Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Quiz
ARTICLE IN PRESS
doi:
10.4103/ijdvl.IJDVL_654_17
pmid:
31317874
CROSSMARK LOGO Buy Reprints
PDF

Chronic subungual lesion in a young woman

Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
Corresponding author: Dr. Negar Bahrololoumi Bafruee, Autoimmune Bullous Diseases Research Center, Razi Hospital, Vahdate-Eslami Square, Tehran 11996, Iran. negar.bb63@yahoo.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Mahmoudi H, Hallaji Z, Daneshpazhooh M, Kiani A, Nikoo A, Bahrololoumi Bafruee N. Chronic subungual lesion in a young woman. Indian J Dermatol Venereol Leprol 2020;1-3.

A 32-year-old woman presented to the outpatient clinic with a nail deformity of 2 years duration. Physical examination revealed subungual hyperkeratosis, onycholysis and swelling of distal phalanx of the left fourth finger without tenderness or sensory deficit [Figure 1]. There was no history of local trauma or any systemic disease. Potassium hydroxide smear of the nail showed dermatophyte. However, antifungal therapy was not successful. Further investigation with magnetic resonance imaging revealed a 7 × 2 × 7 mm lesion in subungual bed of distal phalanx of her left fourth finger, which was hypersignal in T2-weighted and hyposignal in T1-weighted images. Biopsy of the lesion showed numerous dilated blood vessels within a fibroelastic loose stroma in dermis. No nuclear atypia or signs of malignancy were seen. The overlying epidermis showed acanthosis [Figure 2]. The tumor cells were positive for CD34 [Figure 3] and negative for S-100.

Figure 1 a:: Subungual hyperkeratosis and onycholysis of left fourth finger
Figure 1 b:: Paronychia and erythema of distal phalanx of left fourth finger
Figure 1 c:: Swelling of distal phalanx of left fourth finger
Figure 2:: Increased thin-walled vessels in fibromyxoid stroma with mild spindle cell proliferation. Some mononuclear infiltrate in deep dermis (H and E, ×100)
Figure 3:: Tumor cells positive for CD34 (×100)

Question

What is your diagnosis?

Answer

Superficial acral fibromyxoma.

Discussion

Superficial acral fibromyxoma is a rare and benign tumor of soft tissues which tends to involve subungual or periungual areas of hands and feet.1,2 The tumor is typically a 0.6–5.0 cm nodular or lobulated mass that involves the entire dermis and may extend into subcutis. It is usually a painless or mildly tender and slow-growing lesion that may cause nail deformity. Involvement of palm, heel, ankle and leg has also been reported. It has been reported in patients between 4 and 91 years of age. However, most of them are middle-aged adults in the fifth to sixth decade of life. This tumor is more common in males (male to female ratio of 2:1).3,4

The exact pathogenesis and risk factors of superficial acral fibromyxoma are not clearly defined. Histologically, it is a poorly marginated tumor which is mostly located in the dermis or subcutis and rarely invades bone.3 The tumor composed of spindled and stellate cells with pale eosinophilic cytoplasm embedded in a predominantly myxoid, myxocollagenous or collagenous matrix. The tumor cells are typically immunopositive for CD34, CD99, vimentin and epithelial membrane antigen and are negative for S100, HMB45, smooth muscle actin, desmin and keratin.3 The most common histological differential diagnoses are neurofibroma, sclerosing perineurioma and superficial angiomyxoma. However, this tumor may be misdiagnosed with many other benign or malignant tumors.3-5 Clinical differential diagnoses of superficial acral fibromyxoma are other periungual tumors such as pyogenic granuloma, sclerosing perineurioma, dermatofibroma, superficial angiomyxoma, dermatofibrosarcoma protuberans, giant cell tumor of tendon sheet, fibroma of tendon sheet, keratoacanthoma, acquired (digital) fibrokeratoma and wart.3-5

Treatment of choice for this tumor is complete excision of the lesion. The association between margin clearance and recurrence rate after excision is not completely known. The risk of malignant transformation is not clear and possibility of malignancy should be considered if cytologic atypia is seen. However, a report on malignant transformation of this tumor could not be found in the literature. Recurrence rate is 10%–24% and it is recommended to review patients periodically after complete excision.5 Total excision of the lesion was performed for this patient. The tumor did not recur during 18 months of follow-up after excision.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . Superficial acral fibromyxoma: A clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes. Hum Pathol. 2001;32:704-14.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Superficial acral fibromyxoma. Indian J Dermatol. 2016;61:457-9.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , . Digital fibromyxoma (superficial acral fibromyxoma): A detailed characterization of 124 cases. Am J Surg Pathol. 2012;36:789-98.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , . Superficial acral fibromyxoma: An overview. Arch Pathol Lab Med. 2011;135:1064-6.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , . Superficial acral fibromyxoma involving the nail’s apparatus. Case report and literature review. An Bras Dermatol. 2014;89:147-9.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
464

PDF downloads
47
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections