This dermatology and pathology teaching session, led by Dr. Jared Gardner and residents, focuses on diagnosing fibrohistocytic and spindly skin lesions using case presentations based on stain characteristics. The first case, identified as an Elastofibroma Dorsi, is examined using an Elastic stain (likely Verhoeff-Van Gieson/VVG). The diagnosis is supported by the characteristic appearance of beaded and bunched elastic fibers, which look like pipe cleaners in longitudinal section and flower-like structures in cross-section. The discussion highlights that while the lesion is histologically unremarkable on H&E (appearing as bland collagen and fat), the special stain reveals the diagnostic features. The location, typically at the inferior tip of the scapula rubbing against the rib cage, is also noted, and the lesions are usually diagnosed radiographically and only removed if symptomatic.
Case 1: Elastofibroma Dorsi Diagnosis
00:00:08 Introduction: Dr. Jared Gardner begins a session with dermatology/pathology residents to discuss fibrohistocytic and spindly skin lesions.
00:00:31 Case 1 Analysis: The initial low-power view is discussed, noting a background that is confusing if one assumes it is an H&E stain.
00:00:57 Elastic Stain Reveal: The presence of beaded elastic fibers is immediately apparent upon using an Elastic stain (later identified as Verhoeff-Von Gieson/VVG).
00:01:31 Histological Description (H&E): On H&E, the lesion appears as bland, pink collagenous fibrous tissue intermingled with fat (adipose tissue).
00:01:58 Diagnostic Features on Elastic Stain: Higher magnification on the stain reveals characteristic beaded or "pipe cleaner" elastic fibers:
Longitudinal section: Fibers appear beaded and bunched.
Cross-section: Fibers appear like little flowers or florets.
00:02:38 Typical Location: Elastofibromas Dorsi almost always occur on the back, usually near the inferior tip of the scapula, suggesting etiology related to scapular motion rubbing against the ribs.
00:02:55 Clinical Management: The diagnosis is typically made radiographically by orthopedic surgeons; pathology consultation usually only occurs if the lesion is removed due to patient discomfort or size.