Indian Journal of Dermatology
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CASE REPORT
Year : 2008  |  Volume : 53  |  Issue : 1  |  Page : 35-36
Myxoid neurofibroma: An unusual presentation


1 Service of Dermatology, Hospital General de México, Mexico
2 Department of Dermatopathology, Hospital General de México, Mexico

Correspondence Address:
Andres Tirado-Sanchez
Servicio de Dermatología, Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg. Cuauhtemoc, México, D.F, C.P. 06726
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.39742

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   Abstract 

Myxoid neurofibroma (MN) is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. To our knowledge, this is the first time that a trunk location is reported. MN should be included in the differential diagnosis of tumors on this location.


Keywords: Myxoid neurofibroma, nerve sheath tumor, neurofibroma


How to cite this article:
Ponce-Olivera RM, Tirado-Sanchez A, Peniche-Castellanos A, Peniche-Rosado J, Mercadillo-Perez P. Myxoid neurofibroma: An unusual presentation. Indian J Dermatol 2008;53:35-6

How to cite this URL:
Ponce-Olivera RM, Tirado-Sanchez A, Peniche-Castellanos A, Peniche-Rosado J, Mercadillo-Perez P. Myxoid neurofibroma: An unusual presentation. Indian J Dermatol [serial online] 2008 [cited 2020 Sep 20];53:35-6. Available from: http://www.e-ijd.org/text.asp?2008/53/1/35/39742



   Introduction Top


Neurofibroma can present as a single lesion or be part of a neurofibromatosis. [1] Solitary neurofibroma can present as one of the following variants: cutaneous lipomatous, collagenous, epithelioid, granular, pigmented, dendritic cell and myxoid neurofibromas. [2]

We present the case of a myxoid neurofibroma (MN) of the trunk, which is a rare location of this tumor.


   Case Report Top


A 44-year-old woman presented with a non-tender, slow-growing nodular plaque on the anterior trunk that appeared six years ago [Figure - 1]. She sought medical attention for cosmetic reasons.

The patient denied any past medical condition or consumption of medication. There were no drug allergic reactions. On physical examination, a 10 × 5-cm flesh-colored plaque on the anterior trunk was observed.

An incisional biopsy was taken. Gross examination shows a well-circumscribed lesion composed of spindle-shaped cells with wavy nuclei [Figure - 2]. A few mast cell and mucin were present. Immunohistochemical staining was positive for S-100 protein and negative for CD34. The diagnosis made was myxoid neurofibroma.

We scheduled a surgical excision that was incomplete and a few months later, a new lesion emerged, a new surgical procedure was programmed but the patient rejected it.


   Discussion Top


Myxoid neurofibroma is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. [3]

This tumor has a higher incidence in young adults. [4] It usually presents as a non-tender solitary nodule. [3]

The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. [5],[6] To our knowledge, this is the first time that a trunk location has been reported.

MN is usually a solitary lesion, [1] as in our patient, however, they can be numerous and may recur following an incomplete initial excision.

Differential diagnosis includes intramuscular myxoma and myxoid dermatofibrosarcoma protuberans. The first one is negative to S-100; and in the second one, on histological examination, slender tumor cells with large, spindle-shaped nuclei are seen, as well as mitotic figures; a high cellularity and irregular, short, intersecting bands of tumor cells forming a storiform pattern are characteristic. [7],[8]

The usual first-line treatment is total excision of tumor, [9] but only for cosmetic or diagnostic reasons. Some reports have mentioned the danger of these tumors masquerading as malignancies (mainly neurofibrosarcoma or epithelioid sarcoma). [6]

To our knowledge, this is the first report of a MN on the trunk. MN should be included in the differential diagnosis of tumors at this location.

 
   References Top

1.Angervall L, Kindblom LG, Haglid K. Dermal nerve sheath myxoma. Cancer 1984;53: 1752-9.  Back to cited text no. 1  [PUBMED]  
2.Mrugala MM, Batchelor TT, Plotkin SR. Peripheral and cranial nerve sheath tumors. Curr Opin Neurol 2005;18:604-10.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Donofrio V, Passeretti U, Russo S. Neurothekeoma of the thumb: A case report. Tumori 1988;74:751-4.  Back to cited text no. 3    
4.Rosati L, Fratamico FC, Eusebi V. Cellular neurothekeoma. Appl Pathol 1986;4:186-91.  Back to cited text no. 4    
5.King DT, Barr RJ. Bizarre cutaneous neurofibromas. J Cutan Pathol 1980;7:21-31.  Back to cited text no. 5  [PUBMED]  
6.Gmyrek RF, Beer R, Silvers DN. Periungual myxoid neurofibroma. Cutis 2002;69:54-6.  Back to cited text no. 6    
7.Charron P, Smith J. Intramuscular myxomas: A clinicopathologic study with emphasis on surgical management. Am Surg 2004;70:1073-7.  Back to cited text no. 7  [PUBMED]  
8.Orlandi A, Bianchi L, Spagnoli LG. Myxoid dermatofibrosarcoma protuberans: Morphological, ultrastructural and immunohistochemical features. J Cutan Pathol 1998;25:386-93.  Back to cited text no. 8  [PUBMED]  
9.Requena L. Benign neoplasm with neural differentiation. Am J Dermatol 1995;17:75-96.  Back to cited text no. 9    


    Figures

  [Figure - 1], [Figure - 2]

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    Abstract
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