Cutaneous Spindle Cell Neoplasms: Pattern-Based Diagnostic Approach.

CONTEXT - Spindle cell neoplasms arising in the skin comprise a heterogeneous group of tumors with divergent lineages. Cutaneous spindle cell neoplasms are relatively common and present surgical pathologists with diagnostic challenges. Recognition of their histopathologies is important for correct diagnosis and management. The current review presents a pattern-based diagnostic approach to common cutaneous spindle cell neoplasms that often cause diagnostic difficulties. OBJECTIVE - To provide a useful guide for diagnosis of cutaneous spindle cell neoplasms. DATA SOURCES - PubMed (US National Library of Medicine) reports and the authors' personal experiences are reviewed. CONCLUSIONS - The authors briefly summarize the histologic features and differential diagnoses of common cutaneous spindle cell neoplasms.

[1]  S. Spunt,et al.  Pediatric Cutaneous Angiosarcomas: A Clinicopathologic Study of 10 Cases , 2011, The American journal of surgical pathology.

[2]  M. Martínez-González,et al.  Clear Cell Atypical Fibroxanthoma: Clinicopathological Study of 6 Cases and Review of the Literature With Special Emphasis on the Differential Diagnosis , 2016, The American Journal of dermatopathology.

[3]  T. Fioretos,et al.  A novel SERPINE1–FOSB fusion gene results in transcriptional up‐regulation of FOSB in pseudomyogenic haemangioendothelioma , 2014, The Journal of pathology.

[4]  A. Folpe,et al.  MYC amplification and overexpression in primary cutaneous angiosarcoma: a fluorescence in-situ hybridization and immunohistochemical study , 2014, Modern Pathology.

[5]  T. Mentzel.  Sarcomas of the skin in the elderly. , 2011, Clinics in dermatology.

[6]  R. Büttner,et al.  Postradiation cutaneous angiosarcoma after treatment of breast carcinoma is characterized by MYC amplification in contrast to atypical vascular lesions after radiotherapy and control cases: clinicopathological, immunohistochemical and molecular analysis of 66 cases , 2012, Modern Pathology.

[7]  A. Lazar,et al.  Dermatofibrosarcoma protuberans COL1A1-PDGFB fusion is identified in virtually all dermatofibrosarcoma protuberans cases when investigated by newly developed multiplex reverse transcription polymerase chain reaction and fluorescence in situ hybridization assays. , 2008, Human pathology.

[8]  S. Dry,et al.  Differential gene expression profiles of neurothekeomas and nerve sheath myxomas by microarray analysis , 2011, Modern Pathology.

[9]  C. Fletcher,et al.  Myxoid Dermatofibrosarcoma Protuberans: A Rare Variant Analyzed in a Series of 23 Cases , 2007, The American journal of surgical pathology.

[10]  A. Folpe,et al.  Best practices in diagnostic immunohistochemistry: pleomorphic cutaneous spindle cell tumors. , 2007, Archives of pathology & laboratory medicine.

[11]  Thomas Mentzel,et al.  Myopericytoma of Skin and Soft Tissues: Clinicopathologic and Immunohistochemical Study of 54 Cases , 2006, The American journal of surgical pathology.

[12]  A. Solomon,et al.  Clinicopathologic Variants of Cutaneous Squamous Cell Carcinoma , 2001, Advances in anatomic pathology.

[13]  C. Fletcher,et al.  Cutaneous pilar leiomyoma: clinicopathologic analysis of 53 lesions in 45 patients. , 1997, The American Journal of dermatopathology.

[14]  L. Aaltonen,et al.  Increased risk of cancer in patients with fumarate hydratase germline mutation , 2005, Journal of Medical Genetics.

[15]  C. Fletcher,et al.  Superficial angiomyxoma: clinicopathologic analysis of a series of distinctive but poorly recognized cutaneous tumors with tendency for recurrence. , 1999, The American journal of surgical pathology.

[16]  Yiran Guo,et al.  Mutations in PDGFRB cause autosomal-dominant infantile myofibromatosis. , 2013, American journal of human genetics.

[17]  A. Gru,et al.  Atypical fibroxanthoma: a selective review. , 2013, Seminars in diagnostic pathology.

[18]  C. Ramya,et al.  Superficial Acral Fibromyxoma , 2016, Indian journal of dermatology.

[19]  D. Tyler,et al.  Histopathologic Characteristics, Recurrence Patterns, and Survival of 129 Patients With Desmoplastic Melanoma , 2004, Annals of Surgical Oncology.

[20]  S. Dry,et al.  SOX10 Expression Distinguishes Desmoplastic Melanoma From Its Histologic Mimics , 2013, The American Journal of dermatopathology.

[21]  Narasimhan P. Agaram,et al.  Deep-Seated Plexiform Schwannoma: A Pathologic Study of 16 Cases and Comparative Analysis With the Superficial Variety , 2005, The American journal of surgical pathology.

[22]  André M. Oliveira,et al.  Perineurioma: a distinctive and underrecognized peripheral nerve sheath neoplasm. , 2007, Archives of pathology & laboratory medicine.

