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Congenital fibroblastic connective tissue nevi: Unusual and misleading presentations in three infantile cases
Author(s) -
Bouaoud Jebrane,
Fraitag Sylvie,
Soupre Veronique,
Mitrofanoff Marc,
Boccara Olivia,
Galliot Christelle,
Bodemer Christine,
Picard Arnaud,
Khonsari Roman H.
Publication year - 2018
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.13571
Subject(s) - medicine , pathology , differential diagnosis , reticular dermis , pleomorphism (cytology) , connective tissue , dermis , desmoplasia , malignancy , atypia , anatomy , immunohistochemistry , stroma
Background Fibroblastic connective tissue nevi ( FCTN ) are benign skin conditions characterized by bland spindle cells infiltrating the reticular dermis and the upper subcutis with preservation of adnexal structures. A subset of FCTN expresses CD 34, which may cause difficulties in the differential diagnosis, in particular with dermatofibrosarcoma ( DFSP ). We aim to study clinical and histological main features of congenital FCTN to better understand their heterogeneity. Methods We present 3 cases of congenital FCTN with misleading pseudo‐tumoral presentations and compare them with published cases in literature. We provide a diagnostic algorithm for congenital neonatal connective tissue tumors. Results Clinically, FCTN mostly present as well‐limited and nontender plaques or nodules mainly located in the neck and face areas or in the trunk. Histologically, FCTN are composed of irregularly distributed fascicles of bland spindled cells and are defined by a list of fundamental features: (i) no atypia, pleomorphism, or mitotic activity; (ii) skin appendages entrapped but unaffected; (iii) no evidence for malignancy. In most cases CD 34 is positive, but in some cases, cells can express SMA or are even CD 34− and SMA −. Conclusion The initial presentation and natural history of FCTN fit better with a neoplasm than with a hamartoma. Thus, we suggest replacing the term “nevus” with tumor and considering fibroblastic connective tissue tumor ( FCTT ) as the right denomination of this clinico‐pathological entity. FCTT s are difficult to diagnose due to their clinical heterogeneity. Clinical and histological malignant and benign differential diagnoses are discussed.