Case for diagnosis
Nodular Lesion on a Woman's Earlobe
Lesión nodular en el lóbulo de la oreja de una paciente
Servicios de Dermatología y Anatomía Patológica, Hospital Quirón y Hospital Clínico Universitario de Valencia, Spain
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López, F. Giner" "autores" => array:2 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "López" "email" => array:1 [ 0 => "veronica_17@live.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Giner" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicios de Dermatología y Anatomía Patológica, Hospital Quirón y Hospital Clínico Universitario de Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión nodular en el lóbulo de la oreja de una paciente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 173817 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 32-year-old woman sought care for a fast-growing nodular lesion of 2 months’ duration on her right earlobe. The patient had no relevant medical history and denied previous injury to the area.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed a well-circumscribed, violaceous erythematous nodular lesion with a diameter of 8<span class="elsevierStyleHsp" style=""></span>mm on the right earlobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>)</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">Histologic examination following complete surgical excision showed spindle cells arranged in a storiform pattern with hemosiderin-laden Touton-type multinucleated giant cells surrounding cleft-like vascular spaces without epithelial lining (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No cellular atypia or mitotic figures were observed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Aneurysmal dermatofibroma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient remained asymptomatic after surgical removal of the lesion, with no signs of recurrence after 2 years of follow-up.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dermatofibroma is a very common benign tumor that can be of fibroblastic or histiocytic origin. There are several histologic variants depending on the cells that make up the tumor. Diagnosis is generally easy, but atypical forms or variants can sometimes present challenges.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Aneurysmal dermatofibroma is a rare variant that accounts for less than 2% of all these tumors.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> This tumor is also known as aneurysmal benign fibrous histiocytoma, a term coined by Santa Cruz and Kyriakos<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> to describe nodular lesions with a smooth surface located primarily on the extremities and the trunk of middle-aged patients, and women in particular.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These lesions can, however, occur in any location and in patients across a wide age range (12-92 years). To our knowledge, ours is the first report of an aneurysmal dermatofibroma on an earlobe. The aneurysmal lesions tend to measure between 0.5 and 4<span class="elsevierStyleHsp" style=""></span>cm and are generally larger than typical dermatofibromas. They vary in color, presenting as red, red-violaceous, blue, black, or yellow, and can grow quickly and cause pain due to intralesional bleeding.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Very occasionally, previous injury to the site has been reported.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Histologic features include the presence of multiple vascular spaces devoid of endothelial lining, with an interspersed infiltrate composed of histiocytes, fibroblasts, multinucleated giant cells, and abundant hemosiderin deposits.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Hemosiderotic dermatofibroma is considered to be a precursor of aneurysmal dermatofibroma in which extravasation of blood from the capillaries of the lesion leads to the formation of hemosiderin, which is then phagocytosed by dermal histiocytes and tumor cells. If the extravasation continues, histology will show the large spaces typically seen in aneurysmal dermatofibroma.