Case Number : Case 1810 - 05 May - Dr Richard A Carr Posted By: Guest

Round off your week with another lovely set of images, more to follow at 6pm, from Dr Richard A Carr.

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Geoff Cross - DermpathPRO Project

congenital nevus

Benign vascular lesion. Possibly Multinucleated cell angiohistiocytoma; though this patient a little young for this diagnosis.

I would do a small panel of immunos here including CD34. I did consider strongly multinucleate cell angiohistiocytoma but the clinical setting looks weird and there seems to be some pseudovascular spaces too. My differential includes MCA vs dermatofibroma (although some pathologists consider MCA a variant of DF) and finally but unlikely giant cell fibroblastoma. 

Multinucleate cell angiohystiocitoma

I though a lot of an odd dermal variant of GCF, but changed my impression. Favour an angiectatic /hemosiderotic dermatofibroma. 

The epidermal changes in this case are for a dermatofibroma. Agree, has got changes seen with a MCA. Odd location for the latter.

The clinical suspicion of a mole gives me the impression this was a pigmented papule. Microscopic features include epidermal hyperplasia with flattened rete ridges and hyperpigmented basal layer overlying a intradermal poorly circumscribed proliferation of thin-walled ectatic vessels, spindle cells and some multinucleated cells with hemosiderin deposition and peripheral collagen entrapment. Adding clinical and microscopic findings, I favor one of the many variants of dermatofibroma.

DF (aneurysmal fibrous histiocytoma)

The take home msg is: epidermal changes above a dermal fibrovascular lesion is a clue to DF.  Isn'it?

After new images dx is aneurysmal fibrous histiocytoma

Kia ora. From far away it looks a bit worrying but on closer inspection we see it's full of holes. Is it the lions defensive line? On second  inspection I was thinking this is an anurysmal Df. 

There are some very 'giant cell fibroblastoma' like areas, particularly in the initial images. Would do a CD34 to rule out GCF/DFSP overlap. If negative, agree with aneurysmal FH.

Great discussion. I went for fairly typical cellular DF (aneurysmal included in this) with giant cell angiohistiocytoma-like areas (may even be a collision with a haemangioma or perhaps the DF produces haemangioma-like appearances in one type / stage of involution). I don't think I did any immunos.

A bit late- but thought this was an aneurysmal DF...