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 Awards 2020
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 in Response to Previous Publication
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
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Quiz
2018:84:4;437-439
doi: 10.4103/ijdvl.IJDVL_845_16
PMID: 29380752

Solitary dome-shaped erythematous lump of long duration on the palm

Deepashree Daulatabad1 , Deepika Pandhi1 , Nadeem Tanveer2 , Sonal Sharma2 , Ishmeet Kaur1
1 Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
2 Department of Pathology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India

Correspondence Address:
Deepika Pandhi
Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi - 110 095
India
Published: 29-Jan-2018
How to cite this article:
Daulatabad D, Pandhi D, Tanveer N, Sharma S, Kaur I. Solitary dome-shaped erythematous lump of long duration on the palm. Indian J Dermatol Venereol Leprol 2018;84:437-439
Copyright: (C)2018 Indian Journal of Dermatology, Venereology, and Leprology

Clinical Case

An 18-year-old girl presented to us with a solitary dome-shaped erythematous nodule on her right palm present since 10 years of age [Figure - 1]. The lump was asymptomatic, gradually progressive with no preceding history of trauma or evidence of neurological deficit. Dermoscopy revealed a multi-lobulated lesion with multiple arborizing vessels of varying caliber and speckled pigmentation overlying a translucent yellowish background [Figure - 2]. General examination and medical history were unremarkable. Excisional biopsy and histopathological examination (hematoxylin and eosin stain) revealed an encapsulated lobular tumor abutting the dermis with thinning of the overlying epidermis.[Figure - 3]a. At higher magnification (×100) we observed distinct zones made up of compact fascicles of spindle cells with their nuclei arranged in palisades interspersed with loose edematous tissue.[Figure - 3]b.

Figure 1: Single erythematous nodule on the right palm
Figure 2: Lobulated structure with multiple small and large caliber arborizing vessels. Pink-yellow structureless areas and speckled brown pigmentation, with highest density along the septa separating the lobules (×50, Dino-lite pro-polariser USB dermoscope, under oil)

What Is Your Diagnosis?

Answer

Diagnosis: Cutaneous schwannoma.

Discussion

Schwannoma is one of the peripheral nerve sheath tumors derived from the Schwann cells, which are responsible for the production of myelin sheath surrounding the peripheral nerves. As these cells are also called neurilemmocytes, the tumor is also known as neurilemmoma. These often present as swellings along the large peripheral or cranial nerves, the most common being acoustic neuroma.

The peak incidence is seen in the fourth to fifth decade of life with no sexual predilection. When involving the skin, these lesions are known as cutaneous schwannomas which usually present as ill-defined soft tissue swellings or lumps due to their deep subcutaneous location. These are usually asymptomatic but may present with pain or local sensory impairment or paresthesias in one-third of the cases. These are slow growing, encapsulated tumors that follow a benign course and rarely undergo malignant transformation. The most common presentation is that of a solitary tumor, but multiple lesions may also be seen, which mandate evaluation for underlying neurofibromatosis type I and schwannomatosis.

Cutaneous schwannomas are often diagnosed after surgical excision based on their classical histopathology, The tumor is encapsulated by perineurium and characterized by two distinct histological patterns: Antoni type A and Antoni type B depicted distinctly in [Figure - 4]. The former is a highly ordered cellular pattern with spindle cells arranged in compact fascicles with their nuclei arranged in palisades. Verocay bodies are formed by the acellular processes that separate adjacent rows of palisaded nuclei within the Antoni type A tissue. Antoni type B tissue is less cellular with pale zones of gelatinous matrix and evidence of cystic, edematous or myxoid degeneration.[1] Clinically, palisaded encapsulated neuroma (PEN) also presents as a solitary flesh colored dome-shaped tumor but can be differentiated histologically. It is a partially encapsulated mass of interweaving fascicles of spindle cells separated by small clefts, located in the papillary dermis. Immunohistochemistry of schwannoma, as well as PEN, reveals positivity for S100 and collagen type IV, while the capsule stains for epithelial membrane antigen. Another close differential of schwannomas is malignant peripheral nerve sheath tumors. Apart from having fascicles of alternating cellularity and palisades as in schwannoma, malignant peripheral nerve sheath tumor may also have whorls or rosette-like arrangements, perineural/intraneural spread when associated with nerve, subendothelial accentuation of tumor cells and large areas of necrosis in a geographic pattern. Cellular nuclear atypia, mitotic figures and bizzare cells may also be seen. None of these features were observed in our case which helped us differentiate between the two.

Figure 4: The classical Antoni type A tissue is depicted with arrow and Antoni type B with star (×100, H and E). The inset shows a well formed Verocay body.

In our case a very superficial localization of the tumor was observed and differentials such as eccrine poroma, nodular basal cell carcinoma and amelanotic melanoma were considered. Since such superficial lesions of schwannoma are a rarity with scarce reports so far, dermoscopic features of the tumour have not yet been reported.[2],[3],[4] However, the absence of classical dermoscopic features of eccrine poroma such as irregular linear and branched vessels with semi-elliptical or semicircular endings (“chalice-form” and “cherry-blossoms” vessels) or structure-less pink-white areas [5] and the absence of halo around the vessels [6] raised our index of suspicion.

Apart from arborizing vessels and speckled pigmentation, no other characteristic dermoscopic feature of nodular basal cell carcinoma-was observed like leaf-like pattern or blue nests. Histology clinched the final diagnosis in our case.

The treatment involves complete excision while avoiding damage to the nerve of origin. Hence, it is prudent to consider schwannoma in such cases and perform a histopathological examination to circumvent risk of incomplete removal or damage to the parent nerve.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Kurtkaya-Yapicier O, Scheithauer B, Woodruff JM. The pathobiologic spectrum of schwannomas. Histol Histopathol 2003;18:925-34.
[Google Scholar]
2.
Cho SB, Kim HS, Paik JH, Ryu DJ, Oh SH. Dome-shaped tumour with surface changes on the abdominal wall. Clin Exp Dermatol 2010;35:95-6.
[Google Scholar]
3.
Choi YS, Shin MS, Park MY, Park HJ. Case of cystic schwannoma. J Dermatol 2008;35:751-3.
[Google Scholar]
4.
Noh S, Do JE, Park JM, Jee H, Oh SH. Cutaneous schwannoma presented as a pedunculated protruding mass. Ann Dermatol 2011;23 Suppl 2:S264-6.
[Google Scholar]
5.
Espinosa AE, Ortega BC, Venegas RQ, Ramírez RG. Dermoscopy of non-pigmented eccrine poromas: Study of Mexican cases. Dermatol Pract Concept 2013;3:25-8.
[Google Scholar]
6.
Ferrari A, Buccini P, Silipo V, De Simone P, Mariani G, Marenda S, et al. Eccrine poroma: A clinical-dermoscopic study of seven cases. Acta Derm Venereol 2009;89:160-4.
[Google Scholar]

Fulltext Views
575

PDF downloads
104
Show Sections