CORRECT DIAGNOSIS:

Polypoid nodular dermatofibroma

DISCUSSION:

Dermatofibroma, also known as benign fibrous histiocytoma, is a common benign cutaneous neoplasm. Typically dermatofibromas present as firm, dome-shaped nodules and usually are only a few millimeters in diameter. Atypical polypoid nodular dermatofibroma is a rare variant of dermatofibroma first described in 1991. Polypoid dermatofibromas most often arise on the lower extremities and are larger than typical dermatofibromas. It is postulated that firm underlying tissue such as tendons and bones leads to the development of exophytic polypoid lesions.

Primary lymphedema is divided into three groups based on the age of presentation. Congenital lymphedema is an autosomal dominant condition present at birth and is known as Milroy’s disease. We speculate that compromised lymphatic flow contributed to the pathogenesis of the polypoid dermatofibroma. This is the first reported case of Milroy’s disease associated with polypoid dermatofibroma.

TREATMENT:

For this case, the lesion was surgically excised with no recurrence at 3-month follow up.

Dermatofibromas may be treated with excision, potent topical steroids, and intralesional steroids.

REFERENCES:

Sogabe, K., et al. (2002). A case of polypoid dermatofibroma. Journal of Dermatology, 12, 786-789. PMID: 12474566

Puig, L., et al. (1991). Atypical polypoid dermatofibroma: Report of two cases. Journal of the American Academy of Dermatology, 4, 561-565. PMID: 2036368

Sehgal, V. N., et al. (2004). Giant combined dermatofibroma with satellitosis. Clinical and Experimental Dermatology, 29(2), 147-149. PMID: 14751383

Setoyama, M., et al. (1997). Case of dermatofibroma with monster cells: A review and immunohistochemical study. American Journal of Dermatopathology, 19(3), 312-315. PMID: 9183705

Lever, W. F., et al. (1990). Histopathology of the skin (7th ed.). Philadelphia: J.B. Lippincott.