Superficial acral fibromyxoma: a clinicopathological study of new 41 cases from the U.K.: should myxoma (NOS) and fibroma (NOS) continue as part of 21st-century reporting?

Myxoinflammatory Fibroblastic Sarcoma of the Hand

Myxoinflammatory fibroblastic sarcoma is an ultra-rare tumor type with a prevalence of fewer than two per 100,000 people. The tumor poses a challenge because it can be misdiagnosed as a benign lesion in clinical and radiological investigations, causing serious morbidity in patients. We present the case of a 33-year-old patient who presented with painless hand swelling that was misdiagnosed as lymphaticovenous malformation based on magnetic resonance imaging. The patient underwent surgical excision, and myxoinflammatory fibroblastic sarcoma was diagnosed postoperatively. All surgical interventions failed to achieve negative margin. A decision to start radiotherapy was made, and tissue convergence was done temporally using acellular dermal matrix and split-thickness skin graft. On patient follow-up, the graft had taken well, and the patient was undergoing radiotherapy sessions with a plan for permanent hand reconstruction after negative margins are achieved. Based on this case report, we identified that magnetic resonance imaging is not yet a reliable method to diagnose myxoinflammatory fibroblastic sarcoma. Therefore, implementing a multidisciplinary team approach, a preoperative core needle biopsy, planned surgical intervention, and early involvement of radiotherapy is recommended to minimize morbidity. We strongly urge establishing a sarcoma specialized treatment center in the region to limit patient morbidity.

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: A case report

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Superficial Acral Fibromixoma (SAF) is a benign and rare tumor of the soft tissues.

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Local recurrence is often associated with a positive margin.

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Follow-up is recommended due to the risk of recurrence.

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Superficial Acral Fibromixoma, one of the rare myxoid neoplasms should be considered in the differential diagnosis.

Introduction

Superficial Acral Fibromixoma is a benign and rare tumor of the soft tissues, also it called digital fibromyxoma. It is a painful, slow growing solitary mass that is frequently observed in the fingers, toes and nail beds. Local recurrence is often associated with a positive margin.

Presentation of case

A 54-year-old male patient had admitted to local state hospital with complaint of a two-lobed mass lesion in the 5th finger of the right hand. The lesion was closely adjacent to the 5th finger flexor tendon. The specimen of the patient undergoing excisional biopsy was sent to our pathology department.

Conclusion

Superficial Acral Fibromyxoma is one of the rare benign myxoid neoplasms. Its treatment is surgical excision.

We reported the case for its rarity and to keep in mind in the acral region neoplasms.

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.

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.

Fibromyxoma of the Jaw: Case Report and Review of the Literature

We report a case of fibromyxoma of the mandible, a rare benign odontogenic tumor. Our patient presented in the first trimester of pregnancy with a large mass in the right body of the mandible exhibiting displacement of teeth and destruction of an extensive area of the mandibular bone. The mass was biopsied and diagnosed as a fibromyxoma. The large size of the tumor dictated a wide mandibular resection. We will review the clinical, radiographic, and histologic features of fibromyxoma and discuss its differential diagnoses. In addition, we will provide an overview of patient management. Fibromxyoma is a benign gnathic tumor that can be locally aggressive. To ensure appropriate treatment, it is important to distinguish this neoplasm from other mimickers in which myxoid, spindle mesenchymal cell proliferation is prominent.

CD34 negative superficial acral fibromyxoma: A rare case report

Superficial acral fibromyxoma (SAF) is a slow growing soft tissue tumor that mainly appears in the acral areas. Here, we report a case of a SAF with distinctive immunophenotype charachteristics. An 18-year-old female was referred to our clinic with the complaint of painless subungual nodule of great toe for a few months. The diagnosis of SAF was made according to histopathology and immunohistochemical (IHC) study, however, the IHC assessment showed positive staining with vimentin, focal reaction with smooth muscle actin, negative reaction with CD34, and positive staining pattern with CD99. These IHC findings are unusual for SAF. This reported case of SAF supports the fact that, although CD34 expression is characteristic for SAF, it is not always present.

