistry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Solitary circumscribed neuroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Face&#44; oral cavity&#44; penis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>&#40;incomplete&#44; only around the basal and lateral walls of the nodule&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eosinophilic spindle-shaped cells with poorly defined cytoplasm and hyperchromatic nuclei&#46; Artifactual clefts are observed between the cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 in Schwann cells present among numerous neurofilament-positive axons&#46; The incomplete capsule is positive for EMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variable&#46;<br>Upper trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;poorly defined&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wavy&#44; spindle-shaped cells with relatively poorly defined pale cytoplasm among nerves fibers and mast cells&#46; Fibromyxoid matrix&#46;<br>Mix of fibroblasts&#44; perineural cells&#44; and Schwann cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 positive in 30&#37; to 50&#37; of cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schwannoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cranial nerves&#44; bone&#44; digestive tract&#44; deep soft tissues&#44; muscle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antoni A areas &#40;densely cellular&#44; made up of palisaded Schwann cells in a collagen stroma&#44; forming Verocay bodies&#41;&#46; Antoni B areas &#40;paucicellular&#44; made up of Schwann cells with inconspicuous cytoplasm and nuclei that appear to be suspended in a myxoid material&#41;&#46; Mitoses may be observed &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5 in 10<span class="elsevierStyleHsp" style=""></span>HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 diffusely and stongly positive&#46;<br>EMA in the capsule of perineural cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cellular neurothekeoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head and upper limbs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;poorly defined tumor borders&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lobulated or micronodular pattern&#46; Epithelioid or spindle-shaped cells separated by collagen or in a myxoid stroma&#46; No connection with the epidermis&#46; Some osteoclast-like giant cells&#46; The majority of lesions show some degree of cellular atypia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NKI&#47;C3&#44; neuron-specific enolase&#44; smooth muscle actin &#40;focally&#41;&#44; and CD68 &#40;focally&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Perineurioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Limbs and trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;but tumor is circumscribed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar spindle-shaped cells with pale eosinophilic cytoplasm and hyalinized or myxoid stroma&#46; Formation of onion bulb-like whorls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EMA&#44; claudin-1 &#40;20&#37; to 25&#37; of cases&#41;&#46; CD34 &#40;50&#37;&#41;&#46; S100 focally in a few cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BCPHTPCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lips&#44; nose&#44; ankle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;but tumor is circumscribed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plexiform pattern&#46; No contact with epidermis&#46; The majority of the cells are oval or spindle-shaped and have vesicular nuclei with inconspicuous nucleoli&#44; pale eosinophilic cytoplasm&#44; and unclear cell borders&#46; These cells are intermixed with other delicate&#44; elongated bipolar cells&#46; No vascular or neural structures in the center of the whorls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive for S100A6&#44; MiTF&#44; NKI&#47;C3&#44; PGP9&#46;5&#44; EMA&#44; and neuron-specific enolase&#46; Variable focal staining for CD34&#44; claudin-1&#44; and Glut-1&#46; S100 negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary of the Main Differential Diagnoses&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Requena"
                            1 => "P&#46; Sitthinamsuwan"
                            2 => "I&#46; Fried"
                            3 => "S&#46; Kaddu"
                            4 => "C&#46; Schirren"
                            5 => "L&#46; Sch&#228;rer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PAS.0b013e31827edfda"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "845"
                        "paginaFinal" => "852"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23598966"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma arising from the nose"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Yamada"
                            1 => "S&#46; Kitada"
                            2 => "A&#46; Nabeshima"
                            3 => "H&#46; Noguchi"
                            4 => "Y&#46; Sasaguri"
                            5 => "M&#46; Hisaoka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1746-1596-8-165"
                      "Revista" => array:5 [
                        "tituloSerie" => "Diagn Pathol"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24103568"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benign cutaneous biphasic hybrid tumor of perineurioma and cellular neurothekeoma&#58; A case report expanding the clinical and histopathologic features of a recently described entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Linos"
                            1 => "L&#46; Stuart"
                            2 => "V&#46; Goncharuk"
                            3 => "M&#46; Edgar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/DAD.0000000000000105"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dermatopathol"
                        "fecha" => "2015"
                        "volumen" => "37"
                        "paginaInicial" => "319"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25229567"
                            "web" => "Medline"
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                        ]
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Case and Research Letter
Benign Cutaneous Plexiform Hybrid Tumor of Perineurioma and Cellular Neurothekeoma
Tumor benigno cutáneo plexiforme híbrido de perineuroma y neurotecoma celular
C. Areána,
Corresponding author
carolina.arean.cuns@navarra.es

Corresponding author.
