Ann Dermatol.  2018 Dec;30(6):712-715. 10.5021/ad.2018.30.6.712.

Desmoplastic Fibroblastoma of the Scalp Accompanied by Severe Pain; Unusual Location and Symptom

• Yang JH
• Chae JB
• Huh CH
• Na JI
• Park KC
• Shin JW

• KMID: 2428929
• DOI: http://doi.org/10.5021/ad.2018.30.6.712

Abstract

Desmoplastic fibroblastoma is a rare fibrous tumor that usually presents as a painless, slow-growing mass in the subcutaneous tissues and skeletal muscles. It has a wide anatomic distribution, with the most common involvement being the arm and shoulder. Here, we report a case of a tiny painful desmoplastic fibroblastoma arising on the scalp. According to a microscopic examination, this tumor was composed of spindle-shaped fibroblasts in the dense collagenous stroma. On immunohistochemical staining, tumor cells were positive for vimentin and negative for smooth muscle actin, CD34, and S100. Our case is unique in that desmoplastic fibroblastoma developed on the scalp and there was presence of pain despite its small size.

Keyword

Collagenous fibroma; Desmoplastic fibroblastoma; Pain; Scalp

MeSH Terms

Actins
Arm
Collagen
Fibroblasts
Muscle, Skeletal
Muscle, Smooth
Scalp*
Shoulder
Subcutaneous Tissue
Vimentin
Actins
Collagen
Vimentin

Figure

• 

  Fig. 1 Ultrasonography of the scalp. The tumor is shown on the aponeurosis as a hypoechoic mass.

• 

  Fig. 2 The operation field of the tumor. Suspected tumor contour is indicated with red circle.

• 

  Fig. 3 (A) Spindle cell neoplasm without encapsulation (H&E, ×40). (B) The tumor is composed of spindle-shaped cells surrounded by dense fibrous stoma (H&E, ×100). (C) No mitosis and necrosis are found. Note that cellularity and nuclear pleomorphism are moderately increased (H&E, ×400).

• 

  Fig. 4 Immunohistochemical staining of desmoplastic fibroblastoma shows that tumor cells are positive for (A) vimentin (immunoperoxidase staining, ×200), but negative for (B) α-SMA (immunoperoxidase staining, ×200), (C) CD34 (immunoperoxidase staining, ×200), and (D) S100 (immunoperoxidase staining, ×200). (E) Proliferation index estimated by Ki-67 is mildly expressed (immunoperoxidase staining, ×200).

Reference

1. Evans HL. Desmoplastic fibroblastoma. A report of seven cases. Am J Surg Pathol. 1995; 19:1077–1081.

2. Jang JG, Jung HH, Suh KS, Kim ST. Desmoplastic fibroblastoma (collagenous fibroma). Am J Dermatopathol. 1999; 21:256–258.

3. Fong F, Odell E, Simo R. Collagenous fibroma (desmoplastic fibroblastoma) of the neck presenting with neurological symptoms. Head Neck Pathol. 2009; 3:47–50.

4. Park JM, Koh JK, Lee MG. Unusual case of desmoplastic fibroblastoma (collagenous fibroma) with ulceration on toe: mimicking diabetic foot ulcer. J Dermatol. 2012; 39:420–422.

5. Miettinen M, Fetsch JF. Collagenous fibroma (desmoplastic fibroblastoma): a clinicopathologic analysis of 63 cases of a distinctive soft tissue lesion with stellate-shaped fibroblasts. Hum Pathol. 1998; 29:676–682.

6. Stacy RC, Jakobiec FA, Fay A. Collagenous fibroma (desmoplastic fibroblastoma) of the orbital rim. Ophthal Plast Reconstr Surg. 2013; 29:e101–e104.

7. Weisberg NK, DiCaudo DJ, Meland NB. Collagenous fibroma (desmoplastic fibroblastoma). J Am Acad Dermatol. 1999; 41:292–294.

8. de Sousa SF, Caldeira PC, Grossmann Sde M, de Aguiar MC, Mesquita RA. Desmoplastic fibroblastoma (collagenous fibroma): a case identified in the buccal mucosa. Head Neck Pathol. 2011; 5:175–179.

9. Nagaraja V, Coleman HG, Morgan GJ. Desmoplastic fibroblastoma presenting as a parotid tumour: a case report and review of the literature. Head Neck Pathol. 2013; 7:285–290.

10. Kim JH, Oh DY, Kim SW, Lee JH, Ahn ST, Rhie JW. Desmoplastic fibroblastoma of the finger tip in an adult. Arch Plast Surg. 2012; 39:84–86.

11. Nielsen GP, O'Connell JX, Dickersin GR, Rosenberg AE. Collagenous fibroma (desmoplastic fibroblastoma): a report of seven cases. Mod Pathol. 1996; 9:781–785.

12. Back SJ, Kim DH, Kim N, Lee Y, Seo YJ, Park JK, et al. A case of isolated plexiform neurofibroma in a patient with myasthenia gravis. Ann Dermatol. 2009; 21:53–55.

13. Watanabe H, Ishida Y, Nagashima K, Makino T, Norisugi O, Shimizu T. Desmoplastic fibroblastoma (collagenous fibroma). J Dermatol. 2008; 35:93–97.