FOLLOWUP CASE #1 OF DERMATOPATHOLOGY CONFERENCE OF 02/01/02
CELLULAR NEUROTHEKEOMA, GRANULOMA SIMULANT AND SMOOTH MUSCLE TUMOR SIMULANT
The initial biopsy was interpreted by a dermatopathologist as a granulomatous process.  The patient was checked out for sarcoid and other granulomatous diseases without evidence of same. The lesion was injected with a corticosteroid, but it continued to grow slowly. The current specimen was taken 9 months later.

The epithelioid cells of a cellular neurothekeoma may form clusters resembling granulomata. In addition, the spindle cells within fascicles sometimes have vacuolated or clear areas within the cytoplasm resembling those found in smooth muscle tumors. Cytoplasmic junctions are variably distinct and some cellular neurothekeomas are associated with remodeling of the reticular dermis collagen pattern or desmoplasia.


 
Scan power view showing numerous fascicles extending from the superficial dermis into the deep dermis.
A medium power view showing an area that is a granuloma simulant. The cytoplasmic borders are generally not very distinct. This appearance was more common in the most superficial aspect of the tumor.
A high power view of a fascicle of spindle cells having distinct cytoplasmic borders. A mitosis is also present. The cytoplasms contain vacuoles of varying size. The stroma of the reticular dermis is modified.
A high power view of a cross-section of a fascicle showing distinct cytoplasmic borders and variably vacuolated cytoplasm. There is a superficial resemblance to smooth muscle. I have seen this in cellular neurothekeomas that had not been injected with a corticosteroid.
A high power view of a cross-section of a sclerotic fascicle. This was located in the deep aspect of the tumor. A mitosis is also seen.

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