Superficial acral fibromyxoma

Superficial acral fibromyxoma: a case of missed diagnosis

Superficial acral fibromyxoma (SAFM) is a rare, benign, slow-growing fibroblastic tumour of the soft tissue that is part of the group of myxoid soft-tissue neoplasms. It is a rare entity and usually occurs in the acral regions. We report the case of a 64-year-old man who presented to the emergency room for a lesion expected to have occurred as a result of an ingrown toenail. Because this patient had a history of repeated recurrences despite multiple surgical wedge excisions, we performed a complete surgical excision, and the pathological analysis confirmed the suspected diagnosis of SAFM. There was no recurrence at the 6-month follow-up. This case highlights the fact that this tumour is still misunderstood and underrecognized by surgeons and this often leads to delayed diagnosis. Although it is a rare entity, clinicians should be aware of this tumour in cases of recurring ingrown toenails.

An unusual growth in the nail matrix: A case of superficial acral fibromyxoma

We describe a case of superficial acral fibromyxoma arising within the germinal matrix of the index finger. This is an uncommon localisation of this relatively newly described benign soft tissue tumour. Herein, we discuss the varied clinical presentation, distinguishing histopathological features and important differential diagnoses for this condition.

Acral fibromyxoma: a rare plantar nodule

Acral fibromyxomas are benign tumours ranging in size between 0.6 and 5 cm, commonly found around the nailbed. The often asymptomatic presentation of acral fibromyxomas means that there is often a delay in their diagnosis and subsequent treatment. The objective of this paper is to present the unique case of a fibromyxoma present in the acral region, as well as a review of the literature.

Superficial Acral Fibromyxoma, Appearing as Retronychia: A Rare Clinical Entity

We report a case of a subungual superficial acral fibromyxoma (SAFM) in a 37-year-old male patient who presented with a persistent chronic proximal paronychia of the big toenail of the right leg. Our clinical diagnosis was retronychia, an often misinterpreted condition, which must be suspected in cases of persistent paronychia, especially in the setting of trauma. The nail plate avulsion revealed a subungual tumor, which was surgically excised. Histopathology in combination with immunohistochemistry revealed features suggestive of SAFM. The follow-up examination of the patient showed no recurrence 9 months after the surgery.

A Case of Solitary Fibrous Tumor of Subungual Region

Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.

Superficial Acral Fibromyxoma: Literature Review

Superficial acral fibromyxoma is a benign and rare tumor of the soft tissues. It usually manifests itself through a painless mass of slow growth that affects mainly males in the fifth decade of life. It usually affects the distal region, with a polypoid or dome-shaped appearance. The histological appearance is of a dermal mass without capsule, with spindle-shaped fibroblasts in a storiform or fasciculated pattern in the myxocollagenous stroma. The immunohistochemical evaluation of superficial acral fibromyxoma is usually positive for CD34 and CD99, with variable positivity for epithelial membrane antigen. The treatment consists of complete excision of the tumor mass.

A review of the current literature on superficial acral fibromyxoma was performed, with an emphasis on the number of cases reported, location, diagnostic methods, histological characteristics, differential diagnoses and treatment.

A total of 314 reported cases of superficial acral fibromyxoma with variable locations were found in the current literature, mainly in the toes (45.8%) and fingers (39.1%). It has a slightly superior incidence in men (61%) and enormous variability in the age range of occurrence.

Superficial acral fibromyxoma is a single soft-tissue tumor that should enter the differential diagnosis of periungual and subungual acral lesions; the treatment consists of simple excision. More studies are needed to better understand this pathology, which was first described in 2001.

Aggressive superficial acral fibromyxoma of the great toe: A case report and mini-review of the literature

Superficial acral fibromyxoma is a very rare soft tissue tumor. Fetsch et al first described the condition in 2001. It often occurs in the fingers and toes and has slow-progressive features. Since being described, a few cases occurring in the great toe have been reported. The present study indicated a case of a 37-year-old male kickboxer with a history of a rapid-growing lump under the nail of his left great toe with bone erosion. The patient was suspected to have a soft tissue tumor under the nail, such as a glomus tumor, as a differential diagnosis. However, a malignant soft tissue tumor as a differential diagnosis could not be ruled out because of the observed bone erosion. The patient underwent surgical excision, and pathologic analysis revealed superficial acral fibromyxoma. Twenty-four months after the treatment, he had no complaints or functional disorder and no recurrence was noted. Although an unusual diagnosis, surgeons should be aware of this tumor, which requires complete surgical excision and follow-up to detect recurrence. To the best of our knowledge, this is the first reported case of superficial acral fibromyxoma with bone erosion in a great toe.