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering the clinical features of these lesions, it is surprising that a diagnosis of aneurysmal dermatofibroma is rarely considered initially. It is possible to confuse these tumors with benign angiomatous lesions or malignant tumors with similar clinical manifestations, as well as with spindle cell melanocytic tumors. The differential diagnosis should therefore include cutaneous melanoma, Kaposi sarcoma, spindle cell hemangioendothelioma, angiomatoid malignant fibrous histiocytoma, angiosarcoma, hemangiomas, adnexal tumors, and cysts.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Two recent reports described a set of dermoscopic features that might aid in the diagnosis of aneurysmal dermatofibroma.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> In a series of 6 patients, Zaballos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> described the presence of pigmented, homogeneous areas ranging in color from a bluish gray to a reddish brown, with fine white linear structures corresponding to fibrosis, a delicate pigment network, and vascular structures including dotted vessels, comma vessels, and/or irregular vessels.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The treatment of choice for aneurysmal dermatofibroma is surgery, but it is important to bear in mind that, compared with other variants, the aneurysmal form of this tumor has a stronger tendency to recur locally (20% of cases) and can also, albeit very rarely, metastasize after incomplete excision. Several factors have been associated with an increased risk of metastasis; these include lesion size, the presence of tumor necrosis, a history of local recurrence, and certain histologic features such as pronounced cellular pleomorphism, a high mitotic index, and aneurysmal changes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We have presented the case of a rare variant of dermatofibroma on the earlobe of a female patient. Considering the clinical characteristics of this lesion, we believe that aneurysmal dermatofibroma should be considered in the differential diagnosis of violaceous erythematous lesions of the ear.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Histopathology" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] ] ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 5 => 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: López V, Giner F. Lesión nodular en el lóbulo de la oreja de una paciente. Actas Dermosifiliogr. 2013;104:437-8.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 173817 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 669 "Ancho" => 1599 "Tamanyo" => 333268 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification ×4. B, Hematoxylin-eosin, original magnification ×20.</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" => "Aneurysmal (“angiomatoid”) fibrous histiocytoma of the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.J. Santa Cruz" 1 => "M. 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Mod Pathol. 200; 13:654." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000005/v1_201307051101/S1578219013000991/v1_201307051101/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/15782190/0000010400000005/v1_201307051101/S1578219013000991/v1_201307051101/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000991?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 1 | 0 | 1 |
| 2024 Octubre | 136 | 80 | 216 |
| 2024 Septiembre | 145 | 54 | 199 |
| 2024 Agosto | 186 | 80 | 266 |
| 2024 Julio | 127 | 65 | 192 |
| 2024 Junio | 118 | 79 | 197 |
| 2024 Mayo | 97 | 73 | 170 |
| 2024 Abril | 114 | 76 | 190 |
| 2024 Marzo | 105 | 55 | 160 |
| 2024 Febrero | 105 | 41 | 146 |
| 2024 Enero | 84 | 49 | 133 |
| 2023 Diciembre | 85 | 46 | 131 |