, A. Córdobaa, L. Requenab, Ma.L. Álvareza
a Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Departamento de Dermatología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; In the superficial dermis&#44; a circumscribed nonencapsulated nodule is observed that does not make contact with the epidermis&#46; Hematoxylin and eosin &#40;H&#38;E&#41;&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;2&#46; B&#44; Plexiform architectural pattern&#46; The neoplastic cells form round and irregular nests in a predominantly myxoid stroma&#46; No neural or vascular structures are visible within these nests&#46; H&#38;E&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; The majority of the neoplastic cells have ovoid nuclei with inconspicuous nucleoli and eosinophilic cytoplasm with poorly defined borders&#46; These cells are intimately associated with distinct spindle-shaped cells with delicate&#44; elongated&#44; hyperchromatic nuclei&#46; D&#44; Diffuse positivity for MiTF in the nuclei of the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; E&#44; Focal positivity for claudin-1 in the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; F&#44; Positivity for CD163 in numerous interstitial cells between the nests&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma &#40;BCPHTPCN&#41; is an entity described by Requena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> in 2013&#46; It typically presents clinically as a small solitary papule in the perioral region&#44; although other authors have described a lesion on the nose<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and another on the left ankle&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Histology reveals mixed pathological features of perineurioma and of cellular neurothekeoma with a plexiform architecture&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;3</span></a> Immunohistochemistry&#44; when performed&#44; has been positive for S100A6&#44; microphthalmia-associated transcription factor &#40;MiTF&#41;&#44; lysosomal membrane-associated glycoprotein 3 &#40;NKI&#47;C3&#41;&#44; protein gene product 9&#46;5 &#40;PGP9&#46;5&#41;&#44; epithelial membrane antigen &#40;EMA&#41;&#44; and neuron-specific enolase &#40;NSE&#41;&#46; Expression of CD34&#44; claudin-1&#44; and glucose transporter 1 &#40;GLUT1&#41; has been more variable&#44; weaker&#44; and focal&#46; In addition to the 9 patients in the original study&#44; a further 2 cases have been published&#46; We present a new case of this recently identified lesion&#46; The tumor in our case was positive for CD68 and CD163 in a large number of cells situated between the nests of neoplastic cells&#44; a finding that was only described in a few stromal histiocytes in 2 of the cases in the original series&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a man aged 58 years who presented a well-defined&#44; hard&#44; round&#44; elevated lesion that had been growing slowly on his lower lip for 2 years and measured 5<span class="elsevierStyleHsp" style=""></span>mm in diameter at the time of first consultation&#46; The surface of the lesion was erythematous and shiny&#46; The patient was otherwise asymptomatic&#46; Curettage was performed&#46; Histology showed a circumscribed&#44; nonencapsulated nodule in the superficial dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The nodule had a plexiform architecture &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; and did not make contact with the epidermis&#46; Some cells had an epithelioid appearance with abundant eosinophilic cytoplasm&#44; blurred cell borders&#44; vesicular nuclei&#44; and inconspicuous nucleoli&#46; Other cells were delicate and spindle-shaped&#44; with hyperchromatic nuclei&#46; No pleomorphism&#44; mitoses&#44; or necrosis were observed&#46; The stroma was myxoid with areas of collagen appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a><span class="elsevierStyleHsp" style=""></span>C&#41;&#46; The epidermis showed mild hyperpigmentation of the basal layer&#44; hyperkeratosis&#44; and pagetoid dyskeratosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Immunohistochemistry was diffusely positive for vimentin and MiTF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41; and focally positive for claudin-1 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; The tumor cells were negative for S100&#44; Melan-A&#44; NSE&#44; EMA&#44; GLUT1&#44; actin&#44; and CD34&#46; Numerous CD68<span class="elsevierStyleSup">&#43;</span> and CD163<span class="elsevierStyleSup">&#43;</span> cells were observed between the nests &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; A diagnosis of BCPHTPCN was made&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Perineurioma is a tumor formed of perineural cells arranged in whorls in a hyalinized or myxoid collagen stroma&#46; Although immune expression of EMA is typical&#44; these tumors are frequently positive for claudin-1&#44; GLUT1&#44; and CD34&#44; and almost always negative for protein S100&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Cellular neurothekeoma is a tumor of uncertain histogenesis&#44; with a lobulated architectural pattern&#46; It is formed of epithelioid and&#47;or spindle-shaped cells in a predominantly myxoid stroma&#46; It is usually positive for vimentin&#44; NKI-C3&#44; NSE&#44; MiTF1&#44; and