Case and Research Letter
Clinical, Dermoscopic, and Histopathologic Features of a Dermatofibroma With Sebaceous Induction
Hallazgos clínicos, dermatoscópicos e histopatológicos de un dermatofibroma con inducción sebácea
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Monteagudo, O. Figueroa-Silva, O. Suárez-Amor, J.C. Álvarez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Monteagudo" "email" => array:1 [ 0 => "benigno.monteagudo.sanchez@sergas.es" ] "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" => "O." "apellidos" => "Figueroa-Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Suárez-Amor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.C." "apellidos" => "Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol SERGAS, Ferrol, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Ferrol SERGAS, Ferrol, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos clínicos, dermatoscópicos e histopatológicos de un dermatofibroma con inducción sebácea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1463 "Ancho" => 975 "Tamanyo" => 84705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy image showing yellowish globules and vascular erythematous areas. Focal area with a pigment network on the left and a white patch in the lower right area of the image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recently, Abarzúa-Araya et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> published an article describing a dermatofibroma (DF) with osseous metaplasia. We present the case of a patient with DF with sebaceous induction in order to illustrate the marked histopathological variability of this tumor and the value of dermoscopy in its diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 68-year-old woman with a past history of hypertension, dyslipidemia, and hypothyroidism. She consulted for a stable, asymptomatic lesion that had arisen on her left shoulder more than 10 years earlier.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed a firm pink tumor measuring 1<span class="elsevierStyleHsp" style=""></span>cm in diameter on the lateral aspect of the proximal third of the patient's left arm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had a smooth surface and presented the dimple sign. On dermoscopy, yellowish globules were observed in association with vascular erythematous areas. Focally, in some peripheral areas, the lesion presented a delicate pigment network and a white patch (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The lesion was excised and histopathology revealed a hyperplastic epidermis with slight hyperpigmentation of the basal layer. A poorly defined nodular proliferation formed of spindle-shaped cells with no cytologic atypia was present in the dermis. Greater cell density was observed in the more superficial areas, while the intermediate level was predominantly sclerotic. Nests of sebaceous cells were present in the upper dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Staining with factor <span class="elsevierStyleSmallCaps">xiii</span>a was strongly positivity in the nuclei of the fibroblastic cells.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">DF is a very common, benign fibrohistiocytic tumor that typically presents as a firm, brownish-pink, dome-shaped lesion measuring less than 1<span class="elsevierStyleHsp" style=""></span>cm in diameter, localized on the lower extremities of adult women. Although the definitive diagnosis requires histopathology, dermoscopy is useful to differentiate DF from other pigmented skin lesions, such as malignant melanoma, Spitz nevus, atypical melanocytic nevus, and seborrheic keratosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Zaballos et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> described 10 global dermoscopy patterns for DF. The most common is the delicate peripheral pigment network and central white patch, present in 34.7% of cases. Other patterns are pigment network, pigment network and central white network, white network, homogeneous, total white patch, multiple white patches, homogeneous with central white patch, homogeneous with white network, and atypical (multicomponent). Vascular structures are observed in approximately half of lesions.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Many histopathologic variants of DF exist, such as fibrocollagenous, histiocytic, sclerotic or atrophic, storiform, cellular, deep, hemosiderotic, palisading, myxoid, clear cell, epithelioid, keloid, lipidized, and with presence of granular cells, osseous metaplasia, cholesterol crystals, or atypical cells (pseudosarcomatous).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a> Acanthosis, hyperkeratosis, and hyperpigmentation are often observed in the overlying epidermis, sometimes mimicking seborrheic keratosis. Adnexal induction has also been reported in the sebaceous and follicular form.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> This broad histopathological variability leads to distinct dermoscopic findings, with some variants having certain dermoscopic characteristics that aid in their diagnosis. Examples of these are the hemosiderotic/aneurysmal DF, which has a central area of homogeneous bluish or erythematous-violaceous pigmentation, and the lipidized DF, with a homogeneous yellowish area.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although initially considered rare, sebaceous structures are identified in more than 15% of DFs,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5,7</span></a> even in multiple forms.