Dermatopathology

Cellular Neurothekeoma

Cellular Neurothekeoma appear most often in the upper body: head, neck and arms. The tumors are rare and benign, and have very few cases reported.

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Slide 1: 13 year-old girl with a chin lesion. The lesion is located within the dermis. A narrow grenz zone separates the lesion from the overlying epidermis.

Slide 2: A proliferation of spindled cells is noted within the dermis.

Slide 3: The biopsy shows a fairly striking epithelioid tumor which assumes a nested and vesicular growth pattern.

Slide 4: This unusual epithelioid proliferation is without significant cytomorphologic or architectural maturation. The cells are predominantly large epithelioid ones that have abundant lightly eosinophilic to amphophilic cytoplasm. There is a significant degree of nuclear atypia. There are scattered cells that show significant nuclear enlargement, hyperchromasia and multinucleation. Overall the pleomorphism is in the moderate realm. The background stroma has a hyalinized appearance. There is a very focal lymphocytic infiltrate. A few mitotic figures are identified.

Slide 5: There is extensive immunoreactivity for CD68. Melan-A and HMB-45 are negative. The Ki-67 proliferation index is very low. These tumors show predilection for younger adults with a female predominance most commonly identified in the head and neck area.