Suchen und Finden
Preface
5
Acknowledgment
6
Contents
7
Contributors
9
1: Introduction and General Approach
10
Selected References
23
2: Ancillary Diagnostic Tests in the Diagnosis of Cutaneous Soft Tissue Neoplasms
24
Basic Principles of Diagnostic Immunohistochemistry
24
Attention to Positive and Negative Internal Controls
24
Evaluation of all Pieces of Tissue on the Entire Slide and Careful Discrimination of Neoplastic from Nonneoplastic Cell Populations
26
The Use of a Panel of Immunostains, Including Both Expected Positives and Negatives for All of the Entities in the Histologic Differential Diagnosis
26
Epithelial Markers
26
Keratins
26
Epithelial Membrane Antigen (EMA)
28
p63 and p40
28
Nerve Sheath Markers
28
S100 Protein
28
SOX10
29
Claudin-1
29
GLUT-1
29
Melanocyte Specific Markers
29
HMB-45
29
Melan-A
31
Tyrosinase
31
Microphthalmia Transcription Factor
31
Markers of Smooth and Skeletal Muscle
31
Desmin
31
Smooth Muscle Actin
31
MyoD1 and Myogenin
33
H-Caldesmon
33
Endothelial Markers
33
CD31
33
CD34
34
Podoplanin (D2-40)
34
FLI1 and ERG
35
vWF (Factor VIII)
37
Histiocytic Markers (CD68, CD163, CD11c, CD4)
37
ALK
37
Markers that Are Generally of Little Value
37
Vimentin
37
PGP9.5
39
Putative Markers of Atypical Fibroxanthoma and/or Superficial Undifferentiated Pleomorphic Sarcoma (CD99, CD10, Procollagen, CD34)
40
Applications of Immunohistochemistry and Fluorescence In Situ Hybridization in Various Differential Diagnoses in Cutaneous Soft Tissue Pathology
40
IHC in the Evaluation of Cutaneous Pleomorphic Spindle Cell Tumors
40
Leiomyosarcoma
42
Atypical Fibroxanthoma/Superficial Undifferentiated Pleomorphic Sarcoma (AFX/SUPS)
43
Other Rare Pleomorphic Spindle Cell Sarcomas that May Involve the Skin
46
IHC in the Differential Diagnosis of “Monomorphic” Spindle Cell Cutaneous Tumors
46
DFSP, CFH, and Related Lesions
46
LGFMS and Perineurioma
48
IHC in the Differential Diagnosis of Epithelioid Malignant Cutaneous Tumors
48
Epithelioid Sarcoma and Epithelioid Endothelial Tumors
48
Melanoma
51
Myoepithelial Tumors
53
IHC in the Differential Diagnosis of Tumors Composed of Small, Round Cells
55
Comments on Specific Round Cell Tumors
56
Other Application of IHC in Cutaneous Mesenchymal Tumors
60
Adipocytic Tumors
60
Atypical Vascular Lesions and Angiosarcomas Arising After Therapeutic Irradiation
62
Selected References
63
3: Mimics of Cutaneous Mesenchymal Tumors
66
Palisading Necrobiotic Granulomas: Granuloma Annulare and Rheumatoid Nodule
66
Clinical Features
66
Pathologic Features
66
Differential Diagnosis
69
Non-mesenchymal Spindle Cell Neoplasms that Mimic Primary Cutaneous Soft Tissue Lesions
70
Sarcomatoid Carcinoma
70
Clinical Features
70
Pathologic Features
71
Differential Diagnosis
73
Spindle Cell, Desmoplastic, and Dedifferentiated Melanoma
74
Clinical Features
74
Pathologic Features
75
Differential Diagnosis
76
Cellular Blue Nevus
79
Clinical Features
79
Pathologic Features
79
Differential Diagnosis
79
Massive Localized Lymphedema
80
Clinical Features
80
Pathologic Features
81
Differential Diagnosis
82
Silicone Granuloma
83
Clinical Features
83
Pathologic Features
84
Differential Diagnosis
85
Mycobacterial Spindle Cell Pseudotumor
86
Clinical Features
86
Pathologic Features
86
Differential Diagnosis
87
Acroangiodermatitis
89
Clinical Features
89
Pathologic Features
89
Differential Diagnosis
89
Bizarre Parosteal Osteochondromatous Proliferation (BPOP, Nora Lesion)
89
Clinical Features
89
Pathologic Features
90
Differential Diagnosis
92
Crystal-Storing Histiocytosis
92
