Ferlosio Amedeo, Di Prete Monia, Rossi Piero, Campione Elena, Orlandi Augusto
Anatomic Pathology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Surgery, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Case Rep Pathol. 2018 Oct 1;2018:7694272. doi: 10.1155/2018/7694272. eCollection 2018.
We report the case of a seventy-four-year-old man with a slow-growing 2 cm mass on the back that arose near the surgical scar of previously excised melanoma, invasive to a Breslow depth of 3 mm. Preoperative clinical diagnosis was "in-transit" melanoma metastasis. After surgical excision, histopathologic examination revealed a dermal nodular proliferation of spindle cells arranged in storiform pattern, with mild pleomorphism, infiltrating around appendages and into the subcutaneous tissue. Immunohistochemical investigation documented diffuse positivity for CD34 and vimentin of spindle cells. Scattered dendritic cells, containing dark pigment in varying proportion and positive for S100, Melan-A and HMB-45, were also observed. A final diagnosis of Bednar tumour was formulated. Subsequently, the patient developed numerous metastases from the primary melanoma and died after 18 months. Bednar tumour is a rare pigmented variant of dermatofibrosarcoma protuberans of intermediate malignant potential. The presence of pigmented cells in Bednar tumour requires careful differential diagnosis with malignant or benign pigmented skin tumours. The clinical history of a Bednar tumour developing close to the scar of a previous melanoma gives the opportunity of a critical and intriguing discussion about the potential origin of pigmented cells in this rare variant of dermatofibrosarcoma protuberans.
我们报告了一例74岁男性病例，其背部有一个生长缓慢的2厘米肿块，该肿块出现在先前切除的黑色素瘤手术瘢痕附近，浸润性生长至Breslow深度3毫米。术前临床诊断为“移行性”黑色素瘤转移。手术切除后，组织病理学检查显示梭形细胞呈束状排列的真皮结节性增生，有轻度异形性，围绕附属器浸润并侵入皮下组织。免疫组织化学研究显示梭形细胞CD34和波形蛋白弥漫性阳性。还观察到散在的树突状细胞，含有不同比例的深色色素，S100、Melan - A和HMB - 45呈阳性。最终诊断为贝德纳瘤。随后，患者出现了原发性黑色素瘤的多处转移，并在18个月后死亡。贝德纳瘤是一种具有中等恶性潜能的隆突性皮肤纤维肉瘤的罕见色素性变体。贝德纳瘤中色素细胞的存在需要与恶性或良性色素性皮肤肿瘤进行仔细的鉴别诊断。贝德纳瘤在先前黑色素瘤瘢痕附近发生的临床病史为关于这种隆突性皮肤纤维肉瘤罕见变体中色素细胞潜在起源的批判性和有趣讨论提供了机会。
