10.5826/dpc.1302a117
text/xml
2160-9381
2724
en
Piergiacomo Calzavara-Pinton
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
pigmeted dermatofibrosarcoma
Dermoscopy of a BednarTumor: New Case and Review of the Literature
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-07-27
2023-04-29
2023-06-05
e2023117
Dermatol Pract Concept
Piergiacomo Calzavara-Pinton
2023/04/29
10.5826/dpc.1302a117
e2023117
Division of Dermatology, ASST Spedali Civili di Brescia; Division of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
2160-9381
pigmeted dermatofibrosarcoma
en
e2023117
Almeida FT, Carvalho SD, Pereira T, Brito C. When a bruise gets important: Bednar tumour. BMJ Case Rep. 2019 Feb 11;12(2):e228446.
Dermoscopy of a BednarTumor: New Case and Review of the Literature
https://dpcj.org/index.php/dpc/article/download/2724/2077
            Dermatoscopy of Bednar Tumor: New Case
                   and Review of Literature
            Vincenzo Maione1, Giuseppe La Rosa1,2, Laura Miccio1,2, Claudia Zambelli3,
                                Piergiacomo Calzavara-Pinton1,2


1 Division of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
2 Division of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
3 Division of Pathology, ASST Spedali Civili di Brecia, Brescia, Italy



Key words: Bednar tumor, dermoscopy, dermatofibrosarcoma, pigmeted dermatofibrosarcoma
Citation: Maione V, La Rosa G, Miccio L, Zambelli C, Calzavara-Pinton P. Dermatoscopy of Bednar Tumor: New Case and Review
of Literature. Dermatol Pract Concept. 2023;13(2):e2023117. DOI: https://doi.org/10.5826/dpc.1302a117
Accepted: November 23, 2023; Published: April 2023
Copyright: ©2023 Maione et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Dr. Vincenzo Maione, Division of Dermatology, Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy. Phone +39
0303995300, Fax +39 0303995015 E-mail: maionevincenzo@gmail.com




Introduction                                                             in situ hybridization displayed a rearrangement of COL1A1/
                                                                         PDGFB genes, confirming the diagnosis of pigmented der-
Bednar tumor is a rare variant of dermatofibrosarcoma. We                matofibrosarcoma protuberans. The patient underwent sur-
report a new case with its dermatoscopic features, compar-               gical resection with wide margins and removal of the fascia.
ing them with findings of literature.                                    No recurrence was detected so far.


Case Presentation                                                        Conclusions
A 14-year-old female patient presented because of the on-                Pigmented dermatofibrosarcoma protuberans (also called
set of a bluish plaque on the right forearm five months be-              Bednar Tumor), accounts for less than 5% of all dermato-
fore (Figure 1A). Dermoscopy displayed blue-whitish areas                fibrosarcoma protuberans (DFSP), and it is characterized by
with white streaks. A pigmented network was evident at the               the presence of melanin-containing dendritic cells within the
periphery of the lesion and in some areas appeared linearly              tumor [1]. Diagnosis is insidious, as it may be easily m
                                                                                                                                ­ istaken
stretched. Blurry branching vessels were distributed on the              for other skin tumors, and for these reasons, dermoscopy can
entire lesion (Figure 2).                                                assist in the diagnosis.
    Histological exam showed a mesenchymal neoplastic pro-                    Classic dermatofibrosarcoma displays 6 dermatoscopic
liferation of pigmented spindle cells, with a storiform pattern,         patterns: thin regular pigmented network, reticular vessels,
interposed with scattered thin-walled vessels (­
                                               Figure 1B).               structureless light-brown areas, white streaks, pink back-
­Immunochemistry was positive for CD34+ and fluorescence                 ground coloration, and structureless hypo\depigmented


Research Letter | Dermatol Pract Concept. 2023;13(2):e2023117                                                                              1
 Figure 1. (A) Presence of bluish indurated plaque of right arm. (B) Diffuse proliferation of spindle cells in a storiform pattern. Some cells
 contain abundant melanin. (H&E x4).




    Figure 2. (A,B) Diffuse white-bluish pigmentation associated to white streaks (black square). Arborizing vessels are present over the
    entire lesion and are not focused (white square). At periphery, a pigmented network is evident (black arrow). In some part of the lesion
    this network appears linearly stretched (black circle).



areas [2]. Only a few reports described the dermatoscopic                 vessels, generally unfocused, may correlate with the depth of
features of its pigmented counterpart.                                    the tumor and its major need for vascularization.
      In a study of Bernard et al among 15 patients with DFSP,                Moreover, peripheral pigmented network may correspond
only one had a histological confirmed diagnosis of Bednar                 to pigmented basal keratinocytes, as in dermatofibroma. In
tumor and displayed all six dermoscopic patterns described                different areas this network appeared linearly stretched and
above [2] Meada et al reported a case of Bednar tumor in                  this feature could be determined by changes in the rete-ridges
which dermoscopy displayed only blue whitish veil [3]. The                induced by exuberant tumor growth. Besides the potential
same feature was present in a case of pigmented dermatofi-                value of each single dermoscopic criterion, the presence of all
brosarcoma described by Ehara et al [4]. Lastly, Almeida et               these described features could help in differentiating Bednar
al described another case of Bednar tumor which showed                    tumor from the other simulators as basal cell carcinoma, mel-
pigmented network, whitish-blue veil, blurry branching ves-               anoma or hematoma. The diagnosis results more challenging
sels and white streaks as principal dermoscopic patterns [5].             in presence of bluish veil as unique dermatoscopic pattern.
The pathologic features of pigmented dermatofibrosarcoma                      We present a case of Bednar tumor and report the pres-
easily correlate to these aforementioned dermatoscopic find-              ence of a new dermatoscopic finding in addition to those
ings: blue-whitish veil is due to pigmented spindle cells while           previously reported. To confirm these assumptions further
white streaks are caused by altered collagen fibers. Arborizing           evidence is needed.


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References                                                         3. Maeda T, Watabe Y, Yanagi T, et al. Dermoscopic features of Bed-
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Research Letter | Dermatol Pract Concept. 2023;13(2):e2023117                                                                       3
