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American Journal of Dermatopathology:
doi: 10.1097/DAD.0b013e318284a635
Letters to the Editor

Neurofibroma With Numerous Lymphoid Aggregates Simulating Spindle Cell Melanoma: Utilization of CD34 Fingerprint for Diagnosis

Hogan, Sara R. MHS*; Speiser, Jodi J. MD; Lee, John M. MD, PhD; Hutchens, Kelli A. MD

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*Stritch School of Medicine, Loyola University, Chicago, Maywood, IL

Department of Pathology, Loyola University Medical Center, Maywood, IL

Reprints: Kelli A Hutchens, MD, Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 61053 (e-mail: khutchens@lumc.edu).

The authors declare no funding or conflicts of interest.

To the Editors:

We read with interest the August 2012 case report by Yeh et al1 in which they presented a spindle cell melanoma with features of neurofibroma. Their case report was quite timely as we were facing the same dilemma with exact opposite outcome. We recently encountered a dermal-based spindle cell tumor that appeared to be a neurofibroma, except it had numerous lymphoid aggregates throughout, which resulted in spindle cell melanoma being added as a differential diagnosis. This diagnostic dilemma left us in a transposed position as the authors of the aforementioned case report.

We received multiple fragments of an entirely dermal neoplasm removed from the jaw of 49-year-old woman with the clinical description of “atypical nevus.” The tumor was nonencapsulated and composed of delicate spindle-shaped cells embedded in a pink, mildly fibrotic stroma with scattered mast cells throughout (Fig. 1). There were numerous lymphoid aggregates of varying size throughout the tumor, some with germinal center formation (Fig. 2). Only 1 of the 4 fragments received contained epidermis. Close review of the epidermis showed no significant increase in melanocytes (Fig. 3). The tumor cells were diffusely positive for S100 and negative for melan-A, tyrosinase, Mitf, and HMB-45 by immunohistochemical staining (Fig. 4).

FIGURE 1
FIGURE 1
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FIGURE 2
FIGURE 2
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FIGURE 3
FIGURE 3
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FIGURE 4
FIGURE 4
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Although the clinical impression of melanocytic nevus is not uncommonly seen in cases of neurofibroma, it added to our diagnostic concern in light of the numerous lymphoid aggregates, with no explanation for the clinical pigmentation. The patient had no history of autoimmune disorders or other significant clinical disease. Review of the literature did not yield any reported cases of neurofibroma with lymphoid aggregates, although the occasional presence of lymphoid collections in neurofibromas is recognized.2 The finding of lymphoid aggregates, commonly used as a clue to the diagnosis of desmoplastic melanoma, is nonspecific and recently demonstrated to be associated with the diagnosis of desmoplastic melanocytic nevi, including Spitz melanocytic nevi.3

As suggested by the authors, we performed CD34 immunohistochemical staining, which was diffusely positive, supporting the diagnosis of neurofibroma with numerous lymphoid aggregates (Fig. 5).4 A comparative genomic hybridization profile was not completed, as we believe the aforementioned methods of analysis provide substantial information to support this diagnosis.

FIGURE 5
FIGURE 5
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REFERENCES

1. Yeh I, Vemula S, Mirza S, et al. Neurofibroma-like spindle-cell melanoma: CD34 fingerprint and CGH for diagnosis. Am J Dermatopathol. 2012; 34:668–670.

2. McCalmont TH. Clues … Clues … Clues. J Cutan Pathol. 2012; 39:899–900.

3. Kiuru M, Patel RM, Busam KJ. Desmoplastic melanocytic nevi with lymphocytic aggregates. J Cutan Pathol. 2012; 39:940–944.

4. Yeh I, McCalmont T. Distinguishing neurofibroma from desmoplastic melanoma: the value of the CD34 fingerprint. J Cutan Pathol. 2011; 38:625–630.

© 2013 Lippincott Williams & Wilkins

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