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CD99 expression in dermatofibrosarcoma protuberans and dermatofibroma.

Viktoryia Kazlouskaya1, Saurabh Malhotra, Filamer D Kabigting

  • 1*Ackerman Academy of Dermatopathology, New York, NY; †Dartmouth Hitchcock Medical Center, Department of Pathology, Hanover, NH; ‡Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, NY; and §New York College of Osteopathic Medicine, New York, NY.

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CD99 immunostaining can help distinguish dermatofibrosarcoma protuberans (DFSP) from dermatofibroma (DF). DF shows strong, diffuse CD99 positivity, while DFSP typically exhibits weak or moderate, scattered staining.

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Area of Science:

  • Dermatopathology
  • Oncology
  • Immunohistochemistry

Background:

  • Differentiating dermatofibrosarcoma protuberans (DFSP) from hypercellular dermatofibroma (DF) is challenging.
  • Conventional markers often show overlapping expression patterns.
  • CD99 expression is evaluated for its utility in distinguishing these entities.

Purpose of the Study:

  • To assess the expression of CD99 in DFSP and DF.
  • To determine the diagnostic utility of CD99 in differentiating DFSP from DF.
  • To investigate the pattern and intensity of CD99 staining in both lesions.

Main Methods:

  • CD99 immunostaining performed on 34 DFSPs and 24 hypercellular DFs.
  • Staining intensity graded as weak, moderate, or strong.
  • Proportion of positive cells categorized as scattered, focal, or diffusely distributed.

Main Results:

  • DFSPs showed positive CD99 staining in 61.76% of cases, predominantly weak or moderate and scattered.
  • All 24 DF cases displayed strong CD99 positivity in >25% of spindle cells (P = 0.0003).
  • DFSP superficial dermal tumor cells were CD99 negative, whereas DF superficial dermal cells were strongly CD99 positive.

Conclusions:

  • Dermatofibroma (DF) strongly expresses CD99 diffusely, aiding distinction from DFSP.
  • CD99 staining differences are most pronounced in superficial portions, making it useful for superficial biopsies.
  • CD99 immunohistochemistry is a valuable tool for differentiating DF from DFSP, especially when H&E sections are ambiguous.