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
Autor para correspondencia
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" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 9 | 15 |
| 2024 Octubre | 85 | 59 | 144 |
| 2024 Septiembre | 102 | 46 | 148 |
| 2024 Agosto | 103 | 95 | 198 |
| 2024 Julio | 104 | 62 | 166 |
| 2024 Junio | 90 | 43 | 133 |
| 2024 Mayo | 96 | 57 | 153 |
| 2024 Abril | 105 | 37 | 142 |
| 2024 Marzo | 58 | 26 | 84 |
| 2024 Febrero | 102 | 37 | 139 |
| 2024 Enero | 83 | 47 | 130 |
| 2023 Diciembre | 86 | 34 | 120 |
| 2023 Noviembre | 104 | 46 | 150 |
| 2023 Octubre | 84 | 35 | 119 |
| 2023 Septiembre | 94 | 44 | 138 |
| 2023 Agosto | 55 | 29 | 84 |
| 2023 Julio | 74 | 58 | 132 |
| 2023 Junio | 67 | 43 | 110 |
| 2023 Mayo | 73 | 46 | 119 |
| 2023 Abril | 45 | 28 | 73 |
| 2023 Marzo | 63 | 46 | 109 |
| 2023 Febrero | 58 | 25 | 83 |
| 2023 Enero | 48 | 39 | 87 |
| 2022 Diciembre | 56 | 39 | 95 |
| 2022 Noviembre | 38 | 30 | 68 |
| 2022 Octubre | 30 | 26 | 56 |
| 2022 Septiembre | 25 | 53 | 78 |
| 2022 Agosto | 26 | 37 | 63 |
| 2022 Julio | 24 | 37 | 61 |
| 2022 Junio | 18 | 22 | 40 |
| 2022 Mayo | 54 | 49 | 103 |
| 2022 Abril | 52 | 37 | 89 |
| 2022 Marzo | 49 | 53 | 102 |
| 2022 Febrero | 40 | 19 | 59 |
| 2022 Enero | 40 | 44 | 84 |
| 2021 Diciembre | 39 | 47 | 86 |
| 2021 Noviembre | 40 | 48 | 88 |
| 2021 Octubre | 49 | 66 | 115 |
| 2021 Septiembre | 43 | 53 | 96 |
| 2021 Agosto | 43 | 47 | 90 |
| 2021 Julio | 38 | 45 | 83 |
| 2021 Junio | 33 | 51 | 84 |
| 2021 Mayo | 36 | 47 | 83 |
| 2021 Abril | 95 | 100 | 195 |
| 2021 Marzo | 75 | 43 | 118 |
| 2021 Febrero | 74 | 36 | 110 |
| 2021 Enero | 53 | 42 | 95 |
| 2020 Diciembre | 33 | 47 | 80 |
| 2020 Noviembre | 40 | 39 | 79 |
| 2020 Octubre | 34 | 25 | 59 |
| 2020 Septiembre | 31 | 20 | 51 |
| 2020 Agosto | 23 | 30 | 53 |
| 2020 Julio | 24 | 20 | 44 |
| 2020 Junio | 32 | 31 | 63 |
| 2020 Mayo | 20 | 17 | 37 |
| 2020 Abril | 16 | 11 | 27 |
| 2020 Marzo | 30 | 10 | 40 |
| 2020 Febrero | 7 | 2 | 9 |
| 2019 Mayo | 1 | 0 | 1 |
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