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Skin - Nonmelanocytic tumors

Other tumors of skin

Deep benign fibrous histiocytoma

Reviewers: Christopher Hale, M.D., Vijay Shankar, M.D. (see Authors page)
Revised: 4 August 2015, last major update August 2012
Copyright: (c) 2001-2015, PathologyOutlines.com, Inc.


● Benign fibrous histiocytoma of subcutaneous tissue, deep soft tissue or parenchymal organs, with no dermal involvement (Am J Surg Pathol 1994;18:677, Am J Surg Pathol 1990;14:801, Stanford Medicine)
● Rare painless lesions, < 1% of fibrohistiocytic tumors
● Usually adult males > 25 years (range 6-84 years)
● Usually extremities, head and neck, trunk; rarely in deep soft tissue of retroperitoneum, mediastinum or pelvis


● Excision
● May recur if incompletely excised, rare metastases (Am J Surg Pathol 2008;32:354)

Case reports

● 25 year old woman with painful foot mass (Ann Dermatol 2011;23:S239)
● 36 year old man with parotid mass (Case of the Week #360)

Clinical images

Nodule in arch of foot

Gross description

● Well circumscribed with pseudocapsule, typically 4 cm (range 0.5 to 25 cm), variable hemorrhage

Micro description

● Prominent storiform pattern of uniform spindle cells with ill defined eosinophilic cytoplasm and bland, elongated or plump vesicular nuclei with no atypia
● Often hemangiopericytoma-like vasculature
● Scattered lymphocytes, either multinucleated giant cells, osteoclastic giant cells or foam cells in 59%
● Usually less than 5 mitotic figures/10 HPF
● Stroma is myxoid or hyaline
● Borders are non-infiltrative, with no trapping of fat cells
● Necrosis or angiolymphatic invasion are rare

Micro images

Circumscribed tumor with no trapped fat

Cellular tumor

Tumor with more fibrous stroma

Foam cells help distinguish from DFSP

Focal storiform pattern and cellular uniformity

Hemangiopericytoma-like vascular pattern

Various images

Case of the Week #360:



Positive stains

● CD34 (40%), smooth muscle actin (38%)

Negative stains

● Keratin, EMA, desmin, S100

Differential diagnosis

Dermatofibrosarcoma protuberans: not circumscribed, usually infiltrative borders, “tight” storiform pattern, uniform cellularity, usually no foam cells, not sclerotic, strongly CD34+, Factor XIIIa weak/negative (Semin Cutan Med Surg 1999;18:91, Am J Surg Pathol 1994;18:677)
Nodular fasciitis: loose collagenous stroma, myxoid, mixed inflammatory cells, thin walled blood vessels
Solitary fibrous tumor: patternless (not storiform), alternating hypo- and hypercellular areas, prominent collagen fibers, no histiocytes, strongly CD34+

End of Skin - Nonmelanocytic tumors > Other tumors of skin > Deep benign fibrous histiocytoma

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