Giant fibrokeratoma, a rare soft tissue tumor presenting like an accessory digit, a case report and review of literature

Acquired Digital Fibrokeratoma: A Report of Five Cases and Review of the Literature

Acquired digital fibrokeratoma (ADF) is rare in clinical practice and is easily misdiagnosed. Herein, 5 cases of patients (3 males and 2 females) with ADF are reported. The mean age at onset was 42.6 years, and the mean disease duration was 3 years. Four patients had ADF on the hands, and 1 patient had ADF on the foot. The clinical manifestations were all solitary, skin-colored papules, with a firm texture and smooth surface, protruding from the skin surface. In 3 patients, ADF manifested as columnar protrusions, and in 2 patients, ADF manifested as dome-shaped protrusions. For all 5 patients, the diameters of the lesions were <1 cm. Clinically, all 5 patients were misdiagnosed (ie, eccrine poroma (EP), common warts, rudimentary polydactyly, pyogenic granuloma (PG), and acral fibroma). All cases of ADF were confirmed by histopathology. The histopathological manifestations of ADF were as follows: finger-like protrusions on the skin surface; collagen fiber bundles running vertically to the epidermis seen in the dermis; and thick red-stained collagen fibers connected with the normal dermal connective tissue below. All 5 patients underwent surgical resection; the distance between the incision margin and the edge of the tumor was 2-3 mm, and the surgical depth was the deep dermis. No recurrence was observed in more than half a year of follow-up after surgery.

A retrospective study on the clinical features of skin lesions in Chinese acquired digital fibrokeratoma patients

BACKGROUND

Acquired digital fibrokeratoma (ADFK) is an uncommon benign fibro-epithelioma, which is rarely reported in China.

AIMS

To analysis the clinical features of ADFK in Chinese people from current cases.

METHODS

From December 2019 to October 2021, there were 21 patients diagnosed with ADFK, we made a retrospective analysis on the clinical features of skin lesions in them. To summarize the clinical morphology, location, and surgical follow-up of ADFK.

RESULTS

We concluded that ADFK is more common in females than males on the hands (7:3), while the male-to-female ratio is largely the same in feet (6:5). It occurs more frequently on the third finger (60%) and first toe (45.5%). As to clinical morphology, it is typically rod-shaped (52.4%), followed by dome-shaped (42.8%) and wart-shaped (4.8%). It is typically dome-shaped on the hands (80%) and rod-shaped on the feet (81.8%). In terms of location on the fingers (toes), such skin lesions are most common at the proximal nail fold (52.4%), which can also occur at the nail matrix (14.3%), periungual area (23.8%), and subungual area (9.5%). Nevertheless, this ratio also varies on the hands and feet. All patients got surgical excision of the skin lesion, who were followed up for 6-12 months, without recurrence.

CONCLUSIONS

Most ADFKs are associated with trauma, whose clinical features are related to location and gender. ADFKs on the hands are different from those on the feet regarding clinical morphology and location on fingers (toes), and surgery is effective in treating this condition.

Acquired Digital Fibrokeratoma

Acquired digital fibrokeratoma is a rare, benign tumor that mostly occurs on the fingers and toes and may appear to be a supernumerary rudimentary digit. It generally affects adult men and appears as a dome-shaped papule although it can also be elongated or pedunculated. Trauma is believed to be a triggering factor in some cases. We report a male patient with an acquired digital fibrokeratoma on a finger, shaped like a cutaneous horn, and a history of minimal repeated trauma and spontaneous remissions not previously described in the literature.

Acquired fibrokeratoma: A retrospective study in a tertiary centre in South India

Background:

Acquired fibrokeratoma (AFK) is an uncommon, sporadic, benign, acquired, slow-growing dermo-epidermal tumour.

Aims and Objectives:

The purpose of this study was to summarize the demographic, clinical characteristics and treatment outcomes of patients with AFK in a tertiary care centre in South India.

Methods:

We evaluated the records of 26 patients with AFK who were diagnosed and treated in our centre between January 2017 and December 2021. The retrospective data related to age, sex, occupation, consistency, duration of lesions, history of trauma, anatomical site, morphological appearance, histopathological type, treatment provided and recurrence were taken into account and analysed.

Results:

Of the 26 patients, there were 21 males and 5 females. Fingers (n = 23) were the most common site involved, followed by toes (n = 2) and palm (n = 1). A total of 18 patients had finger-like projected lesions and eight patients had dome-shaped lesions. In histopathology, Type I AFK type was observed in 16 cases and Type II in 10 cases.

Conclusion:

We believe that our study would contribute by providing the clinical, histopathology and treatment outcomes of this uncommon dermo-epidermal tumour. The frequency of this condition is often underestimated as it is misdiagnosed for many other dermatological conditions.

