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Solitary Cutaneous Myofibroma on the Sole: An Unusual Localization

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HS Roh, et al

220 Ann Dermatol

Ann Dermatol Vol. 24, No. 2, 2012 http://dx.doi.org/10.5021/ad.2012.24.2.220

LETTER TO THE EDITOR

Received April 11, 2011, Revised June 30, 2011, Accepted for publication June 30, 2011

Corresponding author: Joung Soo Kim, M.D., Ph.D., Department of Dermatology, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: 82-31-560-2285, Fax: 82-31-557-4872, E-mail: tuentuen@hanyang.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://

creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium,

provided the original work is properly cited. Fig. 1. 26×22 mm sized, skin-colored, firm, asymptomatic subcutaneous nodule on the left sole.

Solitary Cutaneous Myofibroma on the Sole:

An Unusual Localization

Hyun Soo Roh, M.D., Jun Oh Paek, M.D., Hee Joon Yu, M.D., Ph.D., Joung Soo Kim, M.D., Ph.D.

Department of Dermatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Dear Editor:

A 61-year-old man presented with several years of history of a solitary cutaneous mass on his left sole. A clinical examination revealed a 26×22 mm sized, skin-colored, firm, asymptomatic subcutaneous nodule (Fig. 1). General laboratory screening, including a complete blood count, renal and liver function tests and lipid levels, were within normal limits. A histopathological examination showed a well-circumscribed mass composed of spindle cells that were arranged in interlacing fascicles or whorls. The spindle cells had elongated nuclei, inconspicuous nucleoli and eosinophilic cytoplasm, resembling smooth muscle cells (Fig. 2). As a result of immunohistochemical staining, these cells were found to be positive for smooth muscle actin, but negative for S-100 protein and desmin. On Masson trichrome staining, many spindle cells with red cytoplasmic stain were found to be dispersed among the blue collagen bundles. Based on both clinical and histological features, a diagnosis of solitary cutaneous myofibroma was made.

Solitary cutaneous myofibroma is a circumscribed benign neoplasm of superficial soft tissue in adolescents and adults; it represents the adult counterpart of infantile myofibromatosis1. Clinically, it typically presents as a painless, slow-growing, firm cutaneous or subcutaneous nodule with an occasional bluish hue. There is a predilec-

tion for it to occur on the head and neck, shoulder girdle, lower extremity and hand2,3. Oral and genital solitary cutaneous myofibromas have also been identified. Plantar involvement is exceptionally rare, and there has been only one case of solitary cutaneous myofibroma affecting the sole in the literature3. Histological findings reveal a distinctive appearance, well recognized in children but much less so in adults. It manifests as a biphasic pattern or a zoning arrangement of two cell types4. Among them, the hemangiopericytomatous components, which are typical of infantile myofibromatosis, may sometimes be incons- picuous or even absent in adult lesions, as in our case3. Spindle cells have eosinophilic cytoplasm arranged in short bundles and fascicles resembling leiomyoma. These cells demonstrate features of both myofibroblasts and fibroblasts. Myofibroblastic differentiation of the tumor cells is supported by their immunophenotype. The spindle cells are desmin negative, but smooth muscle actin posi- tive. The Masson trichrome stain, in which thick fibrous bundles with random, irregularly intersecting angles are

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Solitary Cutaneous Myofibroma on the Sole

Vol. 24, No. 2, 2012 221 Fig. 2. (A) Skin biopsy showed a relatively well-circumscribed tumor in the dermis (H&E, Scanning view). (B) The tumor consists of spindle cells arranged in interlacing fascicles or whorls (H&E, ×100). (C) These spindle cells had pale pink cytoplasm, elongated nuclei, and inconspicuous nucleoli (H&E, ×400). (D) Immunoreactivity of the spindle cells with smooth muscle actin (Smooth muscle actin, ×200) (E) Many spindle cells with eosinophilic cytoplasmic stain dispersed among the blue collagen bundles (Masson-trichrome,

×400).

prominent, can be used to assist in differentiating myo- fibromas from smooth muscle lesions5. In contrast, smooth muscle lesions show delicate fibrous tissues surrounding

the smooth muscle cells and in the septa between the smooth muscle masses. The limited follow-up of solitary cutaneous myofibromas suggests that they tend to follow a

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HS Roh, et al

222 Ann Dermatol

benign clinical course with no evidence of recurrence or metastasis1-3.

To our knowledge, our case represents only the second report of a solitary cutaneous myofibroma occurring on the sole. We suggest, even though it is very rare, that solitary cutaneous myofibroma should be considered in the differential diagnosis of solitary lesions involving the sole.

REFERENCES

1. Holst VA, Junkins-Hopkins JM, Elenitsas R. Cutaneous smooth muscle neoplasms: clinical features, histologic

findings, and treatment options. J Am Acad Dermatol 2002;

46:477-490.

2. Guitart J, Ritter JH, Wick MR. Solitary cutaneous myofibro- mas in adults: report of six cases and discussion of differential diagnosis. J Cutan Pathol 1996;23:437-444.

3. Beham A, Badve S, Suster S, Fletcher CD. Solitary myo- fibroma in adults: clinicopathological analysis of a series.

Histopathology 1993;22:335-341.

4. Requena L, Kutzner H, Hügel H, Rütten A, Furio V. Cuta- neous adult myofibroma: a vascular neoplasm. J Cutan Pathol 1996;23:445-457.

5. Chang JY, Kessler HP. Masson trichrome stain helps differentiate myofibroma from smooth muscle lesions in the head and neck region. J Formos Med Assoc 2008;107:767- 773.

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