Diagnosis Is In!
First the acknowledgements:
Thank you first and foremost to my wife for cleaning and dressing my wound during my recovery. Thank yous also go to Cumberland Pathology Associates (including Dr.s Gill, McCullough, and Haase), Knoxville Dermatopathology Laboratory (Dr. Googe), Premier Medical Center (including Dr.s Miller and Jackson), Gateway Medical Center, and to any assistants and staff who had a hand on my sample.
Next, an updated photo of the healing sutures:
Its kind of hard to scale the image but the lesion they removed was a little over and inch vertical and half an inch horizontal and an inch or so deep.
and Finally, the diagnosis and pathology report:
Cumberland Pathology Associates/Dr. Haase’s report:
Clinical Impression: Lesions
Comment: This case was forwarded for additional consultative review. Our consultant states that dermatofibromas rarely persist or recur even when incompletely removed. However if a lesion remains or recurs clinically, conservative complete removal would be suggested for further evaluation and therapy. A copy of the consultative opinion is attached (Knoxville Dermatopathology laboratory case *******).
Knoxville Dermatopathology Laboratory/Dr. Googe’s report:
Diagnosis: Dermatofibroma, present in base of excision (Please see comment)
Comment: I agree with your diagnosis of dermatofibroma and this example has areas with the “sclerosing hemangioma” pattern which was described many years ago. This example is interesting because of the prominent sebaceous glands located above the neoplasm. This may be an inductive phenomenon of the tumor, but has no other known clinical significance. Dermatofibromas rarely persist or recur even when incompletely removed. In this example, however, there may be quite a bit of lesion left in the patient as the tumor is transected at the base of the specimen. If a lesion remains or recurs clinically, conservative complete removal would be suggested for further evaluation and therapy. Thank you for the opportunity to see this interesting case.
The three slides have sections of a skin excision including epidermis, dermis, and focal superficial elements of subcutaneous fat. There is a spindle cell neoplasm forming a mass having its epicenter in the reticular dermis. The spindled cells have in-distinctive cytoplasmic boarders. They are arranged in haphazard groupings which replace portions of the dermis and which are accompanied by delicate fibrosis. Prominent capillaries are noted with the neoplasm. The tumor cells are somewhat infiltrative, but on low power examination the lesion has a fairly well-circumscribed border. There is overlying epidermal hyperplasia and several prominent sebaceous glands connect directly to the epidermis. The neoplastic cells show little variability or hyperchromasia. Mitotic activity is not noted. There is no necrosis. Tumor is present in the base of the biopsy.
So, the lesion was a benign growth of tissue that usually occurs in kids (agrees with my story of it being around for quite awhile) and is unlikely to cause any problems if any was left in the procedure. I am pretty sure however that Dr. Miller was more aggressive in his excision than Dr. Jackson was; the specimen that was submitted was excised by Dr. Jackson and then he called for Dr. Miller to check his work and suggest appropriate sutures.
Dr. Miller advised that the part taken already was not at all the entirety of the tumor and took to excising more of my back himself. Both of the comments by the pathologists advise some sample was left and excision may or may not be needed but they did not know of the part that Dr. Miller had taken. The piece Dr. Miller took out was at least half to three quarters of an inch deep, likely three times the size of the sample Dr. Jackson had taken and submitted for study.
Because of the length of time that I have had this lesion I did not seriously contemplate that it would be malignant but it is cool to have these reports to know for certain. I like that even the doctors still find these cases interesting and I am glad mine was one of the interesting ones, but I would expect no less from myself. So, that’s it. its out and I’m healing nicely. I will post update pics and maybe a post or two after the stitches come out and I think healing is nearly complete. Thanks for following me on this journey.