Clinical Features
92
Pathologic Features
92
Differential Diagnosis
93
Erythema Elevatum Diutinum
94
Clinical Features
94
Pathologic Features
94
Differential Diagnosis
95
Metastatic Clear Cell Renal Cell Carcinoma
96
Clinical Features
96
Pathologic Features
96
Differential Diagnosis
96
Selected References
98
4: Benign Fibrous, Fibrohistiocytic, and Myofibroblastic Lesions
100
Keloid
100
Clinical Features
100
Pathologic Features
100
Differential Diagnosis
101
Fibrous Papule (Angiofibroma)
101
Clinical Features
101
Pathologic Features
102
Differential Diagnosis
102
Acquired Digital Fibrokeratoma
102
Clinical Features
102
Pathologic Features
106
Differential Diagnosis
106
Angiofibroma of Soft Tissue
106
Clinical Features
106
Pathologic Features
106
Differential Diagnosis
106
Pleomorphic Fibroma of the Skin
108
Clinical Features
108
Pathologic Features
108
Differential Diagnosis
109
Gardner-Associated Fibroma
109
Clinical Features
109
Pathologic Features
110
Differential Diagnosis
110
Nuchal Fibroma
112
Clinical Features
112
Pathologic Features
112
Differential Diagnosis
113
Calcifying Aponeurotic Fibroma
113
Clinical Features
113
Pathologic Features
113
Differential Diagnosis
113
Elastofibroma
115
Clinical Features
115
Pathologic Features
115
Differential Diagnosis
115
Desmoplastic Fibroblastoma (Collagenous Fibroma)
115
Clinical Features
115
Pathologic Features
115
Differential Diagnosis
116
Sclerotic Fibroma (Storiform Collagenoma)
118
Clinical Features
118
Pathologic Features
118
Differential Diagnosis
118
Fibrous Hamartoma of Infancy
118
Clinical Features
118
Pathologic Features
118
Differential Diagnosis
121
Infantile Digital Fibroma (Inclusion Body Fibromatosis)
122
Clinical Features
122
Pathologic Features
122
Differential Diagnosis
124
Plaque-Like CD34-Positive Dermal Fibroma
124
Clinical Features
124
Pathologic Features
124
Differential Diagnosis
124
Dermatomyofibroma
126
Clinical Features
126
Pathologic Features
126
Differential Diagnosis
126
Fibroblastic Connective Tissue Nevus
127
Clinical Features
127
Pathologic Features
127
Differential Diagnosis
128
Superficial Fibromatoses
129
Clinical Features
129
Pathologic Features
129
Differential Diagnosis
132
Juvenile Hyaline Fibromatosis
133
Clinical Features
133
Pathologic Features
133
Differential Diagnosis
133
Infantile Fibromatosis (Lipofibromatosis)
135
Clinical Features
135
Pathologic Features
135
Differential Diagnosis
135
Benign Fibrous Histiocytoma (Dermatofibroma)
137
Clinical Features
137
Pathologic Features
137
Conventional Benign Fibrous Histiocytoma/Dermatofibroma
143
Lipidized (Ankle-Type) Fibrous Histiocytoma
143
Cellular Fibrous Histiocytoma
143
Aneurysmal and/or Hemosiderotic Fibrous Histiocytoma
143
Atypical Fibrous Histiocytoma/Dermatofibroma with Monster Cells
143
Deep Fibrous Histiocytoma
143
Rare Variants
143
Differential Diagnosis
145
Multinucleate Cell Angiohistiocytoma
145
Clinical Features
145
Pathologic Features
146
Differential Diagnosis
147
Epithelioid Fibrous Histiocytoma
147
Clinical Features
147
Pathologic Features
147
Differential Diagnosis
149
Juvenile (Solitary) Xanthogranuloma
149
Clinical Features
149
Pathologic Features
149
Differential Diagnosis
151
Solitary Reticulohistiocytoma/Multicentric Reticulohistiocytosis
151
Clinical Features
151
Pathologic Features
151
Differential Diagnosis
151
Xanthomas
152
Clinical Features
152
Pathologic Features
153
Differential Diagnosis
153
Tenosynovial Giant Cell Tumor
154
Clinical Features
154
Pathologic Features
154
Differential Diagnosis
154
