Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Spindle cell skin lesions
      
  • Epithelial cell: spindle cell or desmoplastic carcinoma (K903 pos SCC)
  • Melanocytic cell: over 98% are S100 positive
    • desmoplastic melanoma
    • Spitz nevus
  • Adipose cell: S100 pos.
  • Vascular cell (angio = factor Viii & CD31 pos.; lymphatic = D2-40 pos.):
    • epithelioid angiosarcoma (vimentin, keratins, EMA co-expression)
    • very poorly differentiated angiosarcoma [L06-2192](can also be CD-68 pos.)
    • lymphangiosarcoma5: lymphatic channels sarcoma (D2-40 pos. & factor VIII & CD31 neg.)
  • Smooth muscle cell: desmin positive leiomyoma or leiomyosarcoma
  • Nerve sheath like cells (CD34 pos):
    • DFSP (dermatofibrosarcoma protuberans): Bednar's pigmented variant; there is a granular cell variant; giant cell fibroblastoma is the juvenile variant
  • Fibrous cell: fibroma...fibrosarcoma
    • fibrous hamartoma of infancy
    • infantile digital fibromatosis
    • infantile myofibromatosis
    • myofibroma...myofibromatosis
    • giant cell fibroblastoma
    • fibromyxosarcoma...fibromyxoid sarcoma
    • plexiform fibrohystiocytic tumor
  • Fibrohistiocytic cell:
    • DF (dermal fibrous histiocytoma; dermatofibroma [there are epitheliod, aneurysmal, angiomatoid, monster cell, clear cell, lipidized, and cellular variants). [IHC]
    • AFX (atypical fibroxanthoma): rarely ever deeper than dermis & labels with procollagen I; large ones penetrating deeply tend to behave more like MFH; regarded as a dermal-based MFH4; must be K903 negative (spindled SCC positive. [S10-3205, S10-3482]
    • superficial malignant fibrous histiocytoma (MFH): skin/dermal/subQ & high mitotic rate & a whorled, storiform-like pattern...more aggressive recurrence behavior (rare mets lung, bone, liver) than AFX; not quite the sarcoma that a deep MFH is4.  [LMC-04-2554; LMC-04-8810]
  • Spindle cell tumor, not further classifiable: [S-05-10434; S-06-15819].

References:

  1. John Maize consult letter (ref. LMC-03-8671.../w ref. #2 in EBS's office tucked in Hajdu's soft tissue book)
  2. Lori A. Erickson, MD, Mayo Clinic, ASCP Teleconference Nov. 2003.
  3. see soft tissue section of Pathology Outlines web site.
  4. Haber MH, et. al., Differential Diagnosis in Surgical Pathology, 2002 (EBS's office).
  5. expert consultants

(posted 12 February 2004; latest addn 21 June 2010)
 
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