Case Number : 83 Posted By: Guest

Ruifeng Guo - (OK, USA) Wrote:

Great case! I love it, although I got it completely wrong. Now I have some better understanding of Nodular Fasciitis.

Submitted on 04/10/2010 23:30
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Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

The final diagnosis is nodular fasciitis. The edema, red cell extravasation and spindle cell proliferation without atypia are the clues. Well done to all who got the right diagnosis!

Submitted on 04/10/2010 22:55
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Sorry for the spelling mistake, I meant to say I now believe not I know believe!!!

Submitted on 04/10/2010 17:55
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Mona Abdel Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Then the clue is in the extravasated RBC's and the clefting between the fibroblasts evident mainly in the centre of the field indicating some myxoid changes in the stroma. I know believe this is Nodular Fascitis as Irina said. Are we right Sir??

Submitted on 04/10/2010 17:47
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Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

Mona good try but you are wrong!The 'background' elements are are the clue. All to be revealed later.

Submitted on 04/10/2010 17:45
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Lushen Pillay - Wits Dermatology, South Africa (South Africa) Wrote:

Dermatofibroma/ ? KS .

Submitted on 04/10/2010 16:10
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

So as DFSP is wrong, I revised the section and went through the most difficult chapter of Fibrous tumors. The spindle cells here have a vesicular nucleus. Some of the cells look like vacuolated. There are no bizzare cells but I think this could be the Spindle cell variant of atypical fibroxanthoma or I might be wrong. Dr Saleem you were right!!

Submitted on 04/10/2010 16:10
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Spindle cell neoplasm of pleomorphic spindle cells. Spidle cell atypical atypical fibroxanthoma.

Submitted on 04/10/2010 15:56
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Irina - Domina Sana (Bucharest) Wrote:

nodular fasciitis

Submitted on 04/10/2010 15:53
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Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

I think you are all struggling with this case. It is not typical of DFSP - what else would you consider ...

Submitted on 04/10/2010 15:30
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ANDREW DANCKWERTS - WITS UNIVERSITY, JOHANNESBURG (JOHANNESBURG, RSA) Wrote:

SPINDLE CELL NEOPLASM WITH STORIFORM GROWTH PATTERN - FAVOUR DFSP. **CANNOT EXCLUDE FIBROSARCOMATOUS TRANSFORMATION**

Submitted on 04/10/2010 11:46
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Definitly, cellular benign fibrous histiocytoma (cellular DF) must be included in such a spot diagnosis. It is differentiated from DFSP by being smaller in size, fewer mitosis and by showing less extensive SC tissue involvement and by being CD34 -ve. All these points can not be verified from a single spot picture, so I agree completely in putting it as a DDx.

Submitted on 04/10/2010 11:46
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Saleem Taibjee - Warwick () Wrote:

I'm impressed that others have already been so definitive for DFSP. I don't find it so easy, although I still favour DFSP, and would still include cellular DF (especially since there appear to be admixed inflammatory cells??) and other storiform spindle cell tumours in the differential.

Submitted on 04/10/2010 11:40
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Spindle cell neoplasm with storiform pattern. DFSP with a ? focal myxoid change.

Submitted on 04/10/2010 11:31
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Amira Tawdy - Cairo University (Egypt) Wrote:

DFSP

Submitted on 04/10/2010 09:06
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Ruifeng Guo - (Oklahoma City, OK USA) Wrote:

I think this is DFSP. This storiform pattern is very characteristic.

Submitted on 04/10/2010 05:42
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