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Skin / Soft Tissue Tumors

Cellular fibrous histiocytoma

 

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Reviewer: David Lucas, M.D., University of Michigan Health Systems (January 2009)

Revised: 26 June 2009, last major update June 2009

 

Definition

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● More cellular than classic fibrous histiocytoma, elongated cells are arranged in storiform pattern or fascicles

 

Clinical

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● 5% of dermal fibrous histiocytomas

● Young or middle-aged adults, 60% men

● Extremities or head and neck are most common

 

Treatment and prognosis

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● Excision; 26% recur (AJSP 1994;18:668); rare metastases (AJSP 1996;20:1361)

 

Gross description

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● Up to 2.5 cm

 

Micro description

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● Fascicular or storiform but no “tight” storiform pattern

● Cells are plumper than DFSP, with eosinophilic cytoplasm and tapering nuclei

● Mean 3 mitotic figures/10 HPF but may be >10 MF/10 HPF

● Extension into subcutaneous fat in 1/3 cases

● At least focal inflammatory cells, foam cells or giant cells

● Epidermal changes in 58%, focal central necrosis in 12%

 

Micro images

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Storiform growth pattern                                                 Deep tumor extension                                     

 

 

                                                                   

More cellular than classic                                               Elongated cells are arranged in

fibrous histiocytoma                                                         fascicles or a storiform pattern

 

 

                                                  

Tumor cells are more histiocyte-like                            DFSP (fig A-C) versus cellular fibrous

and foam cells are present                                             histiocytoma (fig D-F) - H&E, CD34

 

Other images: hyperplastic and acanthotic epithelium;  spindled tumor resembles a leiomyoma 

 

Positive stains

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● Vimentin, CD163, CD68 (83%, J Cutan Pathol 2006;33:353)

● CD63/NKI-C3 (50%), Factor XIIIa (48%), focal smooth muscle actin

 

Negative stains

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● CD34, CD117 (J Cutan Pathol 2007;34:857), desmin, S100, keratin

 

Differential diagnosis

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● Dermatofibrosarcoma protuberans - tight storiform pattern, cells more spindly than cellular fibrous histiocytoma, CD34+ (strong), Factor XIIIa negative

● Leiomyosarcoma - smooth muscle morphology, more pleomorphism, muscle markers+

 

 

End of Skin / Soft Tissue Tumors > Cellular fibrous histiocytoma

 

 

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