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High-quality fibrous histiocytoma

High-quality fibrous histiocytoma (deratofibroma, histiocytoma, sclerosing hemangioma) — a benign tumor of skin of connective tissue genesis.

Epidemiology

The high-quality fibrous histiocytoma arises more often at young women, mainly on the lower extremities.

Classification

According to the WHO classification distinguish the following histologic options of a tumor:
• cellular high-quality fibrous histiocytoma;
• aneurysmal high-quality fibrous histiocytoma;
• epithelioid high-quality fibrous histiocytoma;
• atypical (pseudosarcomatous) high-quality fibrous histiocytoma.

Etiology and pathogeny

As an etiological factor consider microtraumas, stings of insects. Components of any option of a deratofibroma are cells of a fibroblastichesky row, fibrous substances and vessels in various ratios. Fibroblastichesky elements of a tumor have tendency to phagocytosis therefore they often contain lipids and iron.

Clinical signs and symptoms

Single, is more rare the multiple, nodular or blyashkovidny education with a diameter about 1 cm which is slightly towering in the center. Palpatorno a tumor dense, is easily displaced, a surface smooth, sometimes giperkeratotichesky, verrukozny. Color more often henna-red, more saturated in old elements. The multiple disseminated small deratofibromas can be combined with an osteopoikilosis (Bushke's syndrome — Ollendorfa).

The diagnosis and the recommended clinical trials

The biopsy is necessary for statement of the diagnosis.
The histologic picture is variable. In this regard some authors allocate options of a deratofibroma in separate nosological forms. In our opinion, it is reasonable to consider these tumors as kinds of a deratofibroma as their morphological features and a histogenesis are similar. Distinctions consist in dominance of this or that component and degree of their maturity.
• The fibrous type is characterized by dominance of the mature and young collagenic fibers which are located in various directions, places in the form of bunches with turbulences and moire structures. Sites of young collagen are painted by hematoxylin and eosine in pale blue color, fibers are located separately, but not in the form of bunches. Cells of mainly mature look (fibrocytes), but can be also young forms — fibroblasts. The tumor is sometimes sharply delimited from a surrounding derma, sometimes its borders indistinct.
• The cellular type is characterized by existence of a large number of cellular elements, generally the fibroblasts surrounded with a small amount of collagenic fibers. Among fibroblasts are located, sometimes in the form of nests, histiocytes. They are larger than fibroblasts, a kernel their oval, cytoplasm contains a significant amount of lipids and hemosiderin. In some tumors histiocytes, among which are located (sometimes in a large number), Tuton's cells — large cells with the numerous kernels sometimes grouped in massive cytoplasm prevail. Peripheral departments of cytoplasm of these cells contain birefringent lipids, typical ksantomny cells can sometimes meet. When the last prevail, being located in the form of nests among fibroblastichesky elements, call similar option of a deratofibroma a fibroxanthoma. The stroma of cellular type of a deratofibroma consists from gentle, rykhlo the located collagenic fibers, places with existence of rhythmical structures. At all options of a deratofibroma find vessels of various caliber with the bulked-up endotheliocytes. In certain cases among cellular elements and fibrous structures there are in a large number capillary vessels that gives the grounds to some authors to call a similar tumor a sclerosing hemangioma. Sometimes along with vessels of capillary type larger vessels with sharply expanded gleams having an appearance of cracks which are located in connecting fabric where collagenic fibers form characteristic moire structures are observed. In fibroblastichesky elements find birefringent lipids (an angiofibroksantom, on A.K. Apatenko's classification).

Differential diagnosis

Eminating dermatofibrosarcoma.

General principles of treatment

Surgical excision is necessary.

Forecast

Favorable.

 
"The dermatofibrosarcoma is eminating   Benign tumors of a liver"