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Presented by Pedram Argani, M.D. and prepared by Safia Salaria, M.B.B.S.
Case 3: This is a 41 year old female with multiple dermal nodules.
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1. Question
Week 494: Case 3
This is a 41 year old female with multiple dermal nodules.images/1Alex/082911case3image1.jpg
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images/1Alex/082911case3image5.jpgCorrect
Answer: Neurofibroma
Histology: This is a bland spindle cell proliferation with permeates the fat in a diffuse fashion, and grows within nerve trunks to give a “bag of worms” type pattern.The lesional cells are bland spindle cells which are focally adherent to strips of collagen, and separated by myxoid matrix with associated mast cells.The lesions permeate the fat in a lace like fashion in several areas.The lesion was positive S100 protein, supporting the diagnosis of neurofibroma.
Discussion: Schwannomas are typically encapsulating neoplasms that do not permeate the fat. Dermatofibrosarcoma protuberans (DFSP) may permeate the fat in a fashion similar to neurofibroma; however, is an exquisitely cellular and storiform neoplasm, and labels for CD34 but not S100.Dermatofibroma is a more heterogeneous lesion composed of spindle cells, histiocytes, and inflammatory cells. Dermatofibroma labels for factor 13A, but typically does not label for S100 protein.The current case is an example of a neurofibroma with both plexiform and diffuse patterns.The patient had neurofibromatosis type I,which is typical with patients with plexiform neurofibromas.
Incorrect
Answer: Neurofibroma
Histology: This is a bland spindle cell proliferation with permeates the fat in a diffuse fashion, and grows within nerve trunks to give a “bag of worms” type pattern.The lesional cells are bland spindle cells which are focally adherent to strips of collagen, and separated by myxoid matrix with associated mast cells.The lesions permeate the fat in a lace like fashion in several areas.The lesion was positive S100 protein, supporting the diagnosis of neurofibroma.
Discussion: Schwannomas are typically encapsulating neoplasms that do not permeate the fat. Dermatofibrosarcoma protuberans (DFSP) may permeate the fat in a fashion similar to neurofibroma; however, is an exquisitely cellular and storiform neoplasm, and labels for CD34 but not S100.Dermatofibroma is a more heterogeneous lesion composed of spindle cells, histiocytes, and inflammatory cells. Dermatofibroma labels for factor 13A, but typically does not label for S100 protein.The current case is an example of a neurofibroma with both plexiform and diffuse patterns.The patient had neurofibromatosis type I,which is typical with patients with plexiform neurofibromas.
