Indian Journal of Dermatology
CASE REPORT
Year
: 2006  |  Volume : 51  |  Issue : 3  |  Page : 207--208

Aneurysmal benign fibrous histiocytoma of the skin


Amanjit Bal, RPS Punia, Harsh Mohan 
 Department of Pathology, Govt. of Medical College, Sarai Building, Sector-32-A, Chandigarh, India

Correspondence Address:
Amanjit Bal
Department of Pathology, Govt. Medical College, Sarai Building, Sector 32-A, Chandigarh - 160 030
India

Abstract

Aneurysmal benign fibrous histiocytoma is a rare variant of benign fibrous histiocytoma. Clinically it has varied appearances and mimic benign and malignant vascular tumors and malignant melanoma resulting in diagnostic difficulties. Histopathological examination is mandatory for diagnosis.



How to cite this article:
Bal A, Punia R, Mohan H. Aneurysmal benign fibrous histiocytoma of the skin.Indian J Dermatol 2006;51:207-208


How to cite this URL:
Bal A, Punia R, Mohan H. Aneurysmal benign fibrous histiocytoma of the skin. Indian J Dermatol [serial online] 2006 [cited 2020 May 25 ];51:207-208
Available from: http://www.e-ijd.org/text.asp?2006/51/3/207/27990


Full Text

 Introduction



Aneurysmal benign fibrous histiocytoma of the skin is a distinct but rare variant of benign fibrous histiocytoma with reported incidence of 1.7% of all benign fibrous histiocytomas.[1] The clinical and morphological features of this entity are poorly recognized, thus resulting in diagnostic confusion.

We present a case of 22 year male, who presented with rapidly increasing swelling on right thigh.

 Case Report



A 22 year male presented with nodular swelling on right thigh of 6 months' duration which measured 4x2.5 cm. There was rapid increase in size for last 2-3 months. Swelling was grey brown in colour with focal areas of ulceration and bleeding. Clinical possibilities of malignant melanoma or vascular tumour were considered and the lesion was excised.

Pathological findings

Grossly it was a skin covered pigmented nodular growth measuring 4.5 x 2 x 1.5 cm. Cut section was grey brown to tan in appearance [Figure 1].

Microscopic examination showed hyperplastic epidermis which was focally ulcerated. Dermis showed a tumour well demarcated from overlying epidermis. Tumour cells were spindle shaped arranged in short fascicles and vague storiform pattern. There was no cytological atypia or atypical mitosis. In addition, there were cleft like and large blood filled cystic spaces resembling cavernous vascular spaces but without any endothelial lining [Figure 2]. Surrounding stroma showed dense hemosiderin deposits. Perl's stain confirmed the nature of hemosiderin pigment. Tumor was extending into the deep reticular dermis with only focal extension into subcutaneous fat. Based on these findings a diagnosis of aneurysmal benign fibrous histiocytoma was made.

 Discussion



Aneurysmal benign fibrous histiocytoma, first described by Santa Cruz and Kyriakos[2] in 1981 is a distinct histological variant of benign fibrous histiocytoma. Clinically it has varied appearances and mimic benign and malignant vascular tumors and malignant melanoma resulting in diagnostic difficulties.

Aneurysmal variant commonly presents as a solitary nodule on limbs in young to middle aged adults with slight female preponderance. Clinically, it differs from ordinary benign fibrous histiocytoma by larger than average size, rapid growth due to intra-lesional haemorrhage and pigmentation.[1],[3] However, surface ulceration seen in the present case has not been described previously. Because of these features, diagnosis of benign fibrous histiocytoma is usually missed and histopathological examination is mandatory for diagnosis. The main histopathological criteria for diagnosing this lesion is presence of blood filled spaces simulating artifactual clefts or cavernous vascular channels within an ordinary fibrous histiocytoma. Immunohistochemistry does not play any significant role in diagnosis. Tumour cells show diffuse positivity with vimentin only.[4]

Aneurysmal variant of fibrous histiocytoma has to be differentiated from angiomatoid malignant fibrous histiocytoma (angiomatoid MFH) and vascular tumors like nodular Kaposi's sarcoma and angiosarcoma.[5] Angiomatoid MFH occurs at younger age and is composed of monomorphic round cells with prominent lympho-histiocytic infiltrate. Nodular Kaposi's sarcoma shows CD34 positive cells lining slit like spaces containing red blood cells. Cutaneous angiosarcomas occur exclusively on face and scalp and have vascular spaces lined by atypical, mitotically active endothelial cells. Aneurysmal benign fibrous histiocytoma has a high local recurrence rate, possibly because of incomplete first excision of large lesion.

To conclude, it is important to recognize this variant of benign fibrous histiocytoma as it clinically mimics other benign and malignant tumors, thus requiring histopathological examination for diagnosis.

References

1Calonje E, Fletcher CD. Aneurysmal fibrous histiocytoma: Clinicopathological cases of a tumor frequently misdiagnosed as a vascular neoplasm. Histopathol 1995;26:323-31.
2Santa Cruz DJ, Kyriakos M. Aneurysmal (angiomatoid) fibrous histiocytoma of the skin. Cancer 1981;47:2053-61.
3McKenna DB, Kavanagh GM, McLaren KM, Tidman MJ. Aneurysmal fibrous histiocytoma: An unusual variant of cutaneous fibrous histiocytoma. J Eur Acad Dermtol Venerol 1999;12:238-40.
4Yang P, Hirose T, Hasegawa T, Seki K, Hizawa K. Aneurysmal fibrous histiocytoma of the skin: A histological, immunohistochemical and ultrastructural study. Am J Dermatopathol 1995;17:179-84.
5Albonico G, Pellegrino G, Maisano M, Africa G, Pedriali M, Nenci I. Aneurysmal fibrous histiocytoma: Case report and review of the literature. Pathologica 2001;93:136-8.