Pleomorphic Dermal Neoplasms
- 1 March 2014
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Advances in Anatomic Pathology
- Vol. 21 (2), 108-130
- https://doi.org/10.1097/pap.0000000000000009
Abstract
Pleomorphic neoplasms are typically associated with high-grade malignant behavior, but this does not readily apply to primary cutaneous tumors. Despite morphologic features suggestive of malignancy, atypical fibroxanthoma, the classic example of a pleomorphic dermal neoplasm, is characterized by indolent clinical behavior. Atypical fibroxanthoma is a distinctive clinicopathologic disease affecting sun-damaged skin of elderly males. Histologically, it is often ulcerated and dermal based with pushing growth, characterized by a sheet-like and fascicular growth of pleomorphic epithelioid, spindled, and multinucleated tumor cells with brisk and atypical mitotic activity. However, no positive discriminatory histologic or immunohistochemical features exist. Its diagnosis is one exclusion with a wide differential diagnosis, mainly including other mesenchymal, melanocytic, and epithelial neoplasms. Particular considerations are pleomorphic dermal sarcoma, invasive melanoma, squamous cell carcinoma, metaplastic carcinoma, poorly differentiated cutaneous angiosarcoma, cutaneous leiomyosarcoma, myxofibrosarcoma, variants of fibrous histiocytoma (FH), pleomorphic fibroma, and non-neural granular cell tumor. The behavior of these tumors is varied and ranges from outright malignant to entirely benign, requiring confident diagnosis to reliably predict behavior and guide treatment. Although challenging, because of significant clinical and pathologic overlap, it is usually possible to establish a definitive diagnosis when attention is paid to the often subtle differentiating features. This requires careful tumor sampling, recognition of the subtle distinguishing morphologic features, judicious use and analysis of immunohistochemistry, and interpretation of the findings in the appropriate clinical setting.Keywords
This publication has 53 references indexed in Scilit:
- Atypical fibroxanthoma: Clinicopathologic determinants for recurrence and implications for surgical managementJournal of Surgical Oncology, 2011
- Atypical fibroxanthoma showing diffuse staining for CD31Journal of Cutaneous Pathology, 2011
- Atypical Fibroxanthoma: A Histological and Immunohistochemical Review of 171 CasesThe American Journal of Dermatopathology, 2010
- Morphological and immunohistochemical characteristics of atypical fibroxanthoma with a special emphasis on potential diagnostic pitfalls: a reviewJournal of Cutaneous Pathology, 2010
- Cutaneous carcinosarcoma – basal cell carcinoma with osteosarcomaJournal of Cutaneous Pathology, 2006
- Atypical fibroxanthoma: A clinicopathological study of 89 casesAustralasian Journal of Dermatology, 2005
- Dermal non‐neural granular cell tumour (so‐called primitive polypoid granular cell tumour): a distinctive entity further delineated in a clinicopathological study of 11 casesHistopathology, 2005
- Granular cell atypical fibroxanthomaJournal of Cutaneous Pathology, 2005
- Atypical Fibrous Histiocytoma of the SkinThe American Journal of Surgical Pathology, 2002
- Aneurysmal (“Angiomatoid”) fibrous histiocytoma of the skinCancer, 1981