Fibrous histiocytoma (dermatofibroma, sclerosing haemangioma, histiocytoma cutis, nodular subepidermal fibrosis, fibrous xanthoma)

The fibrohistiocytic origin of this tumour is now in doubt3.

Clinical features

Ceullar fibrous histiocytoma may rarely metastasis2.

Immunohistochemistry

• alpha-1-antitrypsin positive

• factor XIIIa positive

Variants1

• with architectural peculiarities:

  • deep
    
  • deep penetrating
    
  • atrophic
    
  • aneurysmal
    
  • haemangiopericytoma-like
    
  • palisading
• cellular/stromal peculiarities
  • clear cell
    
  • granular cell
    
  • myofibroblastic
    
  • sclerotic
    
  • monster cell
    
  • ostoeclast-like giant cells
    
  • atypical (pseudosarcomatous)
    
  • haemosiderotic
    
  • cholesterotic
    
  • palisading
    
  • myxoid
    
  • lipidized "ankle-type"
• with both architectural and cellular/stromal peculiarities
  • epithelioid cell
    
  • cellular benign
    
  • with smooth muscle proliferation
    
  • multinucleate cell histiocytoma
    
  • cellular neurothekeoma
    
  • plexiform fibrohistiocytic
    
  • plexiform xanthoma

Differential diagnosis

• dermatofibrosarcoma protuberans

• malignant fibrous histiocytoma

Prognosis

• Conventional fibrous histiocytoma seldom recurs even when incompletely excised3.

• Atypical, aneurysmal and cellular fibrous histiocytomas have recurrence rates of about 20%3.

References

1 Zelger, B. G., Alonje, E., Zelger, B. Myxoid dermatofibroma. Histopathology 1999;34:357-364

2 De Hertogh, G., Bergmans, G., Molderez, C. and Sciot, R. Cutaneous cellular fibrous histiocytoma metastasizing to the lungs. Histopathology 2002;41:85-6.

3 Gleason BC,Fletcher CD Deep "benign" fibrous histiocytoma: clinicopathologic analysis of 69 cases of a rare tumor indicating occasional metastatic potential. Am J Surg Pathol 2008; 32:354-62