Soft tissue
So called fibrohistiocytic
Deep fibrous histiocytoma
Authors: Christopher S. Hale, M.D., Vijay Shankar, M.D.
Last author update: 1 August 2012
Last staff update: 25 January 2023
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Deep fibrous histiocytoma
Table of Contents
Definition / general | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosisCite this page: Hale CS, Shankar V. Deep fibrous histiocytoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocyticdeepbfh.html. Accessed April 26th, 2024.
Definition / general
- 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
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)
Treatment
- Excision
- Usually benign behavior but may recur if incompletely excised, rare metastases (Am J Surg Pathol 2008;32:354)
Clinical images
Images hosted on other servers:
Nodule in arch of foot
Gross description
- Well circumscribed with pseudocapsule, typically 4 cm (range 0.5 to 25 cm), variable hemorrhage
Microscopic (histologic) 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
Microscopic (histologic) images
AFIP 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
Case #360
Images hosted on other servers:
Various images
Positive stains
- CD34 (40%), smooth muscle actin (38%)
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+
