Case for diagnosis
Tumor on the Great Toe of the Left Foot
Tumoración en el primer dedo del pie izquierdo
J. Bernat-García
, A. Mateu- Puchades, A. Marquina-Vila
Corresponding author
Servicio Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain
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Bernat-García, A. Mateu- Puchades, A. Marquina-Vila" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Bernat-García" "email" => array:1 [ 0 => "josefabernat@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Mateu- Puchades" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Marquina-Vila" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración en el primer dedo del pie izquierdo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 450 "Ancho" => 598 "Tamanyo" => 23997 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man presented with a slow-growing lesion that had appeared 4 years earlier on the great toe of his left foot. The patient reported recurring ingrowth of the nail on the same toe prior to the appearance of the lesion, as well as occasional episodes of self-limited bleeding. The lesion was not painful, except when the nail was ingrown or after minor trauma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion was a partially eroded polylobulated botryomycosis-like tumor with an indurated base and softer surface. It measured approximately 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm and covered the mid-distal part of the great toe of the left foot, displacing the nail (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathological findings showed anastomosing cords of epithelial cells connected to the epidermis and embedded in a fibrovascular stroma. The epithelial cords contained luminal cells of different sizes (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging disclosed a 3.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm multilobulated subungual nodule confined to the soft tissue, with no sign of bone destruction.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Eccrine syringofibroadenoma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was excised, resulting in definitive cure. No recurrence has been observed to date.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Eccrine syringofibroadenoma (ESFA) is a rare tumor that was described by Mascaró in 1963.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinical presentation varies, ranging from solitary lesions to multiple papules and nodules. The clinical classification Starink<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> proposed in 1997 named 4 subtypes: solitary ESFA, multiple ESFA as a marker of the Schöpf syndrome (ectodermal dysplasia), multiple ESFA with no associated skin findings, and nonhereditary unilateral linear ESFA (also referred to as unilateral linear nevoid syringofibroadenoma). Solitary ESFA, the most common type, usually forms in the distal region of the limbs. Histologically, the tumor is composed of thin cords and strands of epithelial cells in a network connected to the epidermis. Cells are paler than epidermal keratinocytes and luminal cells surrounded by an eosinophilic cuticle can often be found within cords. A highly fibrovascular stroma lies between the strands and the cords.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The histologic, ultrastructural, and immunohistochemical features reported in the literature suggest that this tumor has an acrosyringeal and eccrine intradermal ductal nature.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The pathogenesis of solitary ESFA is poorly understood. Some authors suggest that it is not a true benign neoplasm of the eccrine glands but rather reactive hyperplasia of the eccrine ducts as a response to repeated tissue damage (chronic ulcers, chronic lymphedema, burns, nail trauma, etc.).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this context, a new reactive subtype of solitary ESFA has been proposed.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> Our case, in which the lesion developed secondary to repeated ingrowth of the toenail, could be considered a reactive ESFA. Recent reports have described cases of solitary ESFA associated with squamous cell carcinoma and the malignant transformation of solitary ESFA. Histologically, this diagnosis must be differentiated from fibroepithelioma of Pinkus, tumors of the follicular infundibulum, and squamous cell carcinoma. Solitary ESFA is treated according to the number, site, and resectability of the lesions, and simple excision is the treatment of choice in solitary tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bernat-García J, et al. Tumoración en el primer dedo del pie izquierdo. Actas Dermosifiliogr. 2013;104:523–4.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 450 "Ancho" => 598 "Tamanyo" => 23997 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 613 "Ancho" => 750 "Tamanyo" => 150033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>10.