Case for Diagnosis
A Flat Pink Plaque On The Right Anterior Forearm
Placa de color rosa en superficie anterior de antebrazo derecho
S. Campos
, A. João, A. Lencastre
Corresponding author
Unidad de Dermato-Venereología, Centro Hospitalar Lisboa Central, Hospital Santo António dos Capuchos, Lisboa, Portugal
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Campos, A. João, A. Lencastre" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Campos" "email" => array:1 [ 0 => "saraazevedocampos@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "João" ] 2 => array:2 [ "nombre" => "A." 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She had first noticed this lesion 4 years earlier and hadn¿t related with nothing in particular; she also denied subsequent changes in size or appearance. She had no history of personal or family diseases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed an oval, pink to brown, smooth yet finely wrinkled plaque, measuring 12x6<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Palpation was painless and the lesion didn¿t disappear with vitropression.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">The histopathologic examination of an excisional biopsy showed a band like proliferation of fusiform cells, in a parallel distribution, seated on the papillary and upper reticular dermis, with no spreading to the subcutaneous tissue. Mitoses were rare and adnexal structures, nerves, and vessels were preserved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemical staining demonstrated that these cells were CD34 positive, and factor XIIIa and S100 negative (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Taken together, the morphologic and immunophenotypic findings were felt to be most consistent with plaque-like CD34-positive dermal fibroma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course and treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Excisional biopsy was the offered treatment without any complication.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Medallion-like dermal dendrocyte hamartoma (MDDH) also known as plaque-like CD34-positive dermal fibroma (PDF) was first described by Rodriguez-Jurado et al in 2004.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The initial doubling of terminology has been elucidated as studies have suggested that the lesion neither is a hamartoma nor possess dermal dendrocytic differentiation. For these reasons, Kutzner and colleagues have suggested an adjustment in nomenclature to PDF, widening the spectrum of this tumor.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PDF is a rare, benign, spindle cell neoplasm that classically presents as a congenital, asymptomatic, solitary, round- or triangular-shaped patch/plaque, on the neck or trunk, and most commonly in females.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The overlying skin may be pink to brown, finely wrinkled, and/or atrophic.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> With the new nomenclature other cases were described, and this description has included congenital and acquired tumors, lesions located in different body sites rather than neck or trunk and also lacking the typical presentation. In fact, there are reports of lesions located on the limbs, hands and feet and also cases of indurated and angiomatous plaques, dermal nodules and pedunculated lesions.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Our case represents an acquired form, however clinically very similar to the classical presentation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given its clinical heterogeneity, PDF may be clinically misdiagnosed as: congenital nevus; fibroblastic connective tissue nevus; neurofibroma; dermatofibroma; dermatomyofibroma; anetoderma; aplasia cutis; or, most importantly, as dermatofibrosarcoma protuberans (DFSP). It is critical to make the distinction between DFSP and PDF to prevent unnecessary wide excisions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histology is characterized by a band-like dermal proliferation of spindle cells, which strongly express CD34. For this reason, the major differential diagnosis is with DFSP. Thus, it is important to fully characterize its histological and immunohistochemical findings and sometimes add cytogenetic and molecular studies when face with difficult or borderline cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Immunohistochemically, the neoplastic cells are positive for CD34 and show variable expression of factor XIIIa and are negative for melanocytic markers (S100, MelanA, HMB45).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We feel our case description is another example of a PDF. This case included, 21 occurrences of this rare neoplasm have been reported so far. Despite their histopathologic similarities, they have revealed an appreciable variability in clinical features. These differences have been related to the onset of the lesion (congenital or acquired), patient age at presentation, gender, location and specific clinical characteristics, and positivity to Factor XIIIa. Bearing this in mind, it is important to determine whether all apparent clinical variants are distinct subtypes of one same neoplasm or rather represent unique CD34-positive spindle cell proliferations.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although a spectrum of this entity is still being defined, PDF should always be considered within the differential diagnosis of CD34-positive dermal spindle cell neoplasms.