array:24 [
  "pii" => "S1578219011000667"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2011.03.009"
  "estado" => "S300"
  "fechaPublicacion" => "2011-10-01"
  "aid" => "385"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "cita" => "Actas Dermosifiliogr. 2011;102:627-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3473
    "formatos" => array:3 [
      "EPUB" => 47
      "HTML" => 2769
      "PDF" => 657
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731011001694"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2011.03.008"
      "estado" => "S300"
      "fechaPublicacion" => "2011-10-01"
      "aid" => "385"
      "copyright" => "Elsevier España, S.L. y AEDV"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "cor"
      "cita" => "Actas Dermosifiliogr. 2011;102:627-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5759
        "formatos" => array:3 [
          "EPUB" => 2
          "HTML" => 4361
          "PDF" => 1396
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso para el diagn&#243;stico</span>"
        "titulo" => "N&#243;dulo crateriforme en el h&#233;lix"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "627"
            "paginaFinal" => "628"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Crateriform Nodule on the Helix of the Ear"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:6 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 562
                "Ancho" => 475
                "Tamanyo" => 104925
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46; Maldonado, P&#46; Herranz, M&#46; Beato Merino"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Maldonado"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Herranz"
              ]
              2 => array:2 [
                "nombre" => "M&#46; Beato"
                "apellidos" => "Merino"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219011000667"
          "doi" => "10.1016/j.adengl.2011.03.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000667?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011001694?idApp=UINPBA000044"
      "url" => "/00017310/0000010200000008/v1_201304241336/S0001731011001694/v1_201304241336/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219011000679"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2011.03.010"
    "estado" => "S300"
    "fechaPublicacion" => "2011-10-01"
    "aid" => "386"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2011;102:629-30"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3322
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 2632
        "PDF" => 648
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
      "titulo" => "Fever&#44; Cervical Lymphadenopathy&#44; and Erythematous-Violaceous Facial Plaques"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "629"
          "paginaFinal" => "630"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fiebre&#44; linfadenopat&#237;as cervicales y placas eritematoviol&#225;ceas faciales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 658
              "Ancho" => 510
              "Tamanyo" => 117046
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin&#44; original magnification x4&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Fueyo-Casado, L&#46; Campos-Mu&#241;oz, E&#46; L&#243;pez-Bran"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Fueyo-Casado"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Campos-Mu&#241;oz"
            ]
            2 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "L&#243;pez-Bran"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011001700"
        "doi" => "10.1016/j.ad.2011.03.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011001700?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000679?idApp=UINPBA000044"
    "url" => "/15782190/0000010200000008/v1_201304241234/S1578219011000679/v1_201304241234/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219011000588"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2010.11.001"
    "estado" => "S300"
    "fechaPublicacion" => "2011-10-01"
    "aid" => "307"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Actas Dermosifiliogr. 2011;102:623-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8476
      "formatos" => array:3 [
        "EPUB" => 49
        "HTML" => 6783
        "PDF" => 1644
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Diagnostic Utility of Dermoscopy in Pigmented Actinic Keratosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "623"
          "paginaFinal" => "626"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Utilidad de la dermatoscopia en el diagn&#243;stico de las queratosis act&#237;nicas pigmentadas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1251
              "Ancho" => 2826
              "Tamanyo" => 414212
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#44; Clinical image of the lesion in patient 1&#46; There is a dark brown&#44; pigmented macule of 5<span class="elsevierStyleHsp" style=""></span>mm diameter&#44; with well-defined borders and a slightly rough surface&#46; Part of the border of the lesion is moth-eaten&#46; B&#44; Dermoscopic image of the lesion in patient 1&#44; showing rhomboidal structures and an annular-granular pattern&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46; Ciudad, J&#46;A&#46; Avil&#233;s, R&#46; Su&#225;rez, P&#46; L&#225;zaro"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Ciudad"
            ]
            1 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Avil&#233;s"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Su&#225;rez"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "L&#225;zaro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731011000068"
        "doi" => "10.1016/j.ad.2010.11.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011000068?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000588?idApp=UINPBA000044"
    "url" => "/15782190/0000010200000008/v1_201304241234/S1578219011000588/v1_201304241234/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case for diagnosis</span>"
    "titulo" => "Crateriform Nodule on the Helix of the Ear"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "627"
        "paginaFinal" => "628"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Maldonado, P&#46; Herranz, M&#46; Beato Merino"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "Maldonado"
            "email" => array:1 [
              0 => "hola&#46;paola&#64;hotmail&#46;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" => "P&#46;"
            "apellidos" => "Herranz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Beato Merino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a del Hospital Universitario La Paz&#44; Madrid"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica del Hospital Universitario La Paz&#44; Madrid"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "N&#243;dulo crateriforme en el h&#233;lix"
      ]
    ]
    "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" => 594
            "Ancho" => 762
            "Tamanyo" => 221993
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin&#8211;eosin &#40;10x&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 71-year-old ex-smoker&#44; positive for hepatitis C virus &#40;HCV&#41;&#44; and with chronic renal insufficiency was being studied by the respiratory department due to a tumor in the left lung&#46; He presented with a progressively growing bleeding&#44; painful lesion that had appeared several months earlier on the pinna&#46; The patient did not recall having suffered any trauma and had not undergone prior treatment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed a crateriform nodule with a diameter of 1<span class="elsevierStyleHsp" style=""></span>cm on the left pinna&#59; the nodule appeared infiltrated on palpation&#46; The lesion presented a central ulcerated area covered by a necrotic crust &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; No satellite lesions or swollen cervical lymph nodes were observed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Laboratory tests showed pancytopenia&#44; abnormal liver function associated with HCV infection&#44; and renal insufficiency&#44; as reported previously&#46; Tests for tumor markers in blood were negative&#46; A biopsy of the lung nodule was negative for malignant cells&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0020" class="elsevierStylePara elsevierViewall">Histology revealed fusiform cells&#44; together with multinucleated giant cells arranged in interlacing fascicles in the dermis&#46; The nuclei showed varying degrees of atypia&#46; Mitosis