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February 2009

A Solitary Well-Circumscribed Nodular Lesion on the Leg—Diagnosis

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Arch Dermatol. 2009;145(2):195-200. doi:10.1001/archdermatol.2008.579-b

Histopathologic examination of the skin biopsy specimen revealed a multilobulated and multinodular dermal lesion, with the lobules being separated by fine fibrous septa, creating a pseudocapsule and containing abundant myxoid matrix. Embedded within the myxoid matrix were loosely arranged, spindle- and stellate-shaped, and occasionally multinucleated cells. The lesion was mitotically benign (mitotic count of <1 per 10 high-power fields), with no significant nuclear atypia or cellular pleomorphism. Findings from immunohistochemical analysis showed that the tumor cells were immunoreactive with S-100 protein. The histopathologic and immunophenotypic findings were consistent with a diagnosis of dermal nerve sheath myxoma. At 3 months, slight recurrence of the lesion was noted, which will be followed clinically and possibly reexcised.

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