A Solitary Diffuse Neurofibroma in a Young Adult Female: An Unusual Presentation in the Scapular Region

Diffuse neurofibroma is a benign peripheral nerve sheath tumor characterized by non-encapsulated spindle cell proliferation within the dermis and subcutaneous tissue. Although usually associated with neurofibromatosis type I (NF1) and preferentially located in the head and neck of pediatric patients, rare instances of sporadic solitary cases in atypical locations have been documented. We describe the case of a 30-year-old female with no personal or familial signs of neurocutaneous syndromes who presented with a two-year history of a slowly enlarging, asymptomatic plaque on the left scapular region. Dermatologic examination revealed an edematous, skin-colored plaque with multiple soft papillary projections. Histopathological analysis showed a poorly circumscribed proliferation of S-shaped spindle cells within a myxoid stroma, consistent with diffuse neurofibroma. Surgical excision was recommended due to infiltrative growth and margin involvement. The presentation of diffuse neurofibroma as a solitary scapular lesion in an adult without stigmata of NF1 is exceptional. Clinical morphology may mimic other benign dermal proliferations, highlighting the importance of histopathological confirmation. The infiltrative behavior and positive margins require complete surgical removal to minimize recurrence risk. Diffuse neurofibroma should be considered in the differential diagnosis of plaque-like lesions with soft nodularity, even in the absence of systemic features of NF1. Histopathologic evaluation is essential for an accurate diagnosis and adequate management planning.