Case and Research Letters
Linear Dermatomyofibroma
Dermatomiofibroma lineal
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Tinción inmunohistoquímica difusa de las células tumorales para actina de músculo liso (AML) (AML ×<span class="elsevierStyleHsp" style=""></span>40). B. Tinción histoquímica con orceína que muestra fibras reticuladas aumentadas y fragmentadas (orceína ×<span class="elsevierStyleHsp" style=""></span>100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Torres, Á. Revert, L. Terrádez, E. Jordá" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Torres" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Revert" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Terrádez" ] 3 => array:2 [ "nombre" => "E." 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Torres, Á. Revert, L. Terrádez, E. Jordá" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Torres" "email" => array:1 [ 0 => "catitorresan@gmail.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" => "Á." "apellidos" => "Revert" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Terrádez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Jordá" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomiofibroma lineal" ] ] "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" => 1424 "Ancho" => 950 "Tamanyo" => 403461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Dermal proliferation of spindle-shaped cells in interwoven bundles running parallel to the skin surface. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×40. B, Detail of the cells with wavy, elongated nuclei and a rounded outline. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatomyofibroma is a rare benign tumor of myofibroblastic origin. It occurs predominantly in young women and arises mainly on the upper part of the trunk. In the majority of cases it presents as a small, asymptomatic plaque or nodule with a slightly erythematous surface.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> We present a case of dermatomyofibroma that developed in an elderly man at an unusual site and with uncommon clinical characteristics for this entity.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 74-year-old man with a history of in situ melanoma. He consulted for a symptomatic lesion that had appeared 4 months earlier in the right popliteal fossa. Examination revealed an indurated hyperpigmented plaque of 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>cm, with a linear distribution and poorly defined borders (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient did not report trauma and described discomfort on flexing the limb. On a suspicion of morphea, the lesion was biopsied. In the mid and deep dermis there was a proliferation of spindle-shaped cells in interwoven bundles, with a tendency to run parallel to the epidermal surface. This proliferation was composed of cells with wavy, elongated nuclei with a rounded outline, no atypia, and with a poorly defined cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for smooth muscle actin, but the cells were negative for CD34, muscle specific actin, and factor XIIIa. Staining with orcein showed increased numbers and fragmentation of the elastic fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Based on these findings we made a diagnosis of dermatomyofibroma. Surgery was excluded because of the size of the lesion and it was decided to take a wait-and-see approach.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermatomyofibroma was first described in 1991 by Hügel, who used the name plaque fibromatosis, but a year later Kamino proposed the term dermatomyofibroma.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is a rare benign skin tumor that predominantly affects women. In the largest series, published by Wentzel et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> the mean age of the patients was 30 years (range, 3 to 51 years). Some cases have also been reported in men, the majority during childhood; the youngest patient to date has been an 11-month-old infant boy.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> It is thought that in men the lesion may undergo spontaneous regression during puberty, whereas, in women, it grows slowly under the influence of female hormones.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From a clinical point of view, the majority of cases present as a palpable plaque or nodule measuring 1 to 2<span class="elsevierStyleHsp" style=""></span>cm in diameter, with a hyperpigmented or erythematous-yellowish surface.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> However, lesions presenting as large linear plaques of 8<span class="elsevierStyleHsp" style=""></span>cm have been reported, and even annular lesions of up to 13<span class="elsevierStyleHsp" style=""></span>cm in diameter.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a> The lesions typically arise on the upper part of the trunk, shoulders, axillas, and anterior abdomen,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and there is a characteristic predilection for the posterior cervical region in prepubertal children.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the series by Wentzel, 1 lesion was observed in the popliteal fossa, the same site as in our case.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Histology shows a proliferation of spindle-shaped cells in the reticular dermis. The cells are arranged in fascicles that run parallel to the epidermal surface; the skin appendages and epidermis are not affected. The cells present a uniform appearance with abundant eosinophilic cytoplasm and an elongated nucleus, with no atypia or mitoses. The elastic fibers may be increased in number and may be fragmented. Immunohistochemistry should be performed in all cases. The cells are positive for vimentin and often for smooth muscle actin, but are negative for protein S-100, CD34, factor XIIIa, desmin, and caldesmon.