Superficial Acral Fibromyxoma (Digital Fibromyxoma) and Cellular Digital Fibroma
156
Clinical Features
156
Pathologic Features
156
Differential Diagnosis
156
Cutaneous Myxoma/Superficial Angiomyxoma
158
Clinical Features
158
Pathologic Features
158
Differential Diagnosis
158
Cellular Neurothekeoma
160
Clinical Features
160
Pathologic Features
160
Differential Diagnosis
160
Nodular Fasciitis
163
Clinical Features
163
Pathologic Features
163
Differential Diagnosis
163
Proliferative Fasciitis
167
Clinical Features
167
Pathologic Features
168
Differential Diagnosis
169
Ischemic Fasciitis
169
Clinical Features
169
Pathologic Features
169
Differential Diagnosis
171
Fibroma of Tendon Sheath
171
Clinical Features
171
Pathologic Features
171
Differential Diagnosis
171
Calcifying Fibrous Pseudotumor
174
Clinical Features
174
Pathologic Features
174
Differential Diagnosis
174
Fibroosseous Pseudotumor of Digits
175
Clinical Features
175
Pathologic Features
175
Differential Diagnosis
177
Selected References
177
5: Fibrous, Fibrohistiocytic, and Myofibroblastic Tumors of Intermediate Malignancy
184
Dermatofibrosarcoma Protuberans
184
Clinical Features
184
Pathologic Features
185
Pigmented Variant (Bednar Tumor)
185
Giant Cell Fibroblastoma
185
Myxoid DFSP
186
Atrophic Variant
189
Sclerosing Variant
189
Myoid Variant
189
Granular Cell Variant
190
DFSP with Fibrosarcomatous Transformation
190
Differential Diagnosis
191
Plexiform Fibrohistiocytic Tumor
197
Clinical Features
197
Pathologic Features
197
Differential Diagnosis
197
Angiomatoid Fibrous Histiocytoma
200
Clinical Features
200
Pathologic Features
200
Differential Diagnosis
203
Giant Cell Tumor of Soft Tissue
204
Clinical Features
204
Pathologic Features
205
Differential Diagnosis
206
Superficial CD34-Positive Fibroblastic Tumor
206
Clinical Features
206
Pathologic Features
207
Differential Diagnosis
209
Inflammatory Myofibrolastic Tumor
209
Clinical Features
209
Pathologic Features
209
Differential Diagnosis
211
Selected References
212
6: Malignant Fibrous, Fibrohistiocytic, and Myofibroblastic Tumors
214
Congenital/Infantile Fibrosarcoma
214
Clinical Features
214
Pathologic Features
214
Differential Diagnosis
216
Adult-Type Fibrosarcoma
216
Clinical Features
216
Pathologic Features
217
Differential Diagnosis
218
Low-Grade Fibromyxoid Sarcoma
218
Clinical Features
218
Pathologic Features
218
Differential Diagnosis
220
Sclerosing Epithelioid Fibrosarcoma
221
Clinical Features
221
Pathologic Features
221
Differential Diagnosis
222
Myxofibrosarcoma
223
Clinical Features
223
Pathologic Features
223
Differential Diagnosis
227
Undifferentiated Pleomorphic Sarcoma
227
Clinical Features
227
Pathologic Features
227
Differential Diagnosis
228
Low-Grade Myofibroblastic Sarcoma (Myofibrosarcoma)
229
Clinical Features
229
Pathologic Features
229
Differential Diagnosis
230
Myxoinflammatory Fibroblastic Sarcoma
231
Clinical Features
231
Pathologic Features
231
Differential Diagnosis
231
Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma
234
Clinical Features
234
Pathologic Features
234
Differential Diagnosis
239
Selected References
240
7: Cutaneous Vascular Lesions
243
Benign Vascular Proliferations of the Skin
243
Capillary Hemangioma (Cherry Hemangioma or Campbell De Morgan Spot)
243
Clinical Features
243
Pathologic Features
244
Differential Diagnosis
244
Pyogenic Granuloma
244
Clinical Features
244
Pathologic Features
245
Differential Diagnosis
245
Infantile Hemangioma
245
Clinical Features
245
Pathologic Features
247
Differential Diagnosis
250
Congenital Nonprogressive Hemangioma
251
