Skin nonmelanocytic tumor

Fibrous, fibrohistiocytic and myofibroblastic neoplasms

Cutaneous fibroepithelial polyps


Resident / Fellow Advisory Board: Caroline I.M. Underwood, M.D.
Alexander Nirenberg, M.B.B.S.

Minor changes: 14 July 2021

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PubMed Search: Fibroepithelial polyps [title]

Alexander Nirenberg, M.B.B.S.
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Cite this page: Nirenberg A. Cutaneous fibroepithelial polyps. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocyticfibroepithelialpolyp.html. Accessed September 21st, 2021.
Definition / general
  • Benign nonepithelial tumors arising from mesodermal tissue
Essential features
  • Common benign cutaneous tumor
  • On eyelids, flexural areas
  • F = M
  • Associated with trauma, obesity, diabetes mellitus, pregnancy
Terminology
  • Acrochordon, soft fibroma, fibroma molle, skin tag
ICD coding
  • ICD-11: EK71 - skin tags or polyps
  • SNOMED:
    • 201091002 - skin tag (disorder)
    • 31069005 - fibroepithelial polyp (morphologic abnormality)
Epidemiology
Sites
  • Eyelids
  • Flexural areas: axillae, groins
  • Lateral part of neck
  • Under breasts
Pathophysiology
Etiology
Clinical features
Diagnosis
Prognostic factors
  • Benign
Case reports
Treatment
Clinical images

Contributed by Arvind Ranchhod, M.B.Ch.B.
Fibroepithelial polyps Fibroepithelial polyps

Multiple skin tags



Images hosted on other servers:
Penile fibroepithelial polyp

Penile fibroepithelial polyp

Fibroepithelial polyp<br>at posterior wall of<br>external auditory canal

Fibroepithelial
polyp at posterior
wall of external
auditory canal

Gross description
  • Sessile or pedunculated polyp
  • 2 - 5 mm to several centimeters (Australas J Dermatol 2019;60:70)
  • Surface smooth or filiform
  • Smaller ones may be pigmented
  • Larger ones are skin colored
Gross images

Contributed by Alexander Nirenberg, M.B.B.S.
Fibroepithelial polyps

Clinical skin tag

Microscopic (histologic) description
  • Epidermis hyperplastic, papillary, keratotic cysts, pigment
  • Loose fibrocollagenous stroma, abundant vessels
  • Usually no adnexa
  • Variable adipose tissue in larger ones - lipofibroma
  • Traumatic changes: lichen simplex chronicus, ulceration, pagetoid dyskeratosis (Am J Dermatopathol 2006;28:478)
  • Pseudosarcomatous change: pleomorphic stellate stromal cells, multinucleated stromal cells, myxoid to collagenous stroma (Ann Diagn Pathol 2008;12:440)
Microscopic (histologic) images

Contributed by Alexander Nirenberg, M.B.B.S.
Classic features

Classic features

Prominent vascular stroma

Prominent vascular stroma

Stromal edema Stromal edema

Stromal edema


Epidermal hyperplasia

Epidermal hyperplasia

Adipose tissue

Adipose tissue

Trauma / inflammation Trauma / inflammation

Trauma / inflammation

Sample pathology report
  • Left neck, shave biopsy:
    • Fibroepithelial polyp / acrochordon (see comment)
    • Comment: Shave biopsy of skin tag from the left side of the neck (62 year old woman).
    • Macroscopic description: A skin covered polyp, X x Y mm, with a tan smooth surface. Cut surface is uniform and pale.
    • Microscopic description: A polyp covered by mildly acanthotic epidermis with mild hyperkeratosis. There is a mildly cellular fibrovascular core with scattered dilated small thin walled vessels and a sparse lymphocytic infiltrate. Dysplasia or malignancy is not seen.
Differential diagnosis
Board review style question #1

A 62 year old woman presents with multiple lesions on the neck (shown above) with pathological diagnosis of fibroepithelial polyps, NOS. Which clinical association should you consider?

  1. Anorexia
  2. Birt-Hogg-Dubé syndrome
  3. Diabetes mellitus
  4. Dysplastic nevus syndrome
  5. Neurofibromatosis
Board review style answer #1
C. Diabetes mellitus. Skin tags may be associated with diabetes mellitus / metabolic syndrome as well as obesity. The other listed conditions have not been shown to have increased incidence of fibroepithelial polyps but may have other cutaneous polypoid lesions. Birt-Hogg-Dubé syndrome was initially reported as having increased incidence of skin tags, however, the lesions are polypoid trichodiscomas and fibrofolliculomas.

Comment Here

Reference: Cutaneous fibroepithelial polyps
Board review style question #2

A clinician excises a skin tag from the groin of a 73 year old woman (microscopic image shown above). The best diagnosis is

  1. Cutaneous myxoma
  2. Neurofibroma
  3. Pseudosarcomatous fibroepithelial polyp
  4. Pyogenic granuloma
  5. Traumatized fibroepithelial polyp
Board review style answer #2
E. Traumatized fibroepithelial polyp. This is a fibroepithelial polyp with features of trauma, including an area of epidermal necrosis, stromal edema and stromal inflammatory cells. The stroma is loose and has low cellularity of mesenchymal cells, unlike a neurofibroma. The stroma is edematous rather than myxoid. It lacks the pleomorphic stellate and multinucleated stromal cells of a pseudosarcomatous fibroepithelial polyp. The lesion has dilated vessels, however, it lacks the lobular proliferation of capillaries that characterizes a pyogenic granuloma.

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Reference: Cutaneous fibroepithelial polyps
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