PGP9&#46;5&#44; and sometimes for actin and CD68 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> In 2013&#44; Requena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> described BCPHTPCN as a tumor with mixed features of perineurioma and cellular neurothekeoma&#44; with a plexiform architectural pattern&#46; The original series consisted of 9 cases in which the perioral region was affected&#44; as found in our case&#46; However&#44; Yamada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> subsequently reported a case affecting the nose&#44; and Linos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> described one on the left ankle&#46; To date&#44; all reported patients have been adults aged between 30 and 76 years&#44; with no gender difference&#46; Clinically the tumor presents as a solitary papule or nodule covered by skin of normal appearance<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; the histopathology findings have also been similar in all the lesions&#44; with the exception of the case presented by Linos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> in which the plexiform architecture was not observed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The tumor in our patient showed all the typical morphological characteristics and was diffusely positive for MiTF1 &#40;specific to neurothekeoma&#41; and focally positive for claudin-1 &#40;commonly observed in perineurioma&#41;&#46; However&#44; other markers frequently used for the diagnosis of these tumors&#8212;NSE&#44; S100&#44; EMA&#44; GLUT1&#44; actin&#44; and CD34&#8212;were negative&#46; Staining for CD68 and CD163 was positive in numerous cells distributed between the nests of the tumor&#46; This finding was described in 2 of the cases presented by Requena et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> but only affected a few stromal histiocytes&#46; In all cases of BCPHTPCN published to date &#40;including our case&#41;&#44; protein S100&#44; melanoma markers &#40;HMB45&#44; Melan-A&#44; SOX10&#41;&#44; and smooth muscle markers &#40;actin&#44; desmin&#41; have been negative&#46; MiTF1&#44; S100A6&#44; and PGP9&#46;5 have been strongly positive in those cases in which they were studied&#46; NKI&#47;C3&#44; EMA&#44; NSE&#44; CD34&#44; claudin-1&#44; GLUT1&#44; and CD68 have shown more variable results in BCPHTPCN&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; BCPHTPCN is a recently described tumor that shows a preference for the perioral region&#44; and whose pathology findings are a hybrid between perineurioma and cellular neurothekeoma&#46; Immunohistochemistry is variable&#44; but important findings include positivity for S100A6&#44; MiTF&#44; NKI&#47;C3&#44; PGP9&#46;5&#44; EMA&#44; and NSE&#46; In our case&#44; we draw particular attention to the presence of numerous CD68<span class="elsevierStyleSup">&#43;</span> and CD163<span class="elsevierStyleSup">&#43;</span> cells between the tumor nests&#46; This peculiar trait has been reported previously in 2 patients&#44; but as a less intense feature&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Given the variability of the immunohistochemistry findings and&#44; in general&#44; the low levels of expression of typical neural markers in this neoplasm&#44; we consider the clinical and morphological features to be key elements in reaching the diagnosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Are&#225;n C&#44; C&#243;rdoba A&#44; Requena L&#44; &#193;lvarez ML&#46; Tumor benigno cut&#225;neo plexiforme h&#237;brido de perineuroma y neurotecoma celular&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;607&#8211;610&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; In the superficial dermis&#44; a circumscribed nonencapsulated nodule is observed that does not make contact with the epidermis&#46; Hematoxylin and eosin &#40;H&#38;E&#41;&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;2&#46; B&#44; Plexiform architectural pattern&#46; The neoplastic cells form round and irregular nests in a predominantly myxoid stroma&#46; No neural or vascular structures are visible within these nests&#46; H&#38;E&#44; original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;<span class="elsevierStyleHsp" style=""></span>C&#44; The majority of the neoplastic cells have ovoid nuclei with inconspicuous nucleoli and eosinophilic cytoplasm with poorly defined borders&#46; These cells are intimately associated with distinct spindle-shaped cells with delicate&#44; elongated&#44; hyperchromatic nuclei&#46; D&#44; Diffuse positivity for MiTF in the nuclei of the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; E&#44; Focal positivity for claudin-1 in the neoplastic cells&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46; F&#44; Positivity for CD163 in numerous interstitial cells between the nests&#46; Original magnification<span class="elsevierStyleHsp" style=""></span>&#215;10&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BCPHTPCN&#44; benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma&#59; EMA&#44; epithelial membrane antigen&#59; GLUT-1&#44; glucose transporter 1&#59; HPF&#44; high-power fields&#59; MiTF&#44; microphthalmia-associated transcription factor&#59; NKI&#47;C3&#44; lysosomal membrane-associated glycoprotein 3&#59; S100&#44; protein