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> This finding is typical in lesions localized in the anatomical area of the shoulder (shoulder, proximal region of the arm, upper back and deltoid region), being observed in more than 40% of these cases, particularly in DF with seborrheic keratosis-type epidermal hyperplasia or with a sclerotic pattern.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The dermoscopic image shows yellowish globular structures due to the sebaceous component.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Although growth factors and cytokines have been implicated,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> the etiology of sebaceous induction and the reason for its predilection for DF of the shoulder remain unknown.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In this case, the differential diagnosis should include sebaceous tumors and tumors with sebaceous differentiation, such as sebaceous hyperplasia, sebaceous nevus, sebaceous adenoma, sebaceous carcinoma, and reticulated acanthoma or poroma with sebaceous differentiation, which can include yellowish structures in the dermoscopy image.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Yellowish globules have also been identified in melanocytic nevi and balloon cell melanomas.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, DF is a tumor with a marked variability of its clinical, histopathological, and dermoscopic presentation. A diagnosis of DF with sebaceous induction should be considered in lesions in the shoulder area with yellowish globules visible on dermoscopy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">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:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Monteagudo B, Figueroa-Silva O, Suárez-Amor O, Álvarez JC. Hallazgos clínicos, dermatoscópicos e histopatológicos de un dermatofibroma con inducción sebácea. Actas Dermosifiliogr. 2017;108:874–876.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 650 "Ancho" => 975 "Tamanyo" => 100444 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pink tumor measuring 1<span class="elsevierStyleHsp" style=""></span>cm in diameter, localized on the left arm.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1463 "Ancho" => 975 "Tamanyo" => 84705 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy image showing yellowish globules and vascular erythematous areas. Focal area with a pigment network on the left and a white patch in the lower right area of the image.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1197 "Ancho" => 1587 "Tamanyo" => 749753 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, A poorly defined proliferation of spindle-shaped cells with nests of sebaceous cells in the more superficial region. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×40. B, At higher magnification, a dermal proliferation formed of spindle-shaped cells with a whorled pattern. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×200. C, Entrapment of collagen fibers between fibroblastic cells at the periphery of the lesion. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 5 | 19 |
| 2024 October | 102 | 49 | 151 |
| 2024 September | 98 | 53 | 151 |
| 2024 August | 117 | 86 | 203 |
| 2024 July | 113 | 25 | 138 |
| 2024 June | 99 | 26 | 125 |
| 2024 May | 84 | 27 | 111 |
| 2024 April | 91 | 17 | 108 |
| 2024 March | 79 | 22 | 101 |
| 2024 February | 72 | 26 | 98 |
| 2024 January | 70 | 32 | 102 |
| 2023 December | 73 | 15 | 88 |
| 2023 November | 124 | 24 | 148 |
| 2023 October | 98 | 39 | 137 |
| 2023 September | 83 | 33 | 116 |
| 2023 August | 80 | 22 | 102 |
| 2023 July | 85 | 53 | 138 |
| 2023 June | 63 | 32 | 95 |
| 2023 May | 89 | 41 | 130 |
| 2023 April | 68 | 34 | 102 |
| 2023 March | 85 | 42 | 127 |
| 2023 February | 96 | 28 | 124 |
| 2023 January | 46 | 37 | 83 |
| 2022 December | 64 | 41 | 105 |
| 2022 November | 65 | 29 | 94 |
| 2022 October | 42 | 41 | 83 |
| 2022 September | 73 | 48 | 121 |
| 2022 August | 63 | 55 | 118 |
| 2022 July | 41 | 41 | 82 |
| 2022 June | 41 | 34 | 75 |
| 2022 May | 124 | 44 | 168 |
| 2022 April | 133 | 43 | 176 |
| 2022 March | 154 | 59 | 213 |
| 2022 February | 99 | 42 | 141 |
| 2022 January | 163 | 37 | 200 |
| 2021 December | 89 | 33 | 122 |
| 2021 November | 103 | 53 | 156 |
| 2021 October | 99 | 50 | 149 |
| 2021 September | 80 | 47 | 127 |
| 2021 August | 86 | 57 | 143 |
| 2021 July | 65 | 34 | 99 |
| 2021 June | 81 | 29 | 110 |
| 2021 May | 70 | 56 | 126 |
| 2021 April | 85 | 65 | 150 |
| 2021 March | 81 | 32 | 113 |
| 2021 February | 42 | 35 | 77 |
| 2021 January | 52 | 21 | 73 |
| 2020 December | 54 | 24 | 78 |
| 2020 November | 37 | 21 | 58 |
| 2020 October | 32 | 17 | 49 |
| 2020 September | 44 | 27 | 71 |
| 2020 August | 45 | 20 | 65 |
| 2020 July | 32 | 22 | 54 |
| 2020 June | 24 | 27 | 51 |
| 2020 May | 20 | 12 | 32 |
| 2020 April | 30 | 14 | 44 |
| 2020 March | 22 | 25 | 47 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 6 | 0 | 6 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 3 | 0 | 3 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 4 | 0 | 4 |
| 2019 February | 3 | 0 | 3 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 2 | 5 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 9 | 0 | 9 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 22 | 6 | 28 |
| 2018 January | 48 | 6 | 54 |
| 2017 December | 31 | 14 | 45 |
| 2017 November | 68 | 35 | 103 |
| 2017 October | 3 | 8 | 11 |
| 2017 September | 4 | 7 | 11 |
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