Metastasizing cellular dermatofibroma - A report of two cases
Metastasizing cellular dermatofibroma - A report of two cases
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DOI：
10.1097/00000478-199611000-00007
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发表时间：
1996-11-01
影响因子：
5.6
通讯作者：
Evans, HL
中科院分区：
文献类型：
--
作者：
ColomeGrimmer, MI;Evans, HL
两例转移性细胞皮肤纤维瘤（皮肤纤维组织细胞瘤）提出。第一个病人，一个18岁的男性，从他的右大腿上部切除了一个结节，他在1.5年，2年和2.5年发生了三次局部复发和腹股沟淋巴结转移。他在1.5年和4年后接受了肺段切除术治疗转移瘤，并且在最后一次随访时（最后一次手术后15个月）仍然存活，没有肿瘤证据。第二名患者是一名33岁的男性，从他的右后颈部切除了一个结节。3个月后肿瘤复发，再次切除。在第7年和第8年切除右颈淋巴结转移。一年后，右颈淋巴结清扫术产生了一个35个阳性淋巴结，并从右肺切除了多个转移灶。6年后，患者存活，肺转移，这是最后一次随访。大体上，两个肿瘤都是单个的2cm非溃疡性真皮-皮下结节。在组织学上，它们是细胞性皮肤纤维瘤的特征;它们由丰满到纺锤形的“纤维组织细胞”细胞组成，排列成故事状图案，并有出血区域、含铁血黄素和周围真皮胶原束之间的浸润。除了肺转移瘤呈囊性外，复发和转移瘤在组织学上相似。这两个病例考虑了血管瘤样恶性纤维组织细胞瘤的替代诊断，但被排除，因为肿瘤部分是真皮的，有明确的故事状模式，缺乏大的血湖，多结节，纤维假包膜，周围的慢性炎症。我们得出结论，皮肤纤维瘤很少转移。转移的风险因素可能包括相对较大的尺寸、高细胞性和局部复发。从这两个病例来看，转移性皮肤纤维瘤表现为惰性。
Two cases of metastasizing cellular dermatofibroma (cutaneous fibrous histiocytoma) are presented. The first patient, an 18-year-old man, had a nodule excised from his right upper thigh, He developed three local recurrences at 1.5, 2, and 2.5 years and metastasis to inguinal lymph nodes. He underwent lung segmentectomies for metastases 1.5 and 4 years later and was alive with no evidence of tumor at latest follow-up, which was 15 months after the last surgery. The second patient, a 33-year-old man, had a nodule removed from his right posterior neck. The tumor recurred 3 months later and was reexcised. Right cervical lymph node metastases were excised at 7 and 8 years. A year later, a right cervical lymph node dissection yielded one positive node of 35, and multiple metastases were excised from the right lung. The patient was alive with lung metastases 6 years later, which was the latest follow-up. Grossly, both tumors were single 2 cm nonulcerated dermal-subcutaneous nodules. Histologically, they were characteristic of cellular dermatofibroma; they were composed of plump to spindled ''fibrohistiocytic'' cells arranged in a storiform pattern and had areas of hemorrhage, hemosiderin, and infiltration between dermal collagen bundles peripherally. Recurrences and metastases were histologically similar except that lung metastases were cystic. The alternative diagnosis of angiomatoid malignant fibrous histiocytoma was considered for these two cases but was excluded because the tumors were partly dermal, had a well-defined storiform pattern, and lacked large blood lakes, multinodularity, a fibrous pseudocapsule, and surrounding chronic inflammation, We conclude that dermatofibromas can rarely metastasize. Risk factors for metastasis may include relatively large size, high cellularity, and local recurrence. Judging from these two cases, metastasizing dermatofibromas behave in an indolent manner.