Clinical Features
251
Pathologic Features
251
Differential Diagnosis
251
Venous Malformation (So-Called Cavernous/Sinusoidal Hemangioma)
253
Clinical Features
253
Pathologic Features
254
Differential Diagnosis
255
Hyperkeratotic Vascular Lesions:
256
Angiokeratoma
256
Clinical Features
256
Pathologic Features
257
Differential Diagnosis
257
Verrucous Venulocapillary Malformation (Verrucous Hemangioma)
258
Clinical Features
258
Pathologic Features
258
Differential Diagnosis
258
Arteriovenous Hemangioma (Acral Arteriovenous Tumor) and Arteriovenous Malformations
260
Clinical Features
260
Pathologic Features
260
Differential Diagnosis
261
Venous Lake
261
Clinical Features
261
Pathologic Features
261
Differential Diagnosis
261
Acquired Elastotic Hemangioma
261
Pathologic Features
262
Differential Diagnosis
263
Microvenular Hemangioma
264
Clinical Features
264
Pathologic Features
264
Differential Diagnosis
264
Hobnail Lymphatic Malformation (Hobnail Hemangioma, Targetoid Hemosiderotic Lymphatic Malformation, Targetoid Hemosiderotic Hemangioma)
264
Clinical Features
264
Pathologic Features
266
Differential Diagnosis
266
Tufted Angioma
267
Clinical Features
267
Pathologic Features
267
Differential Diagnosis
267
Spindle Cell Hemangioma
269
Clinical Features
269
Pathologic Features
269
Differential Diagnosis
270
Epithelioid Hemangioma (Angiolymphoid Hyperplasia with Eosinophilia)
271
Clinical Features
271
Pathologic Features
271
Differential Diagnosis
273
Cutaneous Epithelioid Angiomatous Nodule
275
Clinical Features
275
Pathologic Features
275
Differential Diagnosis
275
Cutaneous Lymphatic Malformation (Lymphangioma Circumscriptum)
275
Clinical Features
275
Pathologic Features
275
Differential Diagnosis
278
Acquired Progressive Lymphangioma (“Benign Angioendothelioma”)
278
Clinical Features
278
Pathologic Features
278
Differential Diagnosis
279
Papillary Hemangioma
280
Clinical Features
280
Pathologic Features
280
Differential Diagnosis
280
Reactive Vascular Lesions
282
Intravascular Papillary Endothelial Hyperplasia (Masson Tumor)
282
Clinical Features
282
Pathologic Features
282
Differential Diagnosis
282
Reactive Angioendotheliomatosis
284
Clinical Features
284
Pathologic Features
284
Differential Diagnosis
284
Glomeruloid Hemangioma
284
Clinical Features
284
Pathologic Features
284
Differential Diagnosis
284
Bacillary Angiomatosis
287
Clinical Features
287
Pathologic Features
287
Differential Diagnosis
287
Kaposi Sarcoma
287
Clinical Features
287
Pathologic Features
288
Differential Diagnosis
290
Vascular Tumors of Intermediate Malignancy
292
Kaposiform Hemangioendothelioma
292
Clinical Features
292
Pathologic Features
293
Differential Diagnosis
295
Hobnail Hemangioendotheliomas
295
Clinical Features
295
Pathologic Features
296
Differential Diagnosis
296
Composite Hemangioendothelioma
298
Clinical Features
298
Pathologic Features
298
Differential Diagnosis
298
Pseudomyogenic (Epithelioid Sarcoma-Like) Hemangioendothelioma
301
Clinical Features
301
Pathologic Features
301
Differential Diagnosis
301
Malignant Vascular Tumors
303
Epithelioid Hemangioendothelioma
303
Clinical Features
303
Pathologic Features
303
Differential Diagnosis
305
Angiosarcoma
305
Clinical Features
305
Pathologic Features
305
Differential Diagnosis
306
Radiation- and Lymphedema-Associated Vascular Tumors
309
Angiosarcoma
309
Clinical Features
309
Pathologic Features
309
Differential Diagnosis
309
Radiation-Induced Atypical Vascular Lesion
309
Clinical Features
309
Pathologic Features
311
Differential Diagnosis
311
Selected References
