Case for Diagnosis
A reddish plaque in the forehead
Placa rojiza en la frente
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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). 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|---|---|---|---|
| 2024 Noviembre | 6 | 12 | 18 |
| 2024 Octubre | 43 | 32 | 75 |
| 2024 Septiembre | 61 | 24 | 85 |
| 2024 Agosto | 84 | 45 | 129 |
| 2024 Julio | 64 | 26 | 90 |
| 2024 Junio | 64 | 26 | 90 |
| 2024 Mayo | 53 | 24 | 77 |
| 2024 Abril | 61 | 25 | 86 |
| 2024 Marzo | 60 | 33 | 93 |
| 2024 Febrero | 58 | 29 | 87 |
| 2024 Enero | 37 | 28 | 65 |
| 2023 Diciembre | 37 | 13 | 50 |
| 2023 Noviembre | 53 | 26 | 79 |
| 2023 Octubre | 53 | 28 | 81 |
| 2023 Septiembre | 64 | 31 | 95 |
| 2023 Agosto | 46 | 9 | 55 |
| 2023 Julio | 76 | 31 | 107 |
| 2023 Junio | 63 | 23 | 86 |
| 2023 Mayo | 91 | 21 | 112 |
| 2023 Abril | 73 | 23 | 96 |
| 2023 Marzo | 79 | 30 | 109 |
| 2023 Febrero | 80 | 22 | 102 |
| 2023 Enero | 37 | 23 | 60 |
| 2022 Diciembre | 50 | 30 | 80 |
| 2022 Noviembre | 29 | 44 | 73 |
| 2022 Octubre | 53 | 35 | 88 |
| 2022 Septiembre | 53 | 55 | 108 |
| 2022 Agosto | 42 | 43 | 85 |
| 2022 Julio | 36 | 48 | 84 |
| 2022 Junio | 23 | 28 | 51 |
| 2022 Mayo | 25 | 35 | 60 |
| 2022 Abril | 31 | 22 | 53 |
| 2022 Marzo | 30 | 45 | 75 |
| 2022 Febrero | 26 | 22 | 48 |
| 2022 Enero | 30 | 48 | 78 |
| 2021 Diciembre | 21 | 35 | 56 |
| 2021 Noviembre | 33 | 37 | 70 |
| 2021 Octubre | 43 | 56 | 99 |
| 2021 Septiembre | 27 | 41 | 68 |
| 2021 Agosto | 28 | 33 | 61 |
| 2021 Julio | 23 | 31 | 54 |
| 2021 Junio | 21 | 33 | 54 |
| 2021 Mayo | 44 | 39 | 83 |
| 2021 Abril | 71 | 81 | 152 |
| 2021 Marzo | 78 | 32 | 110 |
| 2021 Febrero | 53 | 45 | 98 |
| 2021 Enero | 43 | 26 | 69 |
| 2020 Diciembre | 38 | 13 | 51 |
| 2020 Noviembre | 25 | 25 | 50 |
| 2020 Octubre | 31 | 21 | 52 |
| 2020 Septiembre | 33 | 20 | 53 |
| 2020 Agosto | 37 | 22 | 59 |
| 2020 Julio | 20 | 18 | 38 |
| 2020 Junio | 34 | 26 | 60 |
| 2020 Mayo | 25 | 11 | 36 |
| 2020 Abril | 18 | 17 | 35 |
| 2020 Marzo | 31 | 12 | 43 |
| 2020 Febrero | 6 | 1 | 7 |
| 2020 Enero | 2 | 0 | 2 |
| 2019 Diciembre | 9 | 0 | 9 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Septiembre | 10 | 0 | 10 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 5 | 0 | 5 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 8 | 0 | 8 |
| 2019 Abril | 4 | 0 | 4 |
| 2019 Febrero | 4 | 0 | 4 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Agosto | 1 | 0 | 1 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 5 | 5 | 10 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 2 | 1 | 3 |
| 2018 Febrero | 11 | 9 | 20 |
| 2018 Enero | 20 | 11 | 31 |
| 2017 Diciembre | 10 | 11 | 21 |
| 2017 Noviembre | 18 | 9 | 27 |
| 2017 Octubre | 23 | 14 | 37 |
| 2017 Septiembre | 48 | 77 | 125 |
| 2017 Agosto | 6 | 16 | 22 |
| 2017 Julio | 0 | 14 | 14 |
| 2017 Junio | 0 | 14 | 14 |
| 2017 Mayo | 0 | 9 | 9 |
| 2017 Abril | 0 | 10 | 10 |
| 2017 Marzo | 0 | 10 | 10 |
| 2017 Febrero | 0 | 15 | 15 |
| 2017 Enero | 0 | 15 | 15 |
| 2016 Diciembre | 0 | 18 | 18 |
| 2016 Noviembre | 0 | 17 | 17 |
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