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Indian Journal of Dermatology
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Year : 2020  |  Volume : 65  |  Issue : 6  |  Page : 558-560
Dermatofibroma botryoides on nipple: A report


1 Department of Dermatology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
2 Department of Dermatology; Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA

Date of Web Publication23-Oct-2020

Correspondence Address:
William C Lambert
Department of Dermatology; Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_235_19

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How to cite this article:
Behbahani S, Karanfilian KM, Elias ML, Patel S, Lambert WC. Dermatofibroma botryoides on nipple: A report. Indian J Dermatol 2020;65:558-60

How to cite this URL:
Behbahani S, Karanfilian KM, Elias ML, Patel S, Lambert WC. Dermatofibroma botryoides on nipple: A report. Indian J Dermatol [serial online] 2020 [cited 2020 Dec 4];65:558-60. Available from: https://www.e-ijd.org/text.asp?2020/65/6/558/298904


Sir,

A dermatofibroma is a round, brown to red-purple growth commonly found on the lower extremities. It is also referred to as benign fibrous histiocytoma of the skin. Its etiology is unknown, but often occurs after local trauma.[1] The diagnosis of a dermatofibroma is clinical but requires an excisional biopsy with removal of subcutaneous fat in cases of diagnostic uncertainty.[2] No treatment is necessary unless it is symptomatic (e.g. tenderness), in which case a complete excision is recommended.[2] Alternatively, we suggest that corticosteroids may be directly injected into the lesion for non-excisional management.

Histologically, there is a dermal and often superficial subcutaneous proliferation of oval to spindle cells, appearing as histiocytes and spindle-shaped cells, respectively. These cells resemble fibroblasts and myofibroblasts. Histopathologic examination may reveal hyperplasia of the overlying epidermis and increased melanin in the basal layer (“dirty fingernail” sign). Several histologic variants of dermatofibromas have been described including cellular, aneurysmal, atypical (dermatofibroma with monster cells), epithelioid, atrophic, polypoid, dermatofibroma with spreading satellitosis, and deep (subcutaneous).[2],[3],[4],[5] We present a unique architectural variant.

The patient was a 51-year-old woman who presented with a 4.5-centimeter, grape-like hard lesion with 20 spheroid grape-like structures on her right nipple with progressive enlargement over the last four years. The patient had previously worked as an exotic dancer, where she routinely hung and twirled eight-inch tassels from her nipples in a cyclical manner. She had been inactive in her profession for two years prior to presentation. The lesion was pruritic, but otherwise asymptomatic. Histologically, there were acellular masses of collagen, with sparse fibroblasts and absence of atypia [Figure 1]. The lesion was strikingly positive for Masson trichrome stain, signifying the presence of collagen [Figure 2]. The lesion was negative for “cigar-shaped” nuclei and other markers of smooth muscle. It was also positive for factor XIIIa [Figure 3], whereas factor 34a stained only blood vessels. Results from immunohistochemical testing with antibodies to factor XIIIa are frequently positive in dermatofibroma.[2]
Figure 1: Histopathology showing acellular masses of collagen with sparse fibroblasts (H and E, x155)

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Figure 2: Masson trichome stain showing nodularity and high collagen content (×155)

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Figure 3: Fibrotic nodule with factor XIIIa staining dermal fibroblasts brown (×155)

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To our knowledge, this is the first dermatofibroma showing a botryoid architecture, especially in this anatomic region. The word botryoid is derived from the Greek word, meaning a bunch of grapes. The histological findings of dermatofibroma botryoides are otherwise typical of hypocellular dermatofibromas except the lesions appear histologically and clinically as globular masses.

It is important to recognize that a dermatofibroma may present with this architecture in order to be able to distinguish it from other benign and malignant lesions. Based on the clinical or histological findings, the differential of a dermatofibroma may include a leiomyoma, pilomatricoma, atypical fibroxanthoma, juvenile xanthogranuloma, dermatofibromsarcoma protruberans, primary cutaneous carcinoma, or metastatic carcinoma of the skin.[2] Breast malignancy was also a concern in this case given the location.

In cases with similar preliminary clinical and histologic finding as this patient, dermatofibroma with botryoid architecture should be on the differential; and, it may be prudent to obtain Masson trichrome, factor XIIIa and 34a stains to further evaluate for a dermatofibroma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bandyopadhyay MR, Besra M, Dutta S, Sarkar S. Dermatofibroma: Atypical presentations. Indian J Dermatol 2016;61:121.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Parish LC, Yazdanian S, Lambert WC, Lambert PC. Dermatofibroma: A curious tumor. Skin Med 2012;10:268-70.  Back to cited text no. 2
    
3.
Calonje E, Fletcher CD. Aneurysmal benign fibrous histiocytoma: clinicopathological analysis of 40 cases of a tumour frequently misdiagnosed as a vascular neoplasm. Histopathology 1995;26:323-31.  Back to cited text no. 3
    
4.
Kaddu S, McMenamin M, Fletcher CDM. Atypical fibrous histiocytoma of the skin: Clinicopathologic analysis of 59 cases with evidence of infrequent metastasis. Am J Surg Pathol 2002;26:35-46.  Back to cited text no. 4
    
5.
Glusac EJ, Barr RJ, Everett MA, Pitha J, Santa Cruz DJ. Epithelioid cell histiocytoma: A report of 10 cases including a new cellular variant. Am J Surg Pathol 1994;18:583-90.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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