リンパ節転移をきたした皮膚線維腫の 1 例

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  • A case of metastasizing dermatofibroma of the cervical lymph node

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Background : Dermatofibroma (DF) rarely metastasizes to the lymph nodes and lungs. We report a case of metastatic DF to the cervical lymph node with cytological findings.<br>Case : A woman in her 30’s underwent surgical treatment for a protruding right occipital lesion. Four year postoperatively, CT and PET/CT were suggestive of a metastatic tumor in the right cervical lymph node, and then neck dissection was performed. Imprint cytology revealed celluar clusters showing a fascicular structure with foamy macrophages and a hemorrhagic background. The tumor cells were composed of spindle-shaped fibroblastic cells and oval to polygonal histiocytic cells. The nuclei were of spindle to ovoid form without hyperchromasia and atypia. Histological examination revealed proliferation of spindle-shaped fibroblasts showing a storiform pattern with aneurysmal changes and foamy macrophages. The immunohistochemical findings revealed that the tumor cells were positive for factor XIIIa and negative for CD34. Fusion gene transcripts of COL1A1-PDGFB were not detected with the real-time polymerase chain reaction (RT-PCR) technique using paraffin-embedded sections. A diagnosis of metastatic DF to the lymph node was made. Review of the previous histological specimen proved that the primary lesion was DF but not dermatofibrosarcoma protuberans.<br>Conclusion : The possibility of metastatic DF should be considered in diagnosis of metastasis, and it is necessary to refer to the clinical information because of the difficulty of making a diagnosis based on the cytological examination alone.

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