312
8: Perivascular Tumors
315
Angioleiomyoma
315
Clinical Features
315
Pathologic Features
315
Differential Diagnosis
316
Glomus Tumor
316
Clinical Features
316
Pathologic Features
318
Differential Diagnosis
318
Glomuvenous Malformation
318
Clinical Features
318
Pathologic Features
319
Differential Diagnosis
319
Glomangiomyoma
319
Clinical Features
319
Pathologic Features
319
Differential Diagnosis
320
Myopericytoma
321
Clinical Features
321
Pathologic Features
321
Differential Diagnosis
323
Myofibroma
324
Clinical Features
324
Pathologic Features
324
Differential Diagnosis
324
Malignant Glomus Tumor and Glomus Tumor of Uncertain Malignant Potential
324
Clinical Features
324
Pathologic Features
326
Differential Diagnosis
328
Selected References
328
9: Adipocytic Tumors
330
Lipoma
330
Clinical Features
330
Pathologic Features
330
Differential Diagnosis
332
Angiolipoma
333
Clinical Features
333
Pathologic Features
333
Differential Diagnosis
333
Spindle Cell Lipoma and Pleomorphic Lipoma
333
Clinical Features
333
Pathologic Features
334
Differential Diagnosis
337
Chondroid Lipoma
338
Clinical Features
338
Pathologic Features
338
Differential Diagnosis
339
Hibernoma
339
Clinical Features
339
Pathologic Features
339
Differential Diagnosis
339
Lipoblastoma
340
Clinical Features
340
Pathologic Features
340
Differential Diagnosis
340
Nevus Lipomatosus
342
Clinical Features
342
Pathologic Features
342
Differential Diagnosis
342
Pleomorphic Liposarcoma
342
Clinical Features
342
Pathologic Features
342
Differential Diagnosis
342
Atypical Lipomatous Tumor
345
Clinical Features
345
Pathologic Features
345
Differential Diagnosis
345
Dedifferentiated Liposarcoma
347
Clinical Features
347
Pathologic Features
347
Differential Diagnosis
347
Myxoid Liposarcoma
348
Clinical Features
348
Pathologic Features
348
Differential Diagnosis
350
Selected References
350
10: Nerve Sheath and Related Tumors
352
Neurofibroma
352
Clinical Features
352
Pathologic Features
352
Differential Diagnosis
354
Schwannoma
356
Clinical Features
356
Pathologic Features
356
Cellular Schwannoma
357
Plexiform Schwannoma
358
Microcystic/Reticular Schwannoma
359
Epithelioid Schwannoma
360
Neuroblastoma-Like Schwannoma
361
Pseudoglandular Schwannoma and Schwannomas with True Glands
361
Schwannoma with Secondary Malignancy
361
Differential Diagnosis
362
Perineurioma
364
Clinical Features
364
Pathologic Features
365
Differential Diagnosis
367
Hybrid Schwannoma/Perineurioma
368
Clinical Features
368
Pathologic Features
369
Differential Diagnosis
369
Granular Cell Tumor
370
Clinical Features
370
Pathologic Features
371
Differential Diagnosis
373
Atypical and Malignant Granular Cell Tumor
374
Clinical Features
374
Pathologic Features
374
Differential Diagnosis
374
Dermal Nerve Sheath Myxoma
375
Clinical Features
375
Pathologic Features
376
Differential Diagnosis
376
Solitary Circumscribed Neuroma (Palisaded Encapsulated Neuroma)
377
Clinical Features
377
Pathologic Features
378
Differential Diagnosis
379
Other Neuromas
379
Traumatic Neuroma
379
Morton Neuroma
379
Pacinian Neuroma
379
Rudimentary Polydactyly (Supernumerary Digit)
379
Meningioma
381
Clinical Features
381
Pathologic Features
381
Differential Diagnosis
381
Malignant Peripheral Nerve Sheath Tumor (MPNST)
382
Clinical Features
382
Pathologic Features
383
Differential Diagnosis
383
Ewing Sarcoma
384
Clinical Features
384
Pathologic Features
385
Differential Diagnosis
387
Selected References
387
11: Genital Mesenchymal Tumors
389
Genital Stromal Tumors
389
Fibroepithelial Stromal Polyp