was abundant but no necrosis was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemistry was positive for vimentin&#44; smooth-muscle actin&#44; and CD10 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; and negative for CD34 and S-100 protein&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis&#63;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was fully excised with deep margins &#40;to the cartilage&#41;&#46; The patient died 4 months after surgery due to the progression of his renal insufficiency&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma was first described by Helwig in1961&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is a rare tumor that usually presents as a single nodule most frequently located on the head or neck&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It affects men more than women and generally appears in elderly patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The lesion presents clinically as a single painless nodule that usually measures up to 2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> and develops over a period of between 1 and 12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The lesion is located in the dermis&#46; The tumor cells are of 3 types&#58; fusiform cells &#40;the majority&#41; with varying degrees of nuclear atypia&#59; histiocytoid cells&#44; which give this tumor the name fibroxanthoma&#59; and multinucleated giant cells&#46; Necrosis&#44; infiltration of deep layers of tissue&#44; and vascular invasion&#44; however&#44; are more characteristic of malignant fibrous histiocytoma than of atypical fibroxanthoma&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Immunohistochemistry shows these cells to be positive for vimentin alone&#44; whereas melanoma is positive for vimentin and S100 proteins&#59; spindle cell carcinoma is positive for cytokeratin&#59; and leiomyosarcoma is positive for vimentin and desmin&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Variable positivity has been reported in atypical fibroxanthoma for CD68&#44; factor XIIIa&#44; and CD99 and intense positivity for CD105&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our case&#44; the clinical differential diagnosis should include lung cancer metastasis&#44; spindle cell carcinoma&#44; basal cell carcinoma&#44; keratoacanthoma&#44; pyogenic granuloma&#44; and desmoplastic malignant melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The histologic differential diagnosis should include cutaneous leiomyosarcoma&#44; malignant fibrous histiocytoma&#44; spindle cell carcinoma&#44; and malignant melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Atypical fibroxanthoma is a cutaneous tumor that is considered to be a member of the family of fibrous histiocytic tumors&#46; It has traditionally been thought to be a tumor of mesenchymal origin&#46; It is thought to be a more superficial version of malignant fibrous histiocytoma because of its histologic similarity&#46; It has been argued that atypical fibroxanthoma may be an undifferentiated variant of spindle cell carcinoma or melanoma&#44; but immunohistochemistry findings rule out this argument and it is currently thought to be a tumor arising from fibroblasts or myofibroblasts&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In terms of histology&#44; it is a malignant tumor and may be locally aggressive&#44; but with little tendency to metastasize &#40;less than 1&#37; of cases&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment of atypical fibroxanthoma is the subject of debate&#46; Most studies recommend Mohs surgery<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a> over local excision with a wide margin&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> due to a lower observed rate of local recurrence&#46; A follow-up of at least 2 years is recommended&#44; as most recurrences are observed before this cut-off&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Clinical History"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Physical Examination"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Additional Tests"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Histopathology"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Diagnosis"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Course and Treatment"
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Comment"
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of Interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Maldonado P&#44; et al&#46; N&#243;dulo crateriforme en el h&#233;lix&#46; Actas Dermosifiliogr&#46; 2011&#59;102&#58;629-30&#46;</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" => 564
            "Ancho" => 477
            "Tamanyo" => 80815
          ]
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 594
            "Ancho" => 762
            "Tamanyo" => 221993
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin&#8211;eosin &#40;10x&#41;&#46;</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" => 578
            "Ancho" => 762
            "Tamanyo" => 188185
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CD10 marker &#40;10x&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical fibroxanthoma&#46; Tumor Seminar&#58; proceedings of 18th annual seminar of San Antonio society of pathologists&#44; 1961"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;B&#46; Helwig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Tex J State Med"
                        "fecha" => "1963"
                        "volumen" => "59"
                        "paginaInicial" => "664"
                        "paginaFinal" => "667"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fibroxantoma at&#237;pico&#46; Estudio clinicopatol&#243;gico de 10 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; G&#243;mez de la Fuente"
                            1 => "M&#46; Sols"
                            2 => "F&#46; Pinedo"
                            3 => "J&#46;G&#46; &#193;lvarez-Fern&#225;ndez"
                            4 => "F&#46;J&#46; Vicente"
                            5 => "E&#46; Naz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "153"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An unusual presentation of atypical fibroxanthoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;W&#46; Vandergriff"
                            1 => "J&#46;A&#46; Reed"
                            2 => "I&#46;F&#46; Orengo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dermatol Online J"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19094844"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical fibroxanthoma&#58; review of the literature and summary of 13 patients treated with Mohs micrographic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Seavolt"
                            1 => "M&#46; McCall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2006.32087.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "435"
                        "paginaFinal" => "441"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16640694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inmunohistochemical staining of CD10 in atypical fibroxanthomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;L&#46; Hultgren"
                            1 => "D&#46;J&#46; DiMaio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0560.2006.00635.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Pathol"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "415"
                        "paginaFinal" => "419"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17448198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical fibroxanthoma&#58; A Review of the Literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;J&#46; Iorizzo 3rd"
                            1 => "M&#46;D&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2010.01807.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21070463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010200000008/v1_201304241234/S1578219011000667/v1_201304241234/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/15782190/0000010200000008/v1_201304241234/S1578219011000667/v1_201304241234/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011000667?idApp=UINPBA000044"
]
Compartir
Información de la revista
Vol. 102. Núm. 8.
Páginas 627-628 (octubre 2011)
Visitas
8464
Vol. 102. Núm. 8.
Páginas 627-628 (octubre 2011)
Case for diagnosis
Acceso a texto completo
Crateriform Nodule on the Helix of the Ear
Nódulo crateriforme en el hélix
Visitas
8464
P. Maldonadoa,
Autor para correspondencia
hola.paola@hotmail.com

