Ulcerated cellular benign fibrous histiocytoma: A challenging diagnosis in biopsy practice

Vladimír Bartoš


A biopsy diagnosis of conventional (common) type of benign fibrous histiocytoma (BFH) is usually easy. However, there are many other histopathologic variants, that may cause difficulties to make an accurate diagnosis. The author describes a 53-year old women, who presented with a protuberated ulcerated skin tumor arising on the left shoulder. It consisted of a highly cellular mass of proliferating spindle-shaped cells with a fascicular growth pattern, that was confined to dermis. The cells were relatively uniform with a slightly increased mitotic rate and proliferation activity. Immunohistochemically, the tumor expressed vimentin, Factor XIIIa and alpha-SMA, while it was negative for CK5/6, CK7, BerEP4, p63, EMA, S-100, melan A, HMB-45, MSA, h-caldesmon and CD34. A diagnosis of ulcerated cellular BFH was made. Although BFH is a very frequent cutaneous tumor, its less common cellular variant may result in diagnostic pitfalls. The purpose of this paper was to point out that even such "banal" and prognostically favourable cutaneous lesion sometimes requires a complex differential diagnostic approach in biopsy practice.



benign fibrous histiocytoma, dermatofibroma, alpha-SMA, factor XIIIa

Full Text:



Elder DE, Massi D, Scolyer RA, Willemze R. (Eds). WHO classification of skin tumours. 4th ed. Lyon:IARC, 2018.

Choi JH, Ro JY. Cutaneous spindle cell neoplasms: pattern-based diagnostic approach. Arch Pathol Lab Med. 2018;142:958-72.

Luzar B, Calonje E. Cutaneous fibrohistiocytic tumours – an update. Histopathology. 2010;56:148-65.

Hollmig ST, Sachdev R, Cockerell CJ, et al. Spindle cell neoplasms encountered in dermatologic surgery: a review. Dermatol Surg. 2012;38:825-50.

Calonje E, Mentzel T, Fletcher CD. Cellular benign fibrous histiocytoma. Clinicopathologic analysis of 74 cases of a distinctive variant of cutaneous fibrous histiocytoma with frequent recurrence. Am J Surg Pathol. 1994a;18:668-76.

Calonje E, Fletcher CDM. Cutaneous fibrohistiocytic tumors: an update. Adv Anat Pathol.1994b;1:2-15.

Zhong YP, Wang J. Cellular fibrous histiocytoma: a clinicopathologic analysis of 27 cases. Zhonghua Bing Li Xue Za Zhi. 2013;42:153-7.

Sánchez Yus E, Soria L, de Eusebio E, Requena L. Lichenoid, erosive and ulcerated dermatofibromas. Three additional clinico-pathologic variants. J Cutan Pathol. 2000;27:112-7.

Sachdev R, Sundram U. Expression of CD163 in dermatofibroma, cellular fibrous histiocytoma, and dermatofibrosarcoma protuberans: comparison with CD68, CD34, and Factor XIIIa. J Cutan Pathol. 2006;33:353-60.

Lyu A, Wang Q. Dermatofibrosarcoma protuberans: A clinical analysis. Oncol Lett. 2018;16:1855-62.

Bhattacharjee P. Lazova R. Immunohistochemical expression of cutaneous leiomyosarcoma:abstracts. J Cutan Pathol. 2008;32:76.


  • There are currently no refbacks.

ISSN: 1560-9014