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2</a>B&#41;&#46; Factor XIIIa was positively stained&#44; but CD34 was negatively stained&#46; Elastica van Gieson stain revealed decreased elastic fibers in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; Immunohistochemistry was performed using antibodies against Matrix Metalloproteinase-2 &#40;MMP-2&#41;&#44; MMP-7&#44; MMP-9 and MMP-12&#44; and intense expression of MMP-2 was observed in the fibroblastic tumor cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Atrophic dermatofibroma is a rare form of dermatofibroma and is clinically characterized by a solitary brownish nodule or plaque with a central umbilication&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Its dermal thickness is usually half of the thickness of the adjacent dermal tissue&#46; In a recent review of atrophic dermatofibroma in 64 patients&#44; the most common locations were shoulder &#40;25&#37;&#41;&#44; lower extremity &#40;23&#46;4&#37;&#41;&#44; and back &#40;17&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Because of the characteristic clinical features such as brownish nodules or plaque with central depression&#44; the clinical diagnosis is not so difficult&#46; Dermoscopic examination shows a patchy pigment network multiple scar-like white patches&#44; and pink-reddish coloration&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> which may be of some help for the clinical diagnosis of atrophic dermatofibroma&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathomechanism of dermal atrophy in atrophic dermatofibroma is unknown&#46; Previous studies revealed that elastic fibers are either decreased or absent in atrophic dermatofibromas&#46; Recently&#44; overexpression of MMP-1 by tumor cells has been reported in atrophic dermatofibroma&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition&#44; in the present study&#44; we have found that MMP-2 was strongly expressed in the fibroblastic cells&#44; whereas expression of other MMPs such as MMP-7&#44; MMP-9&#44; and MMP-12 was not observed&#46; The limitation is that we did not examine MMPs expression in ordinary dermatofibromas without atrophy&#46; Therefore&#44; we cannot conclude that enhanced expression of MMP-2 is the main cause of such a characteristic feature of atrophic dermatofibromas&#46; Nevertheless&#44; MMP-1 and MMP-2 may play an important role in the degradation of connective tissues in atrophic dermatofibromas&#44; and further studies are necessary&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#8217;s contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Misaki Kusano&#58; Data collection&#44; analysis&#44; and interpretation&#59; Preparation and writing of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Manuscript critical review&#59; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
A case of atrophic dermatofibroma: a possible role of matrix metalloproteinase-2
Misaki Kusano, Toshiyuki Yamamoto
Corresponding author
toyamade@fmu.ac.jp

Corresponding author.
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 47-year-old male visited our department complaining of an asymptomatic nodule on the lower extremity&#44; which appeared 5 years previously&#46; He was otherwise healthy and did not recognize any triggering events such as insect bite or minor trauma&#46; Physical examination showed a 5-mm-sized brownish dermal nodule with a central depression on the left thigh &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Dermoscopy showed a central&#44; reddish-colored area with scales surrounded by a brownish pigment network &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; The nodule was surgically removed with a 2-mm margin under local anesthesia&#46; Histopathological examination showed a central depressed area and dermal atrophy &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Higher magnification revealed the proliferation of fibroblastic tumor cells in the dermis and hyperplasia of the overlying epidermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Factor XIIIa was positively stained&#44; but CD34 was negatively stained&#46; Elastica van Gieson stain revealed decreased elastic fibers in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; Immunohistochemistry was performed using antibodies against Matrix Metalloproteinase-2 &#40;MMP-2&#41;&#44; MMP-7&#44; MMP-9 and MMP-12&#44; and intense expression of MMP-2 was observed in the fibroblastic tumor cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Atrophic dermatofibroma is a rare form of dermatofibroma and is clinically characterized by a solitary brownish nodule or plaque with a central umbilication&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Its dermal thickness is usually half of the thickness of the adjacent dermal tissue&#46; In a recent review of atrophic dermatofibroma in 64 patients&#44; the most common locations were shoulder &#40;25&#37;&#41;&#44; lower extremity &#40;23&#46;4&#37;&#41;&#44; and back &#40;17&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Because of the characteristic clinical features such as brownish nodules or plaque with central depression&#44; the clinical diagnosis is not so difficult&#46; Dermoscopic examination shows a patchy pigment network multiple scar-like white patches&#44; and pink-reddish coloration&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> which may be of some help for the clinical diagnosis of atrophic dermatofibroma&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathomechanism of dermal atrophy in atrophic dermatofibroma is unknown&#46; Previous studies revealed that elastic fibers are either decreased or absent in atrophic dermatofibromas&#46; Recently&#44; overexpression of MMP-1 by tumor cells has been reported in atrophic dermatofibroma&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition&#44; in the present study&#44; we have found that MMP-2 was strongly expressed in the fibroblastic cells&#44; whereas expression of other MMPs such as MMP-7&#44; MMP-9&#44; and MMP-12 was not observed&#46; The limitation is that we did not examine MMPs expression in ordinary dermatofibromas without atrophy&#46; Therefore&#44; we cannot conclude that enhanced expression of MMP-2 is the main cause of such a characteristic feature of atrophic dermatofibromas&#46; Nevertheless&#44; MMP-1 and MMP-2 may play an important role in the degradation of connective tissues in atrophic dermatofibromas&#44; and further studies are necessary&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author&#8217;s contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Misaki Kusano&#58; Data collection&#44; analysis&#44; and interpretation&#59; Preparation and writing of the manuscript&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Manuscript critical review&#59; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 03650596
Original language: English
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