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case history" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Course and treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Campos S, João A, Lencastre A. Placa de color rosa en superficie anterior de antebrazo derecho. Actas Dermosifiliogr. 2018;109:823–824.</p>" ] ] "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" => 280 "Ancho" => 900 "Tamanyo" => 31953 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 162394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x40.</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" => 563 "Ancho" => 750 "Tamanyo" => 219355 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CD34-stained sections, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medallion-like dermal dendrocyte hamartoma: A new clinically and histopathologically distinct lesion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Rodriguez-Jurado" 1 => "C. Palacios" 2 => "C. Duran-McKinster" 3 => "P. Mercadillo" 4 => "L. Orozco-Covarrubias" 5 => "M. Saez-de-Ocariz Mdel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2003.11.070" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2004" "volumen" => "51" "paginaInicial" => "359" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15337977" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plaque-like CD34-positive dermal fibroma (“medallion-like dermal dendrocyte hamartoma”): Clinicopathologic, immunohistochemical, and molecular analysis of 5 cases emphasizing its distinction from superficial, plaque-like dermatofibrosarcoma protuberans" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Kutzner" 1 => "T. Mentzel" 2 => "G. Palmedo" 3 => "M. Hantschke" 4 => "A. Rütten" 5 => "B.E. Paredes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0b013e3181c7cf11" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "190" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20061935" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plaque-like CD34-positive dermal fibroma/medallion-like dermal dendrocyte hamartoma: An unusual spindle cell neoplasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.N. Stuart" 1 => "K.M. Hiatt" 2 => "Z. Zaki" 3 => "J.M. Gardner" 4 => "S.C. Shalin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cup.12375" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "625" "paginaFinal" => "629" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25065391" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocellular Plaque-Like CD34-Positive Dermal Fibroma (Medallion-Like Dermal Dendrocyte Hamartoma) Presenting as a Skin-Colored Dermal Nodule" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.A. Mutgi" 1 => "P. Chitgopeker" 2 => "H. Ciliberto" 3 => "M.S. Stone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12726" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2016" "volumen" => "33" "paginaInicial" => "e16" "paginaFinal" => "e19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26645569" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medallion-like dermal dendrocytoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Alexander" 1 => "L. Rizwan" 2 => "A.T. Quintana" 3 => "V. Kazlouskaya" 4 => "D. Elston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2229-5178.131110" "Revista" => array:6 [ "tituloSerie" => "Indian Dermatol Online J" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "198" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24860763" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000009/v1_201811020640/S1578219018302671/v1_201811020640/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000009/v1_201811020640/S1578219018302671/v1_201811020640/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302671?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 9 | 16 |
| 2024 October | 85 | 59 | 144 |
| 2024 September | 102 | 46 | 148 |
| 2024 August | 103 | 95 | 198 |
| 2024 July | 104 | 62 | 166 |
| 2024 June | 90 | 43 | 133 |
| 2024 May | 96 | 57 | 153 |
| 2024 April | 105 | 37 | 142 |
| 2024 March | 58 | 26 | 84 |
| 2024 February | 102 | 37 | 139 |
| 2024 January | 83 | 47 | 130 |
| 2023 December | 86 | 34 | 120 |
| 2023 November | 104 | 46 | 150 |
| 2023 October | 84 | 35 | 119 |
| 2023 September | 94 | 44 | 138 |
| 2023 August | 55 | 29 | 84 |
| 2023 July | 74 | 58 | 132 |
| 2023 June | 67 | 43 | 110 |
| 2023 May | 73 | 46 | 119 |
| 2023 April | 45 | 28 | 73 |
| 2023 March | 63 | 46 | 109 |
| 2023 February | 58 | 25 | 83 |
| 2023 January | 48 | 39 | 87 |
| 2022 December | 56 | 39 | 95 |
| 2022 November | 38 | 30 | 68 |
| 2022 October | 30 | 26 | 56 |
| 2022 September | 25 | 53 | 78 |
| 2022 August | 26 | 37 | 63 |
| 2022 July | 24 | 37 | 61 |
| 2022 June | 18 | 22 | 40 |
| 2022 May | 54 | 49 | 103 |
| 2022 April | 52 | 37 | 89 |
| 2022 March | 49 | 53 | 102 |
| 2022 February | 40 | 19 | 59 |
| 2022 January | 40 | 44 | 84 |
| 2021 December | 39 | 47 | 86 |
| 2021 November | 40 | 48 | 88 |
| 2021 October | 49 | 66 | 115 |
| 2021 September | 43 | 53 | 96 |
| 2021 August | 43 | 47 | 90 |
| 2021 July | 38 | 45 | 83 |
| 2021 June | 33 | 51 | 84 |
| 2021 May | 36 | 47 | 83 |
| 2021 April | 95 | 100 | 195 |
| 2021 March | 75 | 43 | 118 |
| 2021 February | 74 | 36 | 110 |
| 2021 January | 53 | 42 | 95 |
| 2020 December | 33 | 47 | 80 |
| 2020 November | 40 | 39 | 79 |
| 2020 October | 34 | 25 | 59 |
| 2020 September | 31 | 20 | 51 |
| 2020 August | 23 | 30 | 53 |
| 2020 July | 24 | 20 | 44 |
| 2020 June | 32 | 31 | 63 |
| 2020 May | 20 | 17 | 37 |
| 2020 April | 16 | 11 | 27 |
| 2020 March | 30 | 10 | 40 |
| 2020 February | 7 | 2 | 9 |
| 2019 May | 1 | 0 | 1 |
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