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: clinicopathological, immunohistochemical, and molecular study of 11 cases highlighting frequent Rb1 loss/deletions

Superficial acral fibromyxoma (SAF) is an uncommon benign dermal mesenchymal lesion of adults with predilection for acral sites, in particular the nail region. To date, less than 300 cases have been reported. SAFs consistently express CD34, but other diagnostic markers or specific genetic alterations have not been established yet. We describe 11 SAFs occurring in 7 men and 4 women aged 37 to 86years (median, 48 years). Mean size was 6mm (range, 4-20mm). Affected sites were fingers (n=5), toes (n=3), heel (n=1), calf (n=1), and unspecified digit (n=1). None of 10 patients with available follow-up (2-60months; median, 24months) developed recurrence. Histology showed relatively hypocellular vaguely lobulated nodules composed of bland-looking spindled or stellate fibroblast-like cells arranged into storiform or loose fascicles within a variably myxoid, fibromyxoid, or collagenous vascularized stroma. Immunohistochemistry showed expression of CD34 (9/10) and focal weak reactivity for epithelial membrane antigen (2/11). None of the lesions expressed protein S100 (0/11), MUC4 (0/11), or STAT6 (0/11). Loss of Rb1 immunoexpression was observed in 9 (90%) of 10 cases. All 7 cases with successful RB1 fluorescence in situ hybridization testing showed RB1 gene deletions, which was variably associated with co-loss of the corresponding 13q12 signal (monosomy at the 13q region). To our knowledge, this is the first study investigating the expression status of the tumor suppressor Rb1 in SAF by immunohistochemistry and fluorescence in situ hybridization. Our results showed frequent Rb1 deficiency as a possible driver molecular event in SAF (seen in 90% of cases) indicating relationship of SAF to the RB1-deleted tumor family.

Superficial Acral Fibromyxoma: A Rare Entity - A Case Report

Superficial acral fibromyxoma (SAF) is a rare lesion initially described by Fetsch as a tumour with histological and immunohistochemical features located at acral sites. It is a benign slow-growing soft tissue lesion occurring in males. Patients generally look for late medical help as it is generally painless. The lesion consists of spindled and stellate-shaped cells in the myxocollagenous stroma with immunohistochemical positivity for CD34, CD99 and vimentin. Treatment is surgical excision with regular follow-up. Here we present a case of a superficial acral fibromyxoma of the left index finger which radiologically showed features of vascular anomaly on MRI. The lesion was surgically excised and histopathology revealed features suggestive of superficial fibromyxoma with positive immunohistochemistry for CD34 and negative for S-100.

Superficial acral fibromyxoma

Superficial acral fibromyxoma (SAF), also known as digital fibromyxoma, is a rare soft tissue tumor with a predilection for acral surfaces. Superficial acral fibromyxoma classically presents as a pink to flesh-colored nodule located on the subungual or periungual region of the hands or feet. It is typically slow-growing and asymptomatic, which, coupled with its nonspecific clinical appearance, presents a diagnostic dilemma to the dermatologist. As these features overlap with those of a multitude of differential diagnoses, it is imperative to have a good understanding of the characteristics on which the diagnosis of SAF is based. Superficial acral fibromyxoma was initially described in 2001, since when several case reports and literature reviews have contributed to our current understanding of these tumors. In this article, we will review the history, clinical features, diagnosis, and management of SAF. It is our hope that this systematic approach will help to facilitate the recognition and management of this distinct dermatologic entity.

Superficial Acral Fibromyxoma involving the nail's apparatus. Case report and literature review

Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

[Superficial acral fibromyxoma in a sub-matricial location: An unusual variant]

BACKGROUND

Superficial acral fibromyxoma (SAFM) is a benign soft tissue tumor located in the acral areas, particularly the peri- and sub-ungueal areas. Sub-matricial localisations have not been reported to date.

