cellular neurothekeoma, granulomatous simulant

CELLULAR NEUROTHEKEOMA HAVING A COMPONENT SIMULATING GRANULOMATA

Occasional examples of cellular neurothekeoma have a component resembling granulomata. The presence of a fascicular spindle cell component is a valuable clue that the problem is not one of granulomatous inflammation. Mitotic figures are found in some cellular neurothekeomas and would not be expected in the numbers seen in this case in granulomatous diseases. Multinucleated giant cells are seen in many granulomas but can also be seen in cellular neurothekeomas. The combination of the superficial dermal component, age of the patient, and lack of giant cells would distinguish this fascicular spindle cell component from the plexiform fibrohistiocytic tumor.

This is a biopsy of a lesion from the left preauricular area of a 39 year old female. Her chest x-ray is negative, and there is no history of travel outside of the United States. There is no evidence of neuropathy.

This is the initial biopsy. Click on FOLLOWUP to see the subsequent specimen.

Scan power view. The dermis is densely infiltrated, and the infiltrates extend into the superficial subcutis.

A medium power view of one pattern. These cells resemble epithelioid histiocytes and such clusters mimic granulomata. There are no multinucleated giant cells in this lesion.

A high power view from an area similar to the above within which there is a mitotic figure. There was approximately one mitotic figure per 20 high power fields. There are vacuoles of varying size within some of these cells. The cytoplasmic borders in this field are indistinct. Such borders may be very distinct in other examples of this tumor.

A medium power view showing another pattern. This was near one edge of the specimen, and minimal crush artifact accounts for some of the hyperchromasia of the nuclei. There were areas (not illustrated) where some of the cells had mixed spindle and epithelioid features.

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	Scan power view. The dermis is densely infiltrated, and the infiltrates extend into the superficial subcutis.
	A medium power view of one pattern. These cells resemble epithelioid histiocytes and such clusters mimic granulomata. There are no multinucleated giant cells in this lesion.
	A high power view from an area similar to the above within which there is a mitotic figure. There was approximately one mitotic figure per 20 high power fields. There are vacuoles of varying size within some of these cells. The cytoplasmic borders in this field are indistinct. Such borders may be very distinct in other examples of this tumor.
	A medium power view showing another pattern. This was near one edge of the specimen, and minimal crush artifact accounts for some of the hyperchromasia of the nuclei. There were areas (not illustrated) where some of the cells had mixed spindle and epithelioid features.