Corresponding author.
, P. Herranza, M. Beato Merinob
a Servicio de Dermatología del Hospital Universitario La Paz, Madrid
b Servicio de Anatomía Patológica del Hospital Universitario La Paz, Madrid
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (3)
Mostrar másMostrar menos
Texto completo
Clinical History

A 71-year-old ex-smoker, positive for hepatitis C virus (HCV), and with chronic renal insufficiency was being studied by the respiratory department due to a tumor in the left lung. He presented with a progressively growing bleeding, painful lesion that had appeared several months earlier on the pinna. The patient did not recall having suffered any trauma and had not undergone prior treatment.

Physical Examination

The physical examination revealed a crateriform nodule with a diameter of 1cm on the left pinna; the nodule appeared infiltrated on palpation. The lesion presented a central ulcerated area covered by a necrotic crust (Fig. 1). No satellite lesions or swollen cervical lymph nodes were observed.

Figure 1
(0.08MB).
Additional Tests

Laboratory tests showed pancytopenia, abnormal liver function associated with HCV infection, and renal insufficiency, as reported previously. Tests for tumor markers in blood were negative. A biopsy of the lung nodule was negative for malignant cells.

Histopathology

Histology revealed fusiform cells, together with multinucleated giant cells arranged in interlacing fascicles in the dermis. The nuclei showed varying degrees of atypia. Mitosis was abundant but no necrosis was observed (Fig. 2). Immunohistochemistry was positive for vimentin, smooth-muscle actin, and CD10 (Fig. 3), and negative for CD34 and S-100 protein.