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The importance of this entity is its differentiation from other tumors formed of spindle-shaped cells, such as dermatofibroma and dermatofibrosarcoma protuberans. Dermatofibroma and, in particular, its plaque variant with an atrophic appearance or multiple clustered dermatofibromas, can be similar to our case, but the cells of dermatofibroma are positive for factor XIIIa. Dermatofibrosarcoma protuberans has a storiform histologic pattern and immunohistochemistry is positive for CD34. Other diagnoses that must be ruled out are plaque neurofibroma, which is positive for S-100, hypertrophic scar, characterized by an absence of elastic fibers, and piloleiomyoma, which is positive for caldesmon and desmin. In the literature we found a case of an unclassifiable myofibroblastic cell proliferation with clinical manifestations similar to those of our patient, but with a more prolonged course and larger size of the lesion.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,7–10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment of choice is excision with adequate surgical margins. No recurrences or distant metastases have been observed. In lesions that have been partially excised or in which conservative management has been applied, no evidence of progression of the lesion has been reported.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We have described an elderly male patient with a large linear dermatomyofibroma of recent onset in the popliteal fossa.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" 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: Torres C, Revert Á, Terrádez L, Jordá E. Dermatomiofibroma lineal. Actas Dermosifiliogr. 2016;107:787–789.</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" => 1067 "Ancho" => 800 "Tamanyo" => 135567 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Indurated, hyperpigmented linear plaque in the right popliteal fossa.</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" => 1424 "Ancho" => 950 "Tamanyo" => 403461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Dermal proliferation of spindle-shaped cells in interwoven bundles running parallel to the skin surface. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×40. B, Detail of the cells with wavy, elongated nuclei and a rounded outline. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</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" => 1422 "Ancho" => 950 "Tamanyo" => 445693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Immunohistochemistry showing diffuse staining of the tumor cells with smooth muscle actin (SMA). Stain for SMA, original magnification<span class="elsevierStyleHsp" style=""></span>×40. B, Histochemical stain with orcein showing an increase in fragmented reticular fibers. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 8 | 15 |
| 2024 Octubre | 65 | 51 | 116 |
| 2024 Septiembre | 86 | 36 | 122 |
| 2024 Agosto | 130 | 77 | 207 |
| 2024 Julio | 109 | 39 | 148 |
| 2024 Junio | 94 | 40 | 134 |
| 2024 Mayo | 92 | 123 | 215 |
| 2024 Abril | 85 | 24 | 109 |
| 2024 Marzo | 80 | 26 | 106 |
| 2024 Febrero | 120 | 33 | 153 |
| 2024 Enero | 75 | 39 | 114 |
| 2023 Diciembre | 79 | 11 | 90 |
| 2023 Noviembre | 73 | 32 | 105 |
| 2023 Octubre | 65 | 24 | 89 |
| 2023 Septiembre | 74 | 23 | 97 |
| 2023 Agosto | 53 | 19 | 72 |
| 2023 Julio | 55 | 41 | 96 |
| 2023 Junio | 57 | 27 | 84 |
| 2023 Mayo | 52 | 23 | 75 |
| 2023 Abril | 50 | 21 | 71 |
| 2023 Marzo | 44 | 17 | 61 |
| 2023 Febrero | 51 | 28 | 79 |
| 2023 Enero | 41 | 29 | 70 |
| 2022 Diciembre | 48 | 39 | 87 |
| 2022 Noviembre | 34 | 27 | 61 |
| 2022 Octubre | 25 | 26 | 51 |
| 2022 Septiembre | 26 | 35 | 61 |
| 2022 Agosto | 25 | 36 | 61 |
| 2022 Julio | 30 | 37 | 67 |
| 2022 Junio | 17 | 17 | 34 |
| 2022 Mayo | 39 | 35 | 74 |
| 2022 Abril | 50 | 29 | 79 |
| 2022 Marzo | 43 | 37 | 80 |
| 2022 Febrero | 39 | 24 | 63 |
| 2022 Enero | 77 | 52 | 129 |
| 2021 Diciembre | 30 | 38 | 68 |
| 2021 Noviembre | 43 | 44 | 87 |
| 2021 Octubre | 43 | 66 | 109 |
| 2021 Septiembre | 34 | 47 | 81 |
| 2021 Agosto | 68 | 33 | 101 |
| 2021 Julio | 35 | 35 | 70 |
| 2021 Junio | 28 | 40 | 68 |
| 2021 Mayo | 53 | 48 | 101 |
| 2021 Abril | 132 | 92 | 224 |
| 2021 Marzo | 60 | 28 | 88 |
| 2021 Febrero | 46 | 24 | 70 |
| 2021 Enero | 34 | 17 | 51 |
| 2020 Diciembre | 28 | 12 | 40 |
| 2020 Noviembre | 39 | 22 | 61 |
| 2020 Octubre | 21 | 11 | 32 |
| 2020 Septiembre | 24 | 22 | 46 |
| 2020 Agosto | 20 | 15 | 35 |
| 2020 Julio | 19 | 23 | 42 |
| 2020 Junio | 36 | 28 | 64 |
| 2020 Mayo | 15 | 10 | 25 |
| 2020 Abril | 24 | 17 | 41 |
| 2020 Marzo | 22 | 12 | 34 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 6 | 0 | 6 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 5 | 0 | 5 |
| 2019 Mayo | 6 | 1 | 7 |
| 2019 Abril | 2 | 4 | 6 |
| 2019 Marzo | 5 | 0 | 5 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 6 | 0 | 6 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Febrero | 31 | 1 | 32 |
| 2018 Enero | 42 | 14 | 56 |
| 2017 Diciembre | 43 | 11 | 54 |
| 2017 Noviembre | 46 | 5 | 51 |
| 2017 Octubre | 33 | 7 | 40 |
| 2017 Septiembre | 26 | 4 | 30 |
| 2017 Agosto | 32 | 8 | 40 |
| 2017 Julio | 51 | 9 | 60 |
| 2017 Junio | 37 | 10 | 47 |
| 2017 Mayo | 25 | 4 | 29 |
| 2017 Abril | 26 | 9 | 35 |
| 2017 Marzo | 15 | 8 | 23 |
| 2017 Febrero | 22 | 6 | 28 |
| 2017 Enero | 14 | 10 | 24 |
| 2016 Diciembre | 27 | 25 | 52 |
| 2016 Noviembre | 45 | 42 | 87 |
| 2016 Octubre | 4 | 4 | 8 |
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