A 33-year-old female presented with gray depressed atrophic lesion accompanying a skin-colored pea-sized nodule arising from it, and erythematous indurated plaque with intermittent itching and pricking on her upper back. She had first noticed an asymptomatic erythematous plaque 7 years ago. Later, a skin-colored nodule had developed on the left lateral rim of that lesion and other part became depressed with grayish discoloration. And then an erythematous indurated plaque newly developed below the preexisting lesion (Fig. 1).
Fig. 1. Gray depressed atrophic lesion (white arrow) with skin colored pea-sized nodule (black arrow) and erythematous indurated plaque (bold arrow) are seen on the upper back.
There was no history of trauma, operation, or biopsy in the vicinity of the lesion. Laboratory tests including complete blood count, blood chemistry analysis, and urinalysis were normal. An incisional biopsy was taken from depressed atrophic lesion including skin colored nodule. The biopsy specimen showed densely- packed, monomorphous, plump spindle cells arranged in a storiform pattern, infiltrating the dermis (Fig. 2A, C) and subcutaneous tissue, producing a characteristic honeycomb pattern (Fig. 2B). Using immuno-histochemical stain, the biopsy specimen exhibited strong and diffuse positivity with CD34 (Fig. 2D). The diagnosis of DFSP was made based on clinical, histological features and immuno- histochemical stain. The patient was referred to the department of plastic surgery for wide excision. However, follow-up failed because the patient transferred to a neighboring hospital of her own.
Fig. 2. Dense spindle cell proliferation with a storiform arrangement infiltrating the dermis (A) and subcutaneous tissue, producing honeycomb pattern (B). Higher magnification shows densely packed, monomorphous, plump spindle cells with some atypical mitotic figures (C). Marked positivity with immunohistochemical marker CD34 (D)