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 503 "Ancho" => 750 "Tamanyo" => 134716 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Considerations on fibro-epithelial tumors: exocrine syringofibradenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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Starink" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(97)70245-7" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1997" "volumen" => "36" "paginaInicial" => "569" "paginaFinal" => "576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9092743" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibroadenoma cutáneo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Grilli" 1 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "L.Requena" "titulo" => "Neoplasias anexiales cutáneas" "paginaInicial" => "67" "paginaFinal" => "72" "serieFecha" => "2004" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of subungual reactive eccrine syringofibroadenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Theunis" 1 => "J. Andre" 2 => "F. Forton" 3 => "J. Wanet" 4 => "M. Song" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000051740" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2001" "volumen" => "203" "paginaInicial" => "185" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11586024" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of reactive eccrine syringofibroadenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Cho" 1 => "J.D. Lee" 2 => "S.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 7 | 20 |
| 2024 October | 96 | 36 | 132 |
| 2024 September | 101 | 18 | 119 |
| 2024 August | 142 | 66 | 208 |
| 2024 July | 115 | 26 | 141 |
| 2024 June | 88 | 26 | 114 |
| 2024 May | 85 | 27 | 112 |
| 2024 April | 83 | 26 | 109 |
| 2024 March | 80 | 31 | 111 |
| 2024 February | 76 | 34 | 110 |
| 2024 January | 81 | 33 | 114 |
| 2023 December | 67 | 25 | 92 |
| 2023 November | 89 | 29 | 118 |
| 2023 October | 87 | 22 | 109 |
| 2023 September | 89 | 24 | 113 |
| 2023 August | 77 | 16 | 93 |
| 2023 July | 88 | 42 | 130 |
| 2023 June | 90 | 37 | 127 |
| 2023 May | 119 | 25 | 144 |
| 2023 April | 82 | 45 | 127 |
| 2023 March | 51 | 40 | 91 |
| 2023 February | 79 | 22 | 101 |
| 2023 January | 47 | 33 | 80 |
| 2022 December | 59 | 63 | 122 |
| 2022 November | 28 | 27 | 55 |
| 2022 October | 31 | 21 | 52 |
| 2022 September | 34 | 41 | 75 |
| 2022 August | 39 | 32 | 71 |
| 2022 July | 37 | 42 | 79 |
| 2022 June | 27 | 32 | 59 |
| 2022 May | 83 | 38 | 121 |
| 2022 April | 116 | 35 | 151 |
| 2022 March | 114 | 59 | 173 |
| 2022 February | 125 | 30 | 155 |
| 2022 January | 112 | 42 | 154 |
| 2021 December | 70 | 37 | 107 |
| 2021 November | 93 | 42 | 135 |
| 2021 October | 79 | 58 | 137 |
| 2021 September | 66 | 40 | 106 |
| 2021 August | 81 | 28 | 109 |
| 2021 July | 56 | 22 | 78 |
| 2021 June | 73 | 40 | 113 |
| 2021 May | 66 | 44 | 110 |
| 2021 April | 212 | 45 | 257 |
| 2021 March | 138 | 24 | 162 |
| 2021 February | 130 | 36 | 166 |
| 2021 January | 80 | 25 | 105 |
| 2020 December | 80 | 17 | 97 |
| 2020 November | 77 | 13 | 90 |
| 2020 October | 94 | 10 | 104 |
| 2020 September | 75 | 12 | 87 |
| 2020 August | 80 | 29 | 109 |
| 2020 July | 79 | 17 | 96 |
| 2020 June | 65 | 23 | 88 |
| 2020 May | 55 | 21 | 76 |
| 2020 April | 43 | 28 | 71 |
| 2020 March | 45 | 17 | 62 |
| 2020 February | 6 | 7 | 13 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 8 | 4 | 12 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 8 | 2 | 10 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 4 | 5 | 9 |
| 2019 June | 3 | 13 | 16 |
| 2019 May | 5 | 8 | 13 |
| 2019 April | 2 | 8 | 10 |
| 2019 March | 2 | 7 | 9 |
| 2019 February | 2 | 2 | 4 |
| 2019 January | 1 | 1 | 2 |
| 2018 December | 1 | 5 | 6 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 0 | 4 |
| 2018 March | 1 | 1 | 2 |
| 2018 February | 30 | 1 | 31 |
| 2018 January | 42 | 4 | 46 |
| 2017 December | 45 | 6 | 51 |
| 2017 November | 45 | 1 | 46 |
| 2017 October | 44 | 4 | 48 |
| 2017 September | 32 | 3 | 35 |
| 2017 August | 24 | 4 | 28 |
| 2017 July | 52 | 8 | 60 |
| 2017 June | 47 | 15 | 62 |
| 2017 May | 37 | 7 | 44 |
| 2017 April | 32 | 8 | 40 |
| 2017 March | 41 | 25 | 66 |
| 2017 February | 55 | 5 | 60 |
| 2017 January | 33 | 8 | 41 |
| 2016 December | 43 | 3 | 46 |
| 2016 November | 68 | 20 | 88 |
| 2016 October | 55 | 15 | 70 |
| 2016 September | 72 | 7 | 79 |
| 2016 August | 53 | 6 | 59 |
| 2016 July | 24 | 8 | 32 |
| 2016 June | 6 | 4 | 10 |
| 2016 May | 4 | 7 | 11 |
| 2016 April | 3 | 6 | 9 |
| 2016 March | 2 | 1 | 3 |
| 2016 February | 7 | 3 | 10 |
| 2016 January | 8 | 0 | 8 |
| 2015 December | 6 | 1 | 7 |
| 2015 November | 20 | 4 | 24 |
| 2015 October | 24 | 4 | 28 |
| 2015 September | 9 | 1 | 10 |
| 2015 August | 7 | 2 | 9 |
| 2015 July | 47 | 19 | 66 |
| 2015 June | 32 | 3 | 35 |
| 2015 May | 44 | 10 | 54 |
| 2015 April | 23 | 7 | 30 |
| 2015 March | 32 | 2 | 34 |
| 2015 February | 23 | 5 | 28 |
| 2015 January | 31 | 4 | 35 |
| 2014 December | 37 | 11 | 48 |
| 2014 November | 27 | 10 | 37 |
| 2014 October | 38 | 4 | 42 |
| 2014 September | 37 | 6 | 43 |
| 2014 August | 31 | 6 | 37 |
| 2014 July | 26 | 4 | 30 |
| 2014 June | 41 | 5 | 46 |
| 2014 May | 37 | 7 | 44 |
| 2014 April | 31 | 2 | 33 |
| 2014 March | 45 | 9 | 54 |
| 2014 February | 26 | 9 | 35 |
| 2014 January | 29 | 14 | 43 |
| 2013 December | 30 | 6 | 36 |
| 2013 November | 13 | 4 | 17 |
| 2013 October | 9 | 2 | 11 |
| 2013 September | 3 | 6 | 9 |
| 2013 August | 1 | 12 | 13 |
| 2013 July | 6 | 2 | 8 |
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