PATIENTS AND METHODS

We report herein the clinical and pathological presentation of three cases of SAFM located solely under the matrix. The patients presented with pseudo-clubbing, onychogryphosis or triangular macrolunula. The histopathological appearance was characteristic.

DISCUSSION

SAFM is a slow-growing, skin-colored, firm nodule, located chiefly on the digits or the toes, and especially in the nail area. It may or may not be painful. Microscopically, it presents as a relatively well-circumscribed but unencapsulated dermal tumor, composed of spindle shaped cells integrated in a myxocollagenic matrix, sometimes invading the subcutis. Tumor cells diffusely express CD34. A conservative surgical approach is recommended. Both clinicians and pathologists should be aware of this entity in order to avoid misdiagnosis, which can lead to unwarranted mutilating surgery.

CONCLUSION

Sub-matricial localisation of SAFM is extremely rare and may present as pseudo-clubbing, isolated onychogryphosis or a triangular macrolunula. A conservative surgical approach should be recommended.

[Nerve sheath myxoma of the hyponychium]

BACKGROUND

Nerve sheath myxoma is a rare benign tumour of the extremities that was long confounded with neurothekeoma. Herein, we describe a rare case of interest because of its site on the hyponychium.

PATIENTS AND METHODS

A 31-year-old woman presented with a painless distal tumour on the right ring finger that had been present for 3 to 4 years. It consisted of a firm, round nodule under the nail and spreading to the fingertip. Complete excision was carried out after cutting away the distal nail plate. Histological examination revealed a myxoid tumour comprising very clearly delineated lobules containing pale fusiform cells with small nuclear inclusions. These cells expressed S100 protein but no CD34 or epithelial membrane antigen (EMA). Complete excision was performed and a full recovery was made.

DISCUSSION

This type of tumour is characteristic of nerve sheath myxoma, and is almost certainly of Schwannian origin, although distinct from Schwannoma. It is rare, occurs after the age of 35 years and is preferentially located in the extremities of the limbs. There has only been one other description of its occurrence under the fingernail, in which it was described as neurothekeoma. However, neurothekeoma is entirely different, being more cellular, with no expression of protein S100, and marked by the NKIC3 antibody; it occurs in children or young adults, and is frequently found on the face. These two tumours were confused for some time, but today they must be completely distinguished from one another. These myxomas must be completely excised because of the risk of relapse. Finally, they should be distinguished from other myxoid tumours of the digits, certain of which can be malignant.

Superficial Acral Fibromyxoma of the Thumb: A Case Report

The authors report a case of superficial acral fibromyxioma (SAF) in a 74-year-old male who presented with a painless mass in a periungual dorsoradial region of the right thumb. It is a rare benign neoplasm, which was recently described, that arouse on the skin and subcutaneous tissue of the hands and feet, especially in the proximity to the ungual region of male adults. Surgical treatment was performed with the excision in blocks of the margins of the lesion and fragmentation of the nail and nail matrix, according to the literature recommendation. Although there may be local recurrence in 22% of the cases, the patient presents no symptoms, deformities or functional limitations. In addition, there was no sign of tumor recurrence 18 months after the surgery. We are not aware of a similar case report in the Brazilian literature.

[Superficial acral fibromyxoma: three cases]

BACKGROUND

in this report of three new cases of superficial acral fibromyxoma (SAF), we discuss the clinicopathological features of this acral fibrous tumour as well as the differential diagnoses for hard nodules affecting the extremities.

PATIENTS AND METHODS

these three lesions involved the standard presentation of a large solitary flesh coloured nodule causing deformation of a toenail or a fingernail. Biopsy showed the presence within a fibromyxoid tumour of proliferating fusiform cells having no atypical features and expressing CD 34 diffusely, and in more focal and less consistent fashion, epithelial membrane antigen (EMA) and CD 99. FISH testing for translocation t(17; 22) proved negative.

DISCUSSION

this fairly common acral fibrous tumour is poorly known and in certain cases histology results may suggest myxoid dermatofibrosarcoma, which carries a completely different prognosis.