|Year : 2014 | Volume
| Issue : 2 | Page : 83-85
Lobulated intradermal nevus: A rare entity
Madhulika A Mhatre, Venkataram N Mysore
Department of Dermatology, Venereology and Leprosy, Venkat Charmalaya Centre for Advanced Dermatology, Bangalore, Karnataka, India
|Date of Web Publication||18-Dec-2014|
Madhulika A Mhatre
Venkat Charmalaya Centre for Advanced Dermatology, #3437, 1st G Cross, 7th Main, Subanna Garden, Next to BTS Garage, Vijayanagar, Bangalore - 560 040, Karnataka
Source of Support: None, Conflict of Interest: None
Lobulated intradermal nevus is a rare entity characterized clinically by a yellowish lobulated growth and histologically by fat cell infiltration amidst nests of nevus cells in dermis with evidence of dermal fibrosis. This condition can be confused with a regressing intradermal nevus showing fatty changes, which are typically encountered in elderly individuals. We hereby present a case of lobulated intradermal nevus in a 30-year-old female patient. To the best of our knowledge, this is the first case of its kind to be reported from India.
Keywords: Lobulated intradermal nevus, melanocytic nevi, nevus lipomatous superficialis
|How to cite this article:|
Mhatre MA, Mysore VN. Lobulated intradermal nevus: A rare entity. Indian J Dermatopathol Diagn Dermatol 2014;1:83-5
| Introduction|| |
Lobulated intradermal nevus is an entity characterized clinically by a yellowish lobulated growth and histologically by fat cell infiltration amidst nests of nevus cells in dermis. Associated features include neuroid differentiation of nevus cells, and dermal fibrosis. The condition is often confused with intradermal nevus showing lipomatous changes, which are commonly seen in a regressing intradermal nevus in patients older than 50 years. Cho et al.  reported three cases of a lobulated intradermal nevus with peculiar appearance in 1991, and since then there have been only one more report in German literature and three more in Korean literature. ,,, These changes occurred in young patients in whom involution is not ordinarily expected. We hereby present a case of lobulated intradermal nevus in a young 30-year-old female patient. This, to the best of our knowledge, is the first report of such a case in Indian literature.
| Case report|| |
A 30-year-old female patient presented with a 10-year history of an asymptomatic growth over the vertex of scalp [Figure 1]. It started as a pea-sized growth, which gradually increased to 2 × 2 cm. There was no history of any discharge or pain. Physical examination revealed a single pedunculated outgrowth, which was firm in consistency, with a yellowish lobulated surface and with hyperpigmentation at places. Hair growth was noted on the lesion. The following differential diagnoses were considered:
- Nevus lipomatous superficialis
- Intradermal nevus
- Giant acrochordon.
Excisional biopsy of the lesion was performed.
Histopathologic examination revealed epidermis with elongated rete and increased pigmentation of basal layer. Clear Grenz zone was seen in papillary dermis. Collection of nevus cells (theques) was seen throughout the dermis extending to the subcutis. Cells were uniform and rounded in the upper dermis and spindle shaped in the lower dermis. Dilated blood vessels were seen amidst the theques. Several fat cells were seen interspersed in between the collagen bundles and theques in lower and mid-dermis. Fibrous tissue was seen to be increased [Figure 2] and [Figure 3].
|Figure 2: Scanner view showing theques of nevus cells with interspersed fat cells|
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Based on the above-mentioned histopathologic findings and after correlation with clinical appearance, a diagnosis of lobulated intradermal nevus was made.
| Discussion|| |
Cho et al., in 1991, reported intradermal nevi with an unusual growth pattern and appearance in three patients, which differed from previously described clinical types.  The lesions that clinically showed lobulation; were seen in younger age group; and histologically showed prominent fat cell infiltration amidst nests of nevus cells, neuroid differentiation of nevus cells, and dermal fibrosis. The authors distinguished this condition from other similar-looking disease entities, such as nevus lipomatous superficialis and cerebriform nevus, based on the above-mentioned histopathologic findings. Nevus lipomatous superficialis does not show theques of nevus cells, demonstrates groups or strands of fat cells instead of scattered ones, and is commonly seen over lower back. Cerebriform nevus shows solitary or clusters of nevus cells containing varying amounts of melanin and neuroid transformation but does not reveal fatty degeneration or fibrosis. ,
Intradermal nevi are elevated, fleshy, and slightly or moderately pigmented papules. Lesions vary in size from a few millimeters to a centimeter. Intradermal nevi are brown or black, but may become lighter or flesh-colored with time. These appear in a wide morphologic variety, including flat lesions, slightly elevated lesions often with a raised center and a flat periphery, papillomatous lesions, dome-shaped lesions, and pedunculated lesions.  The variance in shape, size, or color of the lesion reflects the evolutionary process in which the nevi extend downward with age and nevus cells degenerate or become replaced by collagen, fat, and fibrous tissue.  Melanocytic nevi are subject to change with age in both clinical and histopathologic findings. 
Cho et al. named the lesions "lobulated intradermal nevus" and suggested that their cases represented an unusual form of regressing melanocytic nevus as lipomatous changes are commonly seen in a regressing intradermal nevus in patients older than 50 years, and that these changes in young females is a rare finding.
Our case is identical with cases described by Cho et al. in 1991 and others mentioned in the literature.
Interestingly, all the previous cases reported in the literature also reported this condition in women. ,,, The sexual predominance implies that lobulated changes might be associated with factors such as female hormones; however, further studies are required to clarify the association.
This case is being reported in view of its rarity and relative absence of publications on the subject in Indian literature.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]