Letter - Clinical
A case of atrophic dermatofibroma: a possible role of matrix metalloproteinase-2
Misaki Kusano, Toshiyuki Yamamoto
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Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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(B) Higher magnification showing proliferation of fibroblastic tumor cells in the dermis and hyperplasia of the overlying epidermis (Hematoxylin & eosin, ×200). (C) Decreased elastic fibers in the atrophic dermis (Elastica van Gieson, ×200). (D) Intense expression of MMP-2 in the fibroblastic tumor cells, magnification ×200.</p>" ] ] ] "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, which appeared 5 years previously. He was otherwise healthy and did not recognize any triggering events such as insect bite or minor trauma. Physical examination showed a 5-mm-sized brownish dermal nodule with a central depression on the left thigh (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopy showed a central, reddish-colored area with scales surrounded by a brownish pigment network (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The nodule was surgically removed with a 2-mm margin under local anesthesia. Histopathological examination showed a central depressed area and dermal atrophy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Higher magnification revealed the proliferation of fibroblastic tumor cells in the dermis and hyperplasia of the overlying epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Factor XIIIa was positively stained, but CD34 was negatively stained. Elastica van Gieson stain revealed decreased elastic fibers in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Immunohistochemistry was performed using antibodies against Matrix Metalloproteinase-2 (MMP-2), MMP-7, MMP-9 and MMP-12, and intense expression of MMP-2 was observed in the fibroblastic tumor cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D).</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.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Its dermal thickness is usually half of the thickness of the adjacent dermal tissue. In a recent review of atrophic dermatofibroma in 64 patients, the most common locations were shoulder (25%), lower extremity (23.4%), and back (17.2%).<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, the clinical diagnosis is not so difficult. Dermoscopic examination shows a patchy pigment network multiple scar-like white patches, and pink-reddish coloration,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> which may be of some help for the clinical diagnosis of atrophic dermatofibroma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathomechanism of dermal atrophy in atrophic dermatofibroma is unknown. Previous studies revealed that elastic fibers are either decreased or absent in atrophic dermatofibromas. Recently, overexpression of MMP-1 by tumor cells has been reported in atrophic dermatofibroma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition, in the present study, we have found that MMP-2 was strongly expressed in the fibroblastic cells, whereas expression of other MMPs such as MMP-7, MMP-9, and MMP-12 was not observed. The limitation is that we did not examine MMPs expression in ordinary dermatofibromas without atrophy. Therefore, we cannot conclude that enhanced expression of MMP-2 is the main cause of such a characteristic feature of atrophic dermatofibromas. Nevertheless, MMP-1 and MMP-2 may play an important role in the degradation of connective tissues in atrophic dermatofibromas, and further studies are necessary.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author’s contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Misaki Kusano: Data collection, analysis, and interpretation; Preparation and writing of the manuscript.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto: Manuscript critical review; Approval of the final version of the manuscript.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Author’s contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-05-11" "fechaAceptado" => "2022-06-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Fukushima Medical University, Fukushima, Japan.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1168 "Ancho" => 3341 "Tamanyo" => 266604 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Clinical appearance of the brownish nodule with a central depression. (B) Dermoscopy showing a central reddish patch with white-yellow scales surrounded by a brownish pigment network.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2511 "Ancho" => 3341 "Tamanyo" => 1222918 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Light Microscopy -(A) Lesion with a central depression showing dermal atrophy (Hematoxylin & eosin, ×40). (B) Higher magnification showing proliferation of fibroblastic tumor cells in the dermis and hyperplasia of the overlying epidermis (Hematoxylin & eosin, ×200). (C) Decreased elastic fibers in the atrophic dermis (Elastica van Gieson, ×200). (D) Intense expression of MMP-2 in the fibroblastic tumor cells, magnification ×200.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrophic dermatofibroma: a comprehensive literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. Cohen" 1 => "C.P. Erickson" 2 => "A. Calame" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13555-019-0309-y" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther (Heidelb)" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "449" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31338755" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrophic dermatofibroma: a unique dermatofibroma variant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Gutierrez" 1 => "A. Calame" 2 => "C. Erickson" 3 => "P.R. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cureus" "fecha" => "2021" "volumen" => "13" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beyond classic dermoscopic patterns of dermatofibromas: a prospective research study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Kelati" 1 => "N. Aqil" 2 => "H. Baybay" 3 => "S. Gallouj" 4 => "F.Z. Mernissi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13256-017-1429-6" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28927449" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of atrophic dermatofibroma with dermoscopic findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.A. Karabay" 1 => "D. Demir" 2 => "F. Gürsoy" 3 => "I. Zindanci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jocd.13917" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Dermatol" "fecha" => "2021" "volumen" => "20" "paginaInicial" => "2598" "paginaFinal" => "2601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33403769" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of atrophic dermatofibroma overexpressing matrix metalloproteinase-1" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Yano-Takamori" 1 => "G. Tsuji" 2 => "T. Nakahara" 3 => "M. Kido-Nakara" 4 => "M. Furue" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000503136" "Revista" => array:6 [ "tituloSerie" => "Case Rep Dermatol" "fecha" => "2019" "volumen" => "11" "paginaInicial" => "264" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31616280" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009900000002/v2_202407221312/S0365059623002398/v2_202407221312/en/main.assets" "Apartado" => array:4 [ "identificador" => "95691" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter – Clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000002/v2_202407221312/S0365059623002398/v2_202407221312/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002398?idApp=UINPBA00008Z" ]
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