Figure 2.

Hematoxylin–eosin (10x).

(0.21MB).
Figure 3.

CD10 marker (10x).

(0.18MB).

What is your diagnosis?

Diagnosis

Atypical fibroxanthoma.

Course and Treatment

The lesion was fully excised with deep margins (to the cartilage). The patient died 4 months after surgery due to the progression of his renal insufficiency.

Comment

Atypical fibroxanthoma was first described by Helwig in1961.1 It is a rare tumor that usually presents as a single nodule most frequently located on the head or neck.2 It affects men more than women and generally appears in elderly patients.3

The lesion presents clinically as a single painless nodule that usually measures up to 2cm3 and develops over a period of between 1 and 12 months.2

The lesion is located in the dermis. The tumor cells are of 3 types: fusiform cells (the majority) with varying degrees of nuclear atypia; histiocytoid cells, which give this tumor the name fibroxanthoma; and multinucleated giant cells. Necrosis, infiltration of deep layers of tissue, and vascular invasion, however, are more characteristic of malignant fibrous histiocytoma than of atypical fibroxanthoma.2 Immunohistochemistry shows these cells to be positive for vimentin alone, whereas melanoma is positive for vimentin and S100 proteins; spindle cell carcinoma is positive for cytokeratin; and leiomyosarcoma is positive for vimentin and desmin.4 Variable positivity has been reported in atypical fibroxanthoma for CD68, factor XIIIa, and CD99 and intense positivity for CD105.

In our case, the clinical differential diagnosis should include lung cancer metastasis, spindle cell carcinoma, basal cell carcinoma, keratoacanthoma, pyogenic granuloma, and desmoplastic malignant melanoma.2 The histologic differential diagnosis should include cutaneous leiomyosarcoma, malignant fibrous histiocytoma, spindle cell carcinoma, and malignant melanoma.2,5

Atypical fibroxanthoma is a cutaneous tumor that is considered to be a member of the family of fibrous histiocytic tumors. It has traditionally been thought to be a tumor of mesenchymal origin. It is thought to be a more superficial version of malignant fibrous histiocytoma because of its histologic similarity. It has been argued that atypical fibroxanthoma may be an undifferentiated variant of spindle cell carcinoma or melanoma, but immunohistochemistry findings rule out this argument and it is currently thought to be a tumor arising from fibroblasts or myofibroblasts.6 In terms of histology, it is a malignant tumor and may be locally aggressive, but with little tendency to metastasize (less than 1% of cases).3,6

Treatment of atypical fibroxanthoma is the subject of debate. Most studies recommend Mohs surgery4,6 over local excision with a wide margin,2 due to a lower observed rate of local recurrence. A follow-up of at least 2 years is recommended, as most recurrences are observed before this cut-off.6

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
E.B. Helwig.
Atypical fibroxanthoma. Tumor Seminar: proceedings of 18th annual seminar of San Antonio society of pathologists, 1961.
Tex J State Med, 59 (1963), pp. 664-667
[2]
E. Gómez de la Fuente, M. Sols, F. Pinedo, J.G. Álvarez-Fernández, F.J. Vicente, E. Naz, et al.
Fibroxantoma atípico. Estudio clinicopatológico de 10 casos.
Actas Dermosifiliogr, 96 (2005), pp. 153-158
[3]
T.W. Vandergriff, J.A. Reed, I.F. Orengo.
An unusual presentation of atypical fibroxanthoma.
Dermatol Online J, 14 (2008), pp. 6
[4]
M. Seavolt, M. McCall.
Atypical fibroxanthoma: review of the literature and summary of 13 patients treated with Mohs micrographic surgery.
Dermatol Surg, 32 (2006), pp. 435-441
[5]
T.L. Hultgren, D.J. DiMaio.
Inmunohistochemical staining of CD10 in atypical fibroxanthomas.
J Cutan Pathol, 34 (2007), pp. 415-419
[6]
L.J. Iorizzo 3rd, M.D. Brown.
Atypical fibroxanthoma: A Review of the Literature.
Dermatol Surg, 37 (2011), pp. 1-12

Please cite this article as: Maldonado P, et al. Nódulo crateriforme en el hélix. Actas Dermosifiliogr. 2011;102:629-30.

Copyright © 2010. Elsevier España, S.L. and AEDV
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?