389
Clinical Features
389
Pathologic Features
390
Differential Diagnosis
390
Cellular Angiofibroma (Angiomyofibroblastoma-Like Tumor of the Male Genital Tract)
390
Clinical Features
390
Pathologic Features
393
Differential Diagnosis
394
Mammary-Type Myofibroblastoma
395
Clinical Features
395
Pathologic Features
396
Differential Diagnosis
396
Angiomyofibroblastoma
398
Clinical Features
398
Pathologic Features
398
Differential Diagnosis
398
Deep Angiomyxoma
398
Clinical Features
398
Pathologic Features
399
Differential Diagnosis
399
Ancillary Studies for Genital Stromal Tumors
400
Immunohistochemistry
400
Genetics
400
RB1/13q14
400
HMGA2/12q14.3
401
Prepubertal Vulval Fibroma
402
Clinical Features
402
Pathologic Features
402
Differential Diagnosis
402
Massive Vulval Edema
403
Clinical Features
403
Pathologic Features
403
Differential Diagnosis
403
Smooth Muscle Tumors of the External Genitalia
404
Clinical Features
404
Pathologic Features
404
Differential Diagnosis
405
Selected References
408
12: Soft Tissue Tumors of Uncertain Histogenesis
410
Epithelioid Sarcoma
410
Clinical Features
410
Pathologic Features
411
Differential Diagnosis
411
Clear Cell Sarcoma
414
Clinical Features
414
Pathologic Features
418
Differential Diagnosis
421
Cutaneous Perivascular Epithelioid Cell Tumor (PEComa)
421
Clinical Features
421
Pathologic Features
422
Differential Diagnosis
423
Ossifying Fibromyxoid Tumor
425
Clinical Features
425
Pathologic Features
425
Differential Diagnosis
428
Pleomorphic Hyalinizing Angiectatic Tumor and Hemosiderotic Fibrolipomatous Tumor
431
Clinical Features
431
Pathologic Features
432
Differential Diagnosis
437
Solitary Fibrous Tumor
438
Clinical Features
438
Pathologic Features
438
Differential Diagnosis
442
Synovial Sarcoma
444
Clinical Features
444
Pathologic Features
445
Differential Diagnosis
449
Alveolar Soft Part Sarcoma
450
Clinical Features
450
Pathologic Features
450
Differential Diagnosis
453
Rosai-Dorfman Disease
453
Clinical Features
453
Pathologic Features
454
Differential Diagnosis
454
Cutaneous Myoepithelial Tumors
456
Clinical Features
457
Pathologic Features
457
Differential Diagnosis
463
Selected References
470
13: Miscellaneous Mesenchymal Tumors: Smooth Muscle, Skeletal Muscle, Cartilaginous, and Osseous Tumors
474
Leiomyoma
474
Clinical Features
474
Pathologic Features
475
Differential Diagnosis
476
Congenital Smooth Muscle Hamartoma
477
Clinical Features
477
Pathologic Features
477
Differential Diagnosis
478
Epstein-Barr Virus-Associated Smooth Muscle Tumors
478
Clinical Features
478
Pathologic Features
478
Differential Diagnosis
479
Leiomyosarcoma
479
Clinical Features
479
Pathologic Features
479
Differential Diagnosis
479
Rhabdomyoma
481
Clinical Features
481
Pathologic Features
482
Differential Diagnosis
482
Rhabdomyomatous Mesenchymal Hamartoma
482
Clinical Features
482
Pathologic Features
482
Differential Diagnosis
484
Cutaneous Rhabdomyosarcoma
484
Clinical Features
484
Pathologic Features
484
Differential Diagnosis
488
Soft Tissue Chondroma
488
Clinical Features
488
Pathologic Features
488
Differential Diagnosis
488
Extraskeletal Myxoid Chondrosarcoma
489
Clinical Features
489
Pathologic Features
490
Differential Diagnosis
491
Osteoma Cutis
491
Clinical Features
491
Pathologic Features
491
Differential Diagnosis
491
Extraskeletal Osteosarcoma
491
Clinical Features
491
Pathologic Features
492
Differential Diagnosis
492
Selected References
493
Correction to: Nerve Sheath and Related Tumors
496
Index
497
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