Derm round 17

50 years old gentleman, presented with right gluteal swelling of one year duration. The swelling bled easily on physical contact. He had symptoms of anaemia with loss of weight but normal apetite.

Clinically, the tumor is cauliflower-liked with ulceration and area of bleeding spots.

He was referred to dermatologist for opinion because of the HPE report:
Section showed skin with underlying spindle shaped illed-define lesion. The cells show a storiform pattern of arrangement. The cells have moderately pleomorphic muclei and few mitotic figures are seen. Foamy macrophages are noted with occasional large bizarre cells. The is no necrosis noted. There is no evidence of malignancy in this biopsy. Diagnosis: Benign fibrous histiocytoma.

However clinically, the lesion looked aggressive. There were multiple inguinal lymph nodes felt. No organomegaly felt. His Hb was 5.9 gm/dl. Other blood investigations were unremarkable. His chest X-ray was normal. CT scan of the lesion showed a soft tissue mass arising from the skin. CT scan chest/abdomen/pelvis revealed multiple lung nodules, inguinal lymphadenopathy and right ilium bone erosion.

In view of the clinical findings, this tumour behaved as malignant with evidence of metastasis.

A repeat biopsy was done on 13/2/2007.

Read:
Fibrous histiocytoma
Atlas of genetics and cytogenetics in oncology and haematology
GpNotebook
Malignant fibrous histiocytoma

Update (2/3/2007):
Repeat biopsy report:
Sections show skin tissue with underlying dermis. A diffuse cellular lesion is noted in the dermis. The lesion composed of spindle-shaped cells arranged in stori-form pattern. The spindle-shaped to plump cells exhibit mild to moderate pleomorphic vesicular nuclei and prominent nucleoli. Mitotic figures are seen. Infiltration by acute and chronic inflammatory cells is noted.
Immunohistochemical stain: The spindle-shaped cells are positive for vimentin.
Diagnosis: Dermatofibrosarcoma protuberans.