Non-polarizable collagen in dermatofibrosarcoma protuberans: a useful diagnostic aid

The stroma in dermatofibrosarcoma protuberans (DFSP) stains with trichrome, but is not polarizable (birefringent, doubly refractile). The usefulness of polarizing neoplastic stroma as a diagnostic aid in distinguishing DFSP from dermatofibroma and fibromatosis was evaluated. Forty cases of dermatofibroma of all types, 12 cases of dermal fibromatosis, and 15 cases of DFSP were examined. None of DFSPs contained polarizable collagen, whereas 11 of the 12 (92%) fibromatoses and 35 of the 40 (88%) dermatofibromas did. Of the 5 dermatofibromas that did not polarize, all were composed primarily of round to polyhedral histiocytic cells, including foam cells, frequently surrounding small obliterated capillaries. Although not pathognomonic, the presence of nonpolarizable collagen appears to be an additional histological marker useful in differentiating DFSP from dermatofibroma and fibromatosis.