Case Number : 1509 - 06 April Posted By: Guest

Collagenoma.

Connective tissue nevus (collagenom)

sorry: Connective tissue nevus (Collagenoma)

I think this is nuchal-type fibroma. If there is an association with FAP it should be called Gardner fibroma, but this last possibility is improbable, since Gardner fibroma tends to occur in children.

My impression is connective tissue nevus with abscence of elastic fibers(nevus anelasticus)

Favour nuchal-type fibroma due to clinical description and histology. If clinical information is not available, nuclear beta catenin expression would support Gardner fibroma

Here are my reasons for not favouring a nuchal fibroma: 

1.  Nuchal fibromas are subcutaneous; this lesion appears to be in the dermis, albeit a thick dermis. 

2.  Continuing from the first point, nuchal fibromas usually show entrapped islands of fat, which we do not have here. 

3.  Nuchal fibromas usually show entrapped traumatic neuroma-like nerves, which we do not have here. 

4.  Nuchal fibroma is a substitutive process, with collagen bundles that are abnormal (abnormally thick and dense); this process appears to be quantitative, with collagen bundles that are normal but in number. 

5.  Lastly, my impression of nuchal fibromas is that, although they are hypocellular, they are usually more cellular than this lesion (I think). 

Of course, I may be wrong.

Abdul, nuchal fibromas are tumors that arise on the dermis and subcutaneous tissue and entrapment of adipose tissue, adnexae and nerve twigs is variable. As you said collagen bundles are usually thickenned and they usually seem to intersect, this is what we see on the third picture on the left (to my point of view). Another important feature is that they usually extend Deep entrapping skeletal muscle (a feature we dont see here). Finally I think connective tissue nevus is usually seen in patients of postpuberal age and are rarely larger than 5 cm. While nuchal type fibroma has a wider age distribution and are usually large.

Of course me too I could be wrong but I guess is good to discuss our points

Ps: There is also a frequent association between nuchal type fibroma and diabetes ( i dont know if its the case)

Scleredema?

Collagenoma.  The last image on both the right and left sides is of elastin (VVG),