[23]  Teo Soleymani,et al.  Conception and Management of a Poorly Understood Spectrum of Dermatologic Neoplasms: Atypical Fibroxanthoma, Pleomorphic Dermal Sarcoma, and Undifferentiated Pleomorphic Sarcoma , 2017, Current Treatment Options in Oncology.

[24]  S. Billings,et al.  Cellular neurothekeoma: analysis of 37 cases emphasizing atypical histologic features , 2014, Modern Pathology.

[25]  C. Fletcher,et al.  Intradermal Nodular Fasciitis: A Rare Lesion Analyzed in a Series of 24 Cases , 2010, The American journal of surgical pathology.

[26]  C. Serra-Guillén,et al.  Dermatofibrosarcoma protuberans: a comprehensive review and update on diagnosis and management. , 2013, Seminars in diagnostic pathology.

[27]  M. Miettinen,et al.  Nerve Sheath Myxoma: A Clinicopathologic and Immunohistochemical Analysis of 57 Morphologically Distinctive, S-100 Protein- and GFAP-Positive, Myxoid Peripheral Nerve Sheath Tumors With a Predilection for the Extremities and a High Local Recurrence Rate , 2005, The American journal of surgical pathology.

[28]  S. Jaffer,et al.  Neurothekeoma and Plexiform Fibrohistiocytic Tumor: Mere Histologic Resemblance or Histogenetic Relationship? , 2009, The American journal of surgical pathology.

[29]  C. Fletcher,et al.  Myopericytomatosis: Clinicopathologic Analysis of 11 Cases With Molecular Identification of Recurrent PDGFRB Alterations in Myopericytomatosis and Myopericytoma , 2017, The American journal of surgical pathology.

[30]  C. Fletcher,et al.  Cellular Neurothekeoma: Detailed Characterization in a Series of 133 Cases , 2007, The American journal of surgical pathology.

[31]  C. Fletcher,et al.  ALK rearrangement and overexpression in epithelioid fibrous histiocytoma , 2015, Modern Pathology.

[32]  D. Dittmer,et al.  Kaposi sarcoma associated herpesvirus pathogenesis (KSHV)--an update. , 2013, Current opinion in virology.

[33]  J. Aneiros-Fernández,et al.  Primary cutaneous and subcutaneous leiomyosarcomas: evolution and prognostic factors , 2016, European Journal of Dermatology.

[34]  J. Goldblum,et al.  Nodular fasciitis of the head and neck region: a clinicopathologic description in a series of 30 cases , 2009, Journal of cutaneous pathology.

[35]  T. Brenn,et al.  Pleomorphic Dermal Sarcoma: Adverse Histologic Features Predict Aggressive Behavior and Allow Distinction From Atypical Fibroxanthoma , 2012, The American journal of surgical pathology.

[36]  B. Wood.  Desmoplastic melanoma: recent advances and persisting challenges , 2013, Pathology.

[37]  C. Fletcher,et al.  WHO classification of tumours of soft tissue and bone , 2013 .

[38]  C. Garbe,et al.  Desmoplastic Malignant Melanoma: A Clinicopathologic Analysis of 113 Cases , 2008, The American Journal of dermatopathology.

[39]  C. Fletcher,et al.  Leiomyosarcoma of soft tissue in children: clinicopathologic analysis of 20 cases. , 1999, The American journal of surgical pathology.

[40]  E. Montgomery,et al.  TGFBR3 and MGEA5 Rearrangements in Pleomorphic Hyalinizing Angiectatic Tumors and the Spectrum of Related Neoplasms , 2014, The American journal of surgical pathology.

[41]  André M. Oliveira,et al.  The Prognostic Significance of Fibrosarcomatous Transformation in Dermatofibrosarcoma Protuberans , 2006, The American journal of surgical pathology.

[42]  C. Fletcher,et al.  Metastasizing “Benign” Cutaneous Fibrous Histiocytoma: A Clinicopathologic Analysis of 16 Cases , 2013, The American journal of surgical pathology.

[43]  B. Scheithauer,et al.  Plexiform schwannoma: a clinicopathologic overview with emphasis on the head and neck region. , 2008, Human pathology.

[44]  R. Sciot,et al.  R132C IDH1 mutations are found in spindle cell hemangiomas and not in other vascular tumors or malformations. , 2013, The American journal of pathology.

[45]  L. Doyle,et al.  Advances in the clinicopathological and molecular classification of cutaneous mesenchymal neoplasms , 2016, Histopathology.

[46]  O. Larsson,et al.  Fusions involving protein kinase C and membrane-associated proteins in benign fibrous histiocytoma. , 2014, The international journal of biochemistry & cell biology.

[47]  S. Devesa,et al.  Cutaneous soft tissue sarcoma incidence patterns in the U.S. , 2008, Cancer.

[48]  M. Llamas-Velasco,et al.  Fumarate hydratase immunohistochemical staining may help to identify patients with multiple cutaneous and uterine leiomyomatosis (MCUL) and hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome , 2014, Journal of cutaneous pathology.

