Although four of the eight cases of pleomorphic fibroma described by Kamino et al were stated to be dome shaped, such cases were not and have not been illustrated very well in the literature. Whether these represent the same entity as the  polypoid lesions is problematical. It is possible that the term, pleomorphic fibroma, is being applied  indiscriminately to benign fibrous lesions that do not fit well into any existing catagory and which contain atypical stromal cells. If that is acceptable, then this would be such a case.

There have been a few reports of the atypical cells being CD34 positive and a report of them being CD34 negative. Perhaps further immunohistochemical studies will help clarify the issue. CD34 positive cells are also found in dermatofibrosarcoma protuberans and in giant cell fibroblastoma (plus a few other tumors, some neural), each of which is more cellular than the lesions described as pleomorphic fibromas.
 

	Scan power view of this dome shaped lesion.
	High power view of the superficial part of the lesion. A few atypical cells are found between dermal collagen bundles. The collagen bundles of the papillary dermis  are abnormally coarse as can be seen in fibrous papules of the nose and angiofibromas.
	High power view deeper in the lesion. Scattered atypical spindle cells are present. The background of this lesion is not diagnostic for any of the common benign spindle cell lesions of the skin.
	Very high power view deeper in the lesion. An atypical cell is illustrated.

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