PMC6360974_01
A Erythematous tumor, slightly desquamative, painless, with
a stony consistency on left forearm; B - Close-up of the
lesion
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f1
Upon dermatological examination in 2016, she presented a painless erythematous tumor on her left forearm, with a stony consistency, adhered to deep planes, have grown steadily for a year, leading to reduced strength in the ipsilateral upper limb (Figure 1).
Dermoscopy. Cicatricial areas (black asterisks), milky-red area (white
asterisk), and polymorphous vessels (arrow)
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f2
Dermoscopy showed polymorphous vessels and milky-red and whitish areas, with a cicatricial appearance (Figure 2).
Histopathology of the tumor. Spindle cell proliferation involving nerve
bundle (A-Hematoxylin & eosin, x10; B -
Hematoxylin & eosin, x40)
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f3
Histopathology of the lesion revealed infiltration by a neoplasm consisting of fusiform cells with sparse cytoplasm and elongated nuclei, with moderate pleomorphism and permeated by collagenized stroma (Figure 3).
Nodule on left arm. Metastasis to subcutaneous tissue
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f4
In addition to this lesion, examination evidenced another mobile, painless nodule on the left arm, which had appeared in the previous six months (Figure 4).
Histopathology of nodule on left arm (metastasis). A -
Spindle cell proliferation (Hematoxylin & eosin, x10);
B - fusiform cells with small nuclear atypias, with no
evidence of necrosis or mitotic figures (Hematoxylin & eosin,
x40)
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f5
Histopathology of this nodule showed a spindle cell neoplasm with neural differentiation, consistent with metastasis to the subcutaneous tissue, favoring the diagnosis of invasive DM (Figure 5).