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The cytologic feature of this tumor make it appear to be a much more aggressive lesion. How does one distinguish this (Cellular DF) from other more agressive tumors - ie. sarcomas.

----Comment by: PathDoc15 on 4/27/2008 10:32:59 AM

well derm is not my thing but I can speculate that mitotic figures or one abnormal mitotic figure will push me towards sarcoma...

----Comment by: savco on 4/29/2008 10:32:09 AM

Ongoing studies are aimed at solving this problem with IHC (CD117 and CD163, see article below, are two recently applied stains). In general, it seems that a spectrum (both morphologic and immunohistochemical) exists between DF and DFSP. Generally these two entities can be readily distinguished by routine histology, but in certain instances their microscopic appearances overlap. Cellular DF may be viewed as in “intermediate” variant, with a higher rate of local recurrence but not the aggressive/destructive type of recurrence as seen in DFSP. With the classic immunophenotype of DF, this current lesion was signed out as cellular DF (in spite of the pleomorphism) with a comment stating that the lesion has a significant chance of local recurrence if not completely excised. J Cutan Pathol 2006: 33: 353–360

----Comment by: Iago on 4/29/2008 11:00:42 AM

Dermpath is definitely not my thing either - just this morning, I found myself accidently in a dermpath conference. Funny story, but, Boy, it was rough - I had to do a fake look at my pager with a slight head shake back and forth implying an unwelcome yet silent page to get out of there. (Yes, this is an inside joke for Iago)

----Comment by: PathDoc15 on 4/29/2008 12:21:48 PM

One more note on cytologic features. Distinguishing between DFSP and DF (or one of it's many histologic variants, in this case, cellular DF) on cytologic features is tough. DFSP tend to demonstrate little cytologic atypia while DF’s can have quite striking cellular pleomorphism (monster cell DF). Certain DFSP may contain foci of higher cytologic grade resembling conventional fibrosarcomas. These areas show less of a storiform and more of a fasicular growth pattern. Fibrosarcoma arising in DFSP (or Fibrosarcomatous variant of DFSP as a distinct entity) is somewhat controversial. While these variants may have an inherently more sinister biological potential, studies on these tumors, where surgical margin status is well documented, fail to demonstrate a worse prognosis between these and conventional DFSP. Bottom line, use low power to differentiate between DF and DFSP. I’ll post some examples demonstrating key morphologic differences between DFSP and DF soon.

----Comment by: Iago on 7/26/2008 10:35:11 AM

For some classic DFSP IHC see [Ref #1]

----Comment by: PathDoc15 on 7/27/2008 3:17:02 AM

     

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