Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(4):e2022149 1

Aneurysmal Dermatofibroma After Varicose  
Vein Surgery

Pablo Villagrasa-Boli1, Juan Monte-Serrano1, Sara Martínez-Cisneros1,  
Alejandro Martínez-García2

1 Dermatology Service, Lozano Blesa University Hospital, Zaragoza, Spain

2 Pathology Service, Lozano Blesa University Hospital, Zaragoza, Spain

Citation: Villagrasa-Boli P, Monte-Serrano J, Martínez-Cisneros S, Martínez-García A. Aneurysmal dermatofibroma after varicose vein 
surgery. Dermatol Pract Concept. 2022;12(4):e2022149. DOI: https://doi.org/10.5826/dpc.1204a149

Accepted: January 15, 2022; Published: October 2022

Copyright: ©2022 Villagrasa-Boli 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: Pablo Villagrasa Boli, Dermatology Service, Lozano Blesa University Hospital. San Juan Bosco Avenue, 15, 50009, 
Zaragoza, Spain. E-mail: pablovillaboli@gmail.com

Case presentation

A 45-year-old man was referred to dermatology consulta-

tions for evaluation of a pigmented lesion on the left leg. The 

lesion appeared at the incision site of a varicose vein surgery 

performed one year prior.

Clinical examination revealed an indurated 12 mm brown 

plaque (Figure 1A). Dermoscopy showed at the center white 

network surrounded by bluish areas and a rainbow pattern, 

and at the periphery a homogeneous brown color (Figure 1B). 

Histopathological examination revealed blood-filled spaces 

with peripheral hemosiderin deposits, and a dense collagenous 

stroma containing spindle cells (Figure 1C). Immunohisto-

chemical tinctions for Factor XIIIa (Figure 1D) and for CD68 

were positive, while human herpesvirus 8 was not detected.

Teaching point

Aneurysmatic dermatofibroma represents approximately 

1.7% of all types of dermatofibromas [1]. Like any derma-

tofibroma, this subtype may appear after local trauma. Its 

clinical diagnosis can be difficult due to its resemblance to 

malignant tumors, such as Kaposi sarcoma, angiomatoid 

malignant fibrous histiocytoma and melanoma [2].



2 Image Letter | Dermatol Pract Concept. 2022;12(4):e2022149

References

1. Güngör Ş, Erdemir AT, Öztürk Sarı Ş, Büyükbabani N,  Kocatürk E, 

Gürel MS. Aneurysmatic dermatofibroma with dermoscopic and 

reflectance confocal microscopic features. J Eur Acad  Dermatol 

Venereol. 2016;30(5):880-883. DOI: 10.1111/jdv.13046. PMID: 

25690844.

2. Zaballos P, Llambrich A, Ara M, Olazarán Z, Malvehy J, 

Puig S. Dermoscopic findings of haemosiderotic and aneurys-

mal dermatofibroma: report of six patients. Br J Dermatol. 

2006;154(2):244-250. DOI: 10.1111/j.1365-2133.2005.06844.x. 

PMID: 16433792.

Figure 1. (A) Clinical examination of the lower limbs. The hematoma on the right leg is unrelated to the reason for consultation.  

(B) Multi-component dermoscopic pattern composed of central white stripes with rainbow areas, and a peripheral brown network.  

(C) Dense tumoral stroma with congested blood vessels; the epidermis shows basal layer hyperpigmentation, acanthosis and hyperkerato-

sis. (D) diffuse positivity for factor XIIIa throughout the tumor.