Case for Diagnosis
A reddish plaque in the forehead
Placa rojiza en la frente
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Friedman, E. Cohen Sabban, H. Cabo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Friedman" "email" => array:1 [ 0 => "paufriedman@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Cohen Sabban" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "H." "apellidos" => "Cabo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Instituto de Investigaciones Médicas “A. Lanari”, Dermatology Department, University of Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "School of Medicine, University of Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placa rojiza en la frente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 991 "Ancho" => 1323 "Tamanyo" => 422033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) (H&E). (B) Immunohistochemical staining for cytokeratins (AE1–AE3). (C) CD68. (D) Vimentin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 86-year-old man with an inconspicuous medical history was seen at the Dermatology Department of the Instituto de Investigaciones Médicas “A. Lanari” in April 2015, due to an infiltrated reddish plaque of hard elastic consistency localized in the scalp margin in the frontal region. This plaque had appeared 4 months before, and the patient was asymptomatic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He also had severe actinic damage evidenced by multiple actinic keratoses in his face, mainly in the forehead, temples and nose. He had been prescribed several courses of 5 fluorouracil cream to be applied at night for a month.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The dermoscopy showed arborizing vessels, reddish and whitish structureless areas and shiny white linear structures (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Based on the clinical analysis and dermatoscopy, a biopsy was performed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Examination of the histological sections (H&E) revealed proliferation of cells with abundant cytoplasm, some multinucleated and others with bizarre nuclei, showing marked pleomorphism. Tapered cells coexist, and stroma presented myxoid changes. Immunohistochemistry showed positive staining for CD68 and vimentin and negative staining for cytokeratins (AE1–AE3), smooth muscle actin and S100 protein (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is your diagnosis?</span></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">A plaque-like variant of an atypical fibroxanthoma.</p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma (AFX) is a rare mesenchymal tumor considered a superficial variant of undifferentiated pleomorphic sarcoma. It exhibits locally aggressive behavior, and a tendency to recur after surgery. Metastasis rates are low. The plaque-like variant is a very rare morphological variety, not usually diagnosed clinically.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">FXA has preferential location in sun-exposed areas in elderly patients, so it is believed that ultraviolet radiation plays an important role in its pathogenesis. Our patient matches the description as he is 86 years old and has photodamaged skin marked by multiple actinic keratoses.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The plaque-like variant is a very rare morphological variety, not usually diagnosed clinically. Dermatoscopy is a useful tool in these cases; publications about the dermoscopy of an atypical fibroxanthoma in the literature are scarce. The following dermoscopic findings has been described: (1) atypical vascular pattern with irregularly distributed polymorphic vessels: linear (tortuous and arborizing), dotted and globular, (2) shiny white structures (linear, white areas or rosettes), (3) heterogeneous hyperpigmentation, and (4) rainbow pattern.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the most consistent finding is the atypical vascular pattern, as in the case of our patient, it is unspecific because it can be seen in other clinically similar tumors exhibiting chaotic neoangiogenesis during growth. However, it is important to emphasize that its detection should raise suspicion of malignancy, and complete surgical excision of the lesion should be performed, as we did with our patient who was referred to the Surgery Department for a complete removal of the lesion.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">AFX should be included in the list of differential diagnoses of reddish malignant cutaneous tumors such as squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma, amelanotic/hypomelanotic melanoma and eccrine poroma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case report" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] ] ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 747 "Ancho" => 996 "Tamanyo" => 165355 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 950 "Tamanyo" => 124973 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 991 "Ancho" => 1323 "Tamanyo" => 422033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) (H&E). (B) Immunohistochemical staining for cytokeratins (AE1–AE3). (C) CD68. (D) Vimentin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical fibroxanthoma of the cheek—case report with dermatoscopy and dermatopathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Inskip" 1 => "J. Magee" 2 => "D. Weedon" 3 => "C. 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Pitarch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.11.010" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2014" "volumen" => "105" "paginaInicial" => "97" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23489998" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of uncommon skin tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lallas" 1 => "E. Moscarella" 2 => "G. Argenziano" 3 => "C. Longo" 4 => "Z. Apalla" 5 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 10 | 22 |
| 2024 October | 57 | 46 | 103 |
| 2024 September | 74 | 23 | 97 |
| 2024 August | 79 | 71 | 150 |
| 2024 July | 76 | 36 | 112 |
| 2024 June | 66 | 28 | 94 |
| 2024 May | 56 | 38 | 94 |
| 2024 April | 89 | 19 | 108 |
| 2024 March | 77 | 27 | 104 |
| 2024 February | 56 | 24 | 80 |
| 2024 January | 47 | 28 | 75 |
| 2023 December | 47 | 18 | 65 |
| 2023 November | 63 | 22 | 85 |
| 2023 October | 60 | 24 | 84 |
| 2023 September | 40 | 29 | 69 |
| 2023 August | 26 | 13 | 39 |
| 2023 July | 49 | 36 | 85 |
| 2023 June | 37 | 17 | 54 |
| 2023 May | 40 | 27 | 67 |
| 2023 April | 34 | 14 | 48 |
| 2023 March | 38 | 31 | 69 |
| 2023 February | 28 | 25 | 53 |
| 2023 January | 32 | 33 | 65 |
| 2022 December | 46 | 48 | 94 |
| 2022 November | 19 | 22 | 41 |
| 2022 October | 18 | 19 | 37 |
| 2022 September | 21 | 28 | 49 |
| 2022 August | 22 | 36 | 58 |
| 2022 July | 20 | 35 | 55 |
| 2022 June | 19 | 27 | 46 |
| 2022 May | 32 | 38 | 70 |
| 2022 April | 32 | 32 | 64 |
| 2022 March | 38 | 49 | 87 |
| 2022 February | 36 | 32 | 68 |
| 2022 January | 66 | 50 | 116 |
| 2021 December | 30 | 38 | 68 |
| 2021 November | 36 | 46 | 82 |
| 2021 October | 32 | 57 | 89 |
| 2021 September | 37 | 40 | 77 |
| 2021 August | 32 | 41 | 73 |
| 2021 July | 26 | 29 | 55 |
| 2021 June | 23 | 30 | 53 |
| 2021 May | 26 | 58 | 84 |
| 2021 April | 77 | 80 | 157 |
| 2021 March | 66 | 31 | 97 |
| 2021 February | 58 | 39 | 97 |
| 2021 January | 42 | 38 | 80 |
| 2020 December | 36 | 34 | 70 |
| 2020 November | 27 | 26 | 53 |
| 2020 October | 25 | 17 | 42 |
| 2020 September | 29 | 17 | 46 |
| 2020 August | 27 | 29 | 56 |
| 2020 July | 29 | 22 | 51 |
| 2020 June | 28 | 33 | 61 |
| 2020 May | 10 | 18 | 28 |
| 2020 April | 27 | 17 | 44 |
| 2020 March | 20 | 10 | 30 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 6 | 0 | 6 |
| 2019 November | 2 | 0 | 2 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 2 | 0 | 2 |
| 2019 July | 2 | 0 | 2 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 3 | 0 | 3 |
| 2019 April | 1 | 0 | 1 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 1 | 0 | 1 |
| 2018 December | 6 | 0 | 6 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 5 | 0 | 5 |
| 2018 September | 1 | 0 | 1 |
| 2018 February | 18 | 3 | 21 |
| 2018 January | 15 | 3 | 18 |
| 2017 December | 34 | 6 | 40 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 30 | 11 | 41 |
| 2017 September | 49 | 24 | 73 |
| 2017 August | 96 | 20 | 116 |
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