Acquired Digital Fibrokeratoma of the Toe

Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors and common warts, especially when located on the foot and toes. In this article, we report the case of a 45-year-old man who presented to our clinic for an acquired growth over the plantar surface of the second right toe. The tumor had evolved for 1 year and affected the patient's activities and mobility. On examination, the lesion was a dome-shaped, firm tumor with keratotic distal changes and a broad base attached to the overlying skin. Pathologic assessment was consistent with the diagnosis of acquired digital fibrokeratoma, ruling out other causes of abnormal growth. The tumor was completely excised with surgery, with excellent outcomes and no recurrence at follow-up. Although acquired digital fibrokeratoma is a rare condition, mostly located on the distal upper extremities and fingers, it should be considered in the differential diagnosis of plantar soft-tissue tumors. Surgical management remains the mainstay of treatment.

Horn on the Nail: Acquired Ungual Fibrokeratoma

Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors that are located in the ungual area. They usually presents as asymptomatic, solitary, smooth, dome-shaped, or fingerlike, flesh-colored papules accompanying nail deformities, including a longitudinal groove and trachyonychia. Acquired periungual fibrokeratoma is considered a topographical variant of acquired digital fibrokeratoma; it has a unique “garlic clove” shape. A traumatic origin has been suggested, as acquired ungual fibrokeratomas occur most frequently on the fingers and toes. Herein, we report a case of a 29-year-old man with growth over left little finger, who was treated with surgical excision of the tissue. Histopathological examination confirmed ungual fibrokeratoma. It is a rare variant of digital fibrokeratoma, and so far the first ungual fibrokeratoma to appear de novo on little finger to the best of our knowledge.

Cellular Digital Fibroma: A Comprehensive Review of a CD34-Positive Acral Lesion of the Distal Fingers and Toes

Cellular digital fibroma is a benign fibrous lesion that typically occurred on either a finger or a toe. Cellular digital fibroma was introduced as a distinctive cluster of differentiation 34 (CD34)-positive lesion in July 2005. Cellular digital fibroma has been described in 20 patients: 12 men and 8 women. The patients ranged in age from 27 to 83 years old (median, 52 years old) at diagnosis. The tumor had been present from 2 months to 2 years (median, 11 months) prior to seeking medical attention. The cellular digital fibroma was usually slowly growing and asymptomatic; there has been no prior history of trauma at the tumor site. The lesion typically presented as either an erythematous or a flesh-colored, solitary papule of 5 mm or smaller. It frequently occurred on either the dorsal, lateral or ventral side of a digit. Yet, some of the lesions were located on the nail fold of the digit. Cellular digital fibroma shows a prominent cellular proliferation of spindle-shaped fibroblasts, without any atypia or mitoses, that extends from the papillary into the upper reticular dermis; diffuse and strongly positive CD34 staining is present throughout the entire tumor. There is no erosion by the tumor of the bony phalanx. Other acral tumors, such as superficial acral fibromyxoma (which also has diffuse strongly positive CD34 staining) and acquired digital fibrokeratoma (which is either CD34-negative or only focal CD34 positive), are in the clinical and pathologic differential diagnosis of cellular digital fibroma. Conservative complete excision is the treatment of cellular digital fibroma; however, even for tumors that have only been partially removed during biopsy, recurrence has not been observed. In conclusion, cellular digital fibroma is a unique CD34-positive acral lesion of the distal fingers and toes whose diagnosis requires correlation of the clinical morphology and the pathologic features of the tumor.

Recurrent Familial Digital Fibrokeratoma: A Case Report

Digital fibrokeratoma (DF) is an uncommon, benign, soft tissue tumor. It usually occurs sporadically in adult males, and its recurrence is rare when treated by means of surgical removal. To the best of our knowledge, we report here the first case of recurrent female familial DF. The mother's first DF, on her right hallux, was removed when she was 32 years of age, and her second fibrokeratoma, on the left fifth toe, was removed when she was 49 years of age, and then relapsed 3 years later. The daughter's first DF, on her left fifth toe, was excised when the daughter was 24 years of age and recurred 1 year later. Both the mother's and daughter's recurrent lesions were surgically excised and pathologically diagnosed as DF. Because both the mother's and daughter's DF occurred at relatively early ages, we believe that genetic factors might play a role in the tumorigenesis of DF in this family.

Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis

Acquired digital fibrokeratoma (ADFK) is a rare, benign, fibrous tumor that most often occurs on fingers. It may resemble a rudimentary supernumerary digit and is often misdiagnosed as another common benign condition, such as common wart. It is typically asymptomatic and occurs as a solitary nodule less than 1 cm in diameter. Oftentimes ADFK shares clinical and/or histologic resemblance with other benign and malignant cutaneous conditions so it is crucial that careful examination is undertaken. In this article, we will discuss the clinical presentation, epidemiology, etiology, dermoscopic and histologic findings, management, and differential diagnoses for ADFK, with the hope that this review will facilitate timely diagnosis and management for this distinct condition.