Cutaneous Spindle Cell Neoplasms: Pattern-Based Diagnostic Approach

Context.—

Spindle cell neoplasms arising in the skin comprise a heterogeneous group of tumors with divergent lineages. Cutaneous spindle cell neoplasms are relatively common and present surgical pathologists with diagnostic challenges. Recognition of their histopathologies is important for correct diagnosis and management. The current review presents a pattern-based diagnostic approach to common cutaneous spindle cell neoplasms that often cause diagnostic difficulties.

Objective.—

To provide a useful guide for diagnosis of cutaneous spindle cell neoplasms.

Data Sources.—

PubMed (US National Library of Medicine) reports and the authors' personal experiences are reviewed.

Conclusions.—

The authors briefly summarize the histologic features and differential diagnoses of common cutaneous spindle cell neoplasms.

Superficial acral fibromyxoma: a case report with radiological review

Superficial acral fibromyxoma is a benign, slow-growing soft-tissue neoplasm that has a predilection for the peripheries. Although considered benign, its risk of recurrence warrants consideration in the radiological differential diagnoses of acral tumors. To our knowledge, there has been minimal literature studying the radiological features of this entity. We present a case report with a discussion focusing on its clinical and radiological findings.

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.

Superficial acral fibromyxoma in the heel with new vascular features on dermoscopy

Superficial acral fibromyxoma (SAFM) is an uncommon mesenchymal soft tissue tumor with a predilection for the acral extremites and nail bed involvement. SAFM is diagnosed with clinicopathological and immunohistochemical examination. Awareness of this rare tumor is important because of amounts of benign and malignant neoplasms. We report a case of SAFM in a rare localization in the heel with a new finding on dermoscopy.

Superficial Acral Fibromyxoma of the Toe: Unusual Location of the Mixoid Variant

Superficial acral fibromyxoma (SAFM) is a rare soft tissue tumor that frequently involves the periungual and subungual regions of acral surfaces. Macroscopically, it appears as a flesh-colored dome-shaped solitary mass; microscopically, it consists of a moderately cellular proliferation of spindle-shaped fibroblast-like cells embedded in a myxocollagenous stroma and arranged in a loose storiform and focally fascicular pattern. The tumor cells are immunoreactive for CD34, epithelial membrane antigen, CD99, and CD10. In this study, we describe a case of SAFM on the fourth toe with predominantly myxoid stroma. Our case, in contrast of those reported in the literature, showed an unusual location for the myxoid variant. SAFM is often not recognized; it may resemble some benign and malignant mesenchymal neoplasm. The gold standard treatment is surgery. The tumor was completely excised, and no recurrence was evident at 1-year follow-up. Awareness of this entity facilitates its diagnosis and management, avoiding unwarranted concerns and additional procedures for the patient.

Superficial acral fibromyxoma: A case report

There are a wide variety of benign and malignant soft tissue tumors. Digital superficial acral fibromyxoma is a rare, benign, expansive soft tissue growth which often involves the distal aspect of the digit and the nail plate. While it is often asymptomatic in nature, it may cause a great deal of distress due to involvement of the nail and the resultant cosmetic deformity. Unlike wide excision or amputation needed for more aggressive tumor types, local excision is often curative. We review the literature and describe the presentation of this unique pathology to our clinic in an otherwise healthy 33-year-old female.

First report of an aneurysmal bone cyst presenting as subungual mass

Painful subungual tumor masses in the toes usually emerge as glomus tumors or subungual exostoses. We present a patient with an aneurysmal bone cyst located subungually in whom the diagnosis was delayed due to inadequate diagnostic procedures, which led to marked destruction of the distal phalanx of the great toe of the right foot. After biopsy, the distal phalanx could not be preserved due to critical soft tissue involvement and the size of the process. Thus, we describe this rare entity to encourage clinicians to establish the diagnosis by biopsy of a tissue swelling of unclear origin and duration that does not resolve after a short time. Imaging examinations are useful in demonstrating periosteal involvement and extension of the lesion and can be helpful in the diagnostic algorithm. An interdisciplinary approach is a top priority to ensure optimal treatment.

Clinico-pathologic, dermoscopic and ultrasound examination of a rare acral tumour involving the nail - case report and review of the literature

There is a large spectrum of tumors presenting as nodular lesions that may affect the subungual space. We report the case of a 62-year-old woman presenting with a rapidly growing nodular lesion under the nail of the first left toe. Non-invasive examinations using dermoscopy, ultrasonography and elastography were performed for the preoperative assessment of the lesion. The biopsy of the lesion revealed superficial acral fibromyxoma, a benign tumor with predisposition for acral sites. The patient underwent radical surgery with wide resection margins. This is the first case report of a superficial acral fibromyxoma affecting the subungual region characterized by dermoscopic, ultrasonographic and elastographic features. We also performed a short review of the literature.