[49]  C. Fletcher,et al.  Desmin and CD34 positivity in cellular fibrous histiocytoma: an immunohistochemical analysis of 100 cases , 2012, Journal of cutaneous pathology.

[50]  Vlad V. Simianu,et al.  Squamous Cell Carcinoma , 2016 .

[51]  T. Mentzel,et al.  Atypical Fibroxanthoma Revisited. , 2017, Surgical pathology clinics.

[52]  J. Barnholtz-Sloan,et al.  Incidence and Survival of Primary Dermatofibrosarcoma Protuberans in the United States , 2016, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[53]  A. Lazar,et al.  Molecular characterization of epithelioid haemangioendotheliomas identifies novel WWTR1–CAMTA1 fusion variants , 2015, Histopathology.

[54]  Ishida,et al.  Phenotypic diversity of neurofibromatosis 2: association with plexiform schwannoma , 1998, Histopathology.

[55]  C. Fletcher,et al.  Hybrid Schwannoma/Perineurioma: Clinicopathologic Analysis of 42 Distinctive Benign Nerve Sheath Tumors , 2009, The American journal of surgical pathology.

[56]  D. Schadendorf,et al.  Atypical fibroxanthoma and pleomorphic dermal sarcoma harbor frequent NOTCH1/2 and FAT1 mutations and similar DNA copy number alteration profiles , 2018, Modern Pathology.

[57]  S. Billings,et al.  Histopathology of Spindle Cell Vascular Tumors. , 2017, Surgical pathology clinics.

[58]  Narasimhan P. Agaram,et al.  Frequent FOS Gene Rearrangements in Epithelioid Hemangioma: A Molecular Study of 58 Cases With Morphologic Reappraisal , 2015, The American journal of surgical pathology.

[59]  C. Fletcher,et al.  Pseudomyogenic Hemangioendothelioma: A Distinctive, Often Multicentric Tumor With Indolent Behavior , 2011, The American journal of surgical pathology.

[60]  M. Miettinen,et al.  Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes. , 2001, Human pathology.

[61]  C. Fletcher,et al.  Malignant myopericytoma: expanding the spectrum of tumours with myopericytic differentiation. , 2002, Histopathology.

[62]  L. Guillou,et al.  Spindle Cell Tumors of Adults , 2019, Practical Soft Tissue Pathology: a Diagnostic Approach.

[63]  C. Fletcher,et al.  Atypical Fibrous Histiocytoma of the Skin: Clinicopathologic Analysis of 59 Cases With Evidence of Infrequent Metastasis , 2002, The American journal of surgical pathology.

[64]  G. Haroske,et al.  A 10‐year analysis of cutaneous mesenchymal tumors (sarcomas and related entities) in a skin cancer center , 2013, International journal of dermatology.

[65]  A. Folpe,et al.  Myofibromas With Atypical Features: Expanding the Morphologic Spectrum of a Benign Entity , 2014, The American journal of surgical pathology.

[66]  S. Kraft,et al.  Atypical Intradermal Smooth Muscle Neoplasms: Clinicopathologic Analysis of 84 Cases and a Reappraisal of Cutaneous “Leiomyosarcoma” , 2011, The American journal of surgical pathology.

[67]  G. Ferrara,et al.  Primary cutaneous leiomyosarcoma: clinicopathological analysis of 36 cases , 2010, Histopathology.

[68]  E. Velazquez,et al.  Desmoplastic/Spindle Cell Squamous Cell Carcinoma of the Skin. A Diagnostically Challenging Tumor Mimicking a Scar: Clinicopathologic and Immunohistochemical Study of 6 Cases , 2010, The American Journal of dermatopathology.

[69]  C. Antonescu,et al.  Cutaneous Syncytial Myoepithelioma: Clinicopathologic Characterization in a Series of 38 Cases , 2013, The American journal of surgical pathology.

[70]  C. Fletcher,et al.  Soft Tissue Perineurioma: Clinicopathologic Analysis of 81 Cases Including Those With Atypical Histologic Features , 2005, The American journal of surgical pathology.

[71]  B. Scheithauer,et al.  Congenital and Childhood Plexiform (Multinodular) Cellular Schwannoma: A Troublesome Mimic of Malignant Peripheral Nerve Sheath Tumor , 2003, The American journal of surgical pathology.

[72]  M. Miettinen,et al.  Neurothekeoma: An Analysis of 178 Tumors With Detailed Immunohistochemical Data and Long-term Patient Follow-up Information , 2007, The American journal of surgical pathology.

[73]  J. Kohlmeyer,et al.  Cutaneous sarcomas , 2017, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[74]  C. Fletcher,et al.  Digital Fibromyxoma (Superficial Acral Fibromyxoma): A Detailed Characterization of 124 Cases , 2012, The American journal of surgical pathology.

[75]  C. Fletcher,et al.  Deep “Benign” Fibrous Histiocytoma: Clinicopathologic Analysis of 69 Cases of a Rare Tumor Indicating Occasional Metastatic Potential , 2008, The American journal of surgical pathology.