| 2023 Noviembre | 73 | 46 | 119 |
| 2023 Octubre | 73 | 52 | 125 |
| 2023 Septiembre | 78 | 63 | 141 |
| 2023 Agosto | 54 | 46 | 100 |
| 2023 Julio | 79 | 63 | 142 |
| 2023 Junio | 76 | 48 | 124 |
| 2023 Mayo | 64 | 35 | 99 |
| 2023 Abril | 93 | 41 | 134 |
| 2023 Marzo | 61 | 43 | 104 |
| 2023 Febrero | 35 | 42 | 77 |
| 2023 Enero | 40 | 46 | 86 |
| 2022 Diciembre | 54 | 51 | 105 |
| 2022 Noviembre | 40 | 38 | 78 |
| 2022 Octubre | 33 | 30 | 63 |
| 2022 Septiembre | 35 | 50 | 85 |
| 2022 Agosto | 22 | 55 | 77 |
| 2022 Julio | 39 | 51 | 90 |
| 2022 Junio | 33 | 32 | 65 |
| 2022 Mayo | 84 | 54 | 138 |
| 2022 Abril | 114 | 67 | 181 |
| 2022 Marzo | 115 | 88 | 203 |
| 2022 Febrero | 92 | 39 | 131 |
| 2022 Enero | 136 | 46 | 182 |
| 2021 Diciembre | 67 | 54 | 121 |
| 2021 Noviembre | 78 | 61 | 139 |
| 2021 Octubre | 89 | 72 | 161 |
| 2021 Septiembre | 74 | 45 | 119 |
| 2021 Agosto | 86 | 44 | 130 |
| 2021 Julio | 77 | 50 | 127 |
| 2021 Junio | 100 | 31 | 131 |
| 2021 Mayo | 82 | 41 | 123 |
| 2021 Abril | 267 | 41 | 308 |
| 2021 Marzo | 138 | 39 | 177 |
| 2021 Febrero | 138 | 37 | 175 |
| 2021 Enero | 79 | 19 | 98 |
| 2020 Diciembre | 88 | 26 | 114 |
| 2020 Noviembre | 68 | 42 | 110 |
| 2020 Octubre | 65 | 31 | 96 |
| 2020 Septiembre | 53 | 17 | 70 |
| 2020 Agosto | 54 | 43 | 97 |
| 2020 Julio | 51 | 25 | 76 |
| 2020 Junio | 56 | 48 | 104 |
| 2020 Mayo | 32 | 56 | 88 |
| 2020 Abril | 40 | 38 | 78 |
| 2020 Marzo | 37 | 32 | 69 |
| 2020 Febrero | 4 | 23 | 27 |
| 2020 Enero | 5 | 25 | 30 |
| 2019 Diciembre | 8 | 21 | 29 |
| 2019 Noviembre | 4 | 12 | 16 |
| 2019 Octubre | 0 | 17 | 17 |
| 2019 Septiembre | 4 | 37 | 41 |
| 2019 Agosto | 4 | 11 | 15 |
| 2019 Julio | 4 | 24 | 28 |
| 2019 Junio | 6 | 15 | 21 |
| 2019 Mayo | 4 | 50 | 54 |
| 2019 Abril | 2 | 14 | 16 |
| 2019 Marzo | 4 | 20 | 24 |
| 2019 Febrero | 1 | 12 | 13 |
| 2019 Enero | 3 | 2 | 5 |
| 2018 Diciembre | 0 | 11 | 11 |
| 2018 Noviembre | 0 | 2 | 2 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 2 | 7 | 9 |
| 2018 Agosto | 0 | 20 | 20 |
| 2018 Julio | 0 | 11 | 11 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 17 | 17 |
| 2018 Abril | 0 | 11 | 11 |
| 2018 Marzo | 11 | 19 | 30 |
| 2018 Febrero | 39 | 10 | 49 |
| 2018 Enero | 37 | 19 | 56 |
| 2017 Diciembre | 52 | 17 | 69 |
| 2017 Noviembre | 36 | 19 | 55 |
| 2017 Octubre | 37 | 10 | 47 |
| 2017 Septiembre | 32 | 19 | 51 |
| 2017 Agosto | 44 | 16 | 60 |
| 2017 Julio | 31 | 26 | 57 |
| 2017 Junio | 48 | 29 | 77 |
| 2017 Mayo | 38 | 26 | 64 |
| 2017 Abril | 43 | 17 | 60 |
| 2017 Marzo | 24 | 19 | 43 |
| 2017 Febrero | 31 | 5 | 36 |
| 2017 Enero | 29 | 16 | 45 |
| 2016 Diciembre | 50 | 24 | 74 |
| 2016 Noviembre | 60 | 19 | 79 |
| 2016 Octubre | 73 | 23 | 96 |
| 2016 Septiembre | 85 | 15 | 100 |
| 2016 Agosto | 63 | 10 | 73 |
| 2016 Julio | 34 | 7 | 41 |
| 2016 Junio | 3 | 15 | 18 |
| 2016 Mayo | 8 | 5 | 13 |
| 2016 Abril | 4 | 28 | 32 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 5 | 20 | 25 |
| 2016 Enero | 13 | 11 | 24 |
| 2015 Diciembre | 11 | 9 | 20 |
| 2015 Noviembre | 17 | 14 | 31 |
| 2015 Octubre | 14 | 1 | 15 |
| 2015 Septiembre | 11 | 10 | 21 |
| 2015 Agosto | 8 | 1 | 9 |
| 2015 Julio | 49 | 9 | 58 |
| 2015 Junio | 33 | 12 | 45 |
| 2015 Mayo | 23 | 17 | 40 |
| 2015 Abril | 25 | 12 | 37 |
| 2015 Marzo | 23 | 11 | 34 |
| 2015 Febrero | 27 | 8 | 35 |
| 2015 Enero | 22 | 9 | 31 |
| 2014 Diciembre | 21 | 5 | 26 |
| 2014 Noviembre | 21 | 10 | 31 |
| 2014 Octubre | 37 | 13 | 50 |
| 2014 Septiembre | 15 | 7 | 22 |
| 2014 Agosto | 31 | 7 | 38 |
| 2014 Julio | 24 | 10 | 34 |
| 2014 Junio | 44 | 4 | 48 |
| 2014 Mayo | 41 | 11 | 52 |
| 2014 Abril | 45 | 6 | 51 |
| 2014 Marzo | 37 | 9 | 46 |
| 2014 Febrero | 41 | 8 | 49 |
| 2014 Enero | 32 | 7 | 39 |
| 2013 Diciembre | 42 | 8 | 50 |
| 2013 Noviembre | 11 | 4 | 15 |
| 2013 Octubre | 12 | 4 | 16 |
| 2013 Septiembre | 11 | 5 | 16 |
| 2013 Agosto | 4 | 2 | 6 |
| 2013 Julio | 3 | 7 | 10 |
| 2013 Junio | 3 | 2 | 5 |
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