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Building Blocks of Dermatopathology

BAD DermpathPRO Learning Hub: Special Stains

Dermatopathology
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Case Number : ST0007 Mark A. Hurt MD

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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The patient is a five day old baby with a shave biopsy from the left thigh.


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Guest Saleem Taibjee - Myofibroma - biphasic pattern is supportive. The infant would need a work-up to assess for multiple lesions including imaging.
  
Guest Amira Tawdy - Infantile Myofibromatosis
 
Guest Romualdo - Myofibroma.
  
Sasi Attili - Infantile myofibromatosis/ myofibroma. Nice case....
 
Guest nwpath - Myofibroma(tosis)

IgorSC - Agree, Myofibroma.

Dr. Mona Abdel-Halim - Agree, myofibroma... Nice case

Robledo F. Rocha - Solitary myofibroma displaying beautiful intravascular myofibroblastic clusters and foci of calcification. Increased expression of Ki-67 is expect in a few-days-aged infant.
As pointed out by Dr. Taibjee, it would be prudent if an in-depth investigation were carried out in order to look for multiple lesions superficial soft tissues, and visceral organs, once solitary lesions are not common away from head and neck
 
Mark A. Hurt MD - Yes, this was a myofibroma, and the only one in this patient, to my knowledge. I really learned a lot from this patient, as I misdiagnosed this initially as leiomyosarcoma. I was overly concerned with the massive necrosis in the lesion, as it is rarely shown or discussed. After reading Stout's early descriptions of the condition, and with the aid of some soft tissue experts, I was set on the right course.
  
Robledo F. Rocha - I was overly concerned with the massive necrosis in the lesion, as it is rarely shown or discussed. 

Guest - Very interesting, Dr. Hurt. Although there's no supportive data from the literature, I got a sense that the more frequent the intravascular growth, the more extensive the necrosis. Perhaps this observation may spark interest among researchers.
Thanks for share this nice case. 
   
Mark A. Hurt MD - You may well be right, although it is speculative. Perhaps it is an age-related phenomenon, as I get the distinct impression that necrosis may simply be a finding in very young children, as I don't often see necrosis in myofibromas presenting in adults. Yet, they are uncommon enough that my experience simply may not be rich enough to understand the natural history or the spectrum of these lesions. Anyone who has more experience is welcome to chime in!

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