Dermatopathology

Neurofibroma With Giant Cells

Rarely, neurofibromas have been reported to contain multinucleated floret-like giant cells. This finding does not appear to be associated with risk of recurrence or malignant transformation and is best regarded as a form of senescent change.

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Slide 1: 74 year-old woman with a lower back "skin-tag". The lesion is a relatively cellular dermal-based proliferation. A Grenz zone separates the lesion from the undersurface of the epidermis.

Slide 2: The lesion is composed of delicate fascicles of cells that exhibit oval to spindle shaped nuclei with indefinite eosinophilic cytoplasm that merges imperceptibly with a delicate wavy collagenous matrix.

Slide 3: There are these peculiar floret-like multinucleated cells which is a rare phenomenon that has been described in neurofibromas. This finding could be indicative of senescent change. Immunohistochemical staining reveals positivity of the floret-like multinucleated cells with CD34 and a lack of staining with S100, CD68 (KP1) and Factor XIIIa. The slender neurofibroma cells are diffusely positive with S100. The positivity of the multinucleated cells for CD34 without staining for S100 is characteristic for this benign variant of neurofibroma.