S100&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site Affected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Capsule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immunohistochemistry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Solitary circumscribed neuroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Face&#44; oral cavity&#44; penis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes<br>&#40;incomplete&#44; only around the basal and lateral walls of the nodule&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eosinophilic spindle-shaped cells with poorly defined cytoplasm and hyperchromatic nuclei&#46; Artifactual clefts are observed between the cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 in Schwann cells present among numerous neurofilament-positive axons&#46; The incomplete capsule is positive for EMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variable&#46;<br>Upper trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;poorly defined&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Wavy&#44; spindle-shaped cells with relatively poorly defined pale cytoplasm among nerves fibers and mast cells&#46; Fibromyxoid matrix&#46;<br>Mix of fibroblasts&#44; perineural cells&#44; and Schwann cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 positive in 30&#37; to 50&#37; of cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Schwannoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cranial nerves&#44; bone&#44; digestive tract&#44; deep soft tissues&#44; muscle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Antoni A areas &#40;densely cellular&#44; made up of palisaded Schwann cells in a collagen stroma&#44; forming Verocay bodies&#41;&#46; Antoni B areas &#40;paucicellular&#44; made up of Schwann cells with inconspicuous cytoplasm and nuclei that appear to be suspended in a myxoid material&#41;&#46; Mitoses may be observed &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5 in 10<span class="elsevierStyleHsp" style=""></span>HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100 diffusely and stongly positive&#46;<br>EMA in the capsule of perineural cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cellular neurothekeoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Head and upper limbs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;poorly defined tumor borders&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lobulated or micronodular pattern&#46; Epithelioid or spindle-shaped cells separated by collagen or in a myxoid stroma&#46; No connection with the epidermis&#46; Some osteoclast-like giant cells&#46; The majority of lesions show some degree of cellular atypia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NKI&#47;C3&#44; neuron-specific enolase&#44; smooth muscle actin &#40;focally&#41;&#44; and CD68 &#40;focally&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Perineurioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Limbs and trunk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;but tumor is circumscribed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bipolar spindle-shaped cells with pale eosinophilic cytoplasm and hyalinized or myxoid stroma&#46; Formation of onion bulb-like whorls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EMA&#44; claudin-1 &#40;20&#37; to 25&#37; of cases&#41;&#46; CD34 &#40;50&#37;&#41;&#46; S100 focally in a few cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BCPHTPCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lips&#44; nose&#44; ankle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None<br>&#40;but tumor is circumscribed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plexiform pattern&#46; No contact with epidermis&#46; The majority of the cells are oval or spindle-shaped and have vesicular nuclei with inconspicuous nucleoli&#44; pale eosinophilic cytoplasm&#44; and unclear cell borders&#46; These cells are intermixed with other delicate&#44; elongated bipolar cells&#46; No vascular or neural structures in the center of the whorls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive for S100A6&#44; MiTF&#44; NKI&#47;C3&#44; PGP9&#46;5&#44; EMA&#44; and neuron-specific enolase&#46; Variable focal staining for CD34&#44; claudin-1&#44; and Glut-1&#46; S100 negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Requena"
                            1 => "P&#46; Sitthinamsuwan"
                            2 => "I&#46; Fried"
                            3 => "S&#46; Kaddu"
                            4 => "C&#46; Schirren"
                            5 => "L&#46; Sch&#228;rer"
                          ]
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                      ]
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                      "doi" => "10.1097/PAS.0b013e31827edfda"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2013"
                        "volumen" => "37"
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        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">The authors would like to thank the Dermatology Department and the technicians of the Pathology Department of Complejo Hospitalario de Navarra&#46;</p>"
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Article information
ISSN: 15782190
Original language: English
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