Case and Research Letters
Distal Digital Myopericytoma: A Dermoscopic Case Study
Miopericitoma digital distal: estudio dermatoscópico de un caso
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Reporte de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 97407 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermal spindle melanocytes located between collagen and perivascular fibers (S100 staining, original magnification ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Marín Hernández, Y. Calderón Ponce de León, V. Bautista Piña, L. Sánchez Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Marín Hernández" ] 1 => array:2 [ "nombre" => "Y." 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Boix-Vilanova, L.J. del Pozo Hernando, H. Rodrigo Lara, O. Corral-Magaña" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Boix-Vilanova" "email" => array:1 [ 0 => "julian.boix@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.J." "apellidos" => "del Pozo Hernando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "H." "apellidos" => "Rodrigo Lara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "O." "apellidos" => "Corral-Magaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miopericitoma digital distal: estudio dermatoscópico de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 900 "Tamanyo" => 84051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) The hyperkeratotic lesion on the pulp of the finger. B) Dermoscopic image showing hemorrhagic areas and hyperkeratosis against a pinkish-orange background.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Myopericytomas are classified as benign pericytic (perivascular) soft-tissue tumors by the World Health Organization.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a> Fewer than 200 cases of this rare tumor have been described in the literature, and fewer than 30 on the hands have been reported.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 48-year-old man with no relevant medical history who consulted us for a lesion that had appeared 9 months earlier on the pulp of the third finger of his right hand. He attributed it to an injury. Examination showed a hyperkeratotic lesion measuring 6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Under a dermoscope the lesion appeared pinkish-orange in color. Hemorrhagic areas and a well-defined collar were visible on the periphery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Pathology revealed a hyperkeratotic epidermis without atypia and with hemorrhagic areas in the stratum corneum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A proliferation of spindle cells in intersecting bundles surrounded thick-walled small-caliber vessels; no endothelial atypia was evident (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The cells — especially those closest to vessels — were positive for actin and h-caldesmon; 10% stained positive for Ki-67 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The etiology of myopericytoma is unknown, but cases have been reported in association with injuries, compromised immunity, and Epstein-Barr virus infection.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Myopericytomas usually present as well-defined nodules less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter. They are slow-growing masses that are usually located on the upper extremities, head, or neck but may appear at any site.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The sensitivity of images obtained by magnetic resonance or ultrasound, for example, is low. Histology shows myopericytomas to be well-circumscribed, unencapsulated, and composed of oval myoid-appearing cells. Atypia and mitotic activity are absent. An eosinophilic or amphophilic cytoplasm usually surrounds the vessels. Immunohistochemistry detects positive staining for smooth-muscle actin and h-Caldesmon; findings are usually negative for desmin.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Five histologic patterns have been described in myopericytoma, as follows, possibly corresponding to different stages of development: 1) a vascular pattern; 2) a glomus tumor-like pattern; 3) a nodular or cellular pattern, as in our case; 4) a multinodular or biphasic appearance; and 5) a piloleiomyoma-like pattern.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Also described is a malignant variant with cellular pleomorphism, high mitotic activity and atypia, areas of necrosis, and an aggressive clinical course that can lead to metastasis and death.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis mainly considers the possibility of myofibromatosis, in which cells like those of myofibroblasts are found but grouped together and separated by collagen bundles. Glomus tumors must also be ruled out. These unencapsulated masses consist of nodules surrounded by connective tissue. Finally, angioleiomyomas must be considered. These tumors are usually well defined by a fibrous capsule of variable thickness consisting mainly of smooth muscle bundles lying among blood vessels in a fascicular pattern.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We found a single reference for dermoscopic findings in myopericytoma. Mentioned were the presence of branching vessels on the surface.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> The hemorrhagic areas we observed under the dermoscope were related to extravasated blood cells in the dermis (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The unstructured orange-colored area corresponded to hemosiderin deposits. Tumor cells by themselves apparently do not give rise to a particular dermoscopic pattern. The clinical–dermoscopic differential diagnosis in our case would require consideration of other distal subungual lesions of the digits, such as subungual exostosis, which is characterized by areas of vascular ectasia, hyperkeratosis, onycholysis, and ulceration.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Other such lesions are palmar–plantar warts, in which unstructured brownish-yellow and reddish-black globules corresponding to thrombosed vessels can be observed.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> These findings recall those we have described for this case of myopericytoma. Tungiasis may also present in a distal digital location, although the observation of a brownish circular area with a black dot in the center, which corresponds to the posterior part of the parasite's abdomen,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> makes this infestation difficult to confuse with a myopericytoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The recurrence rate after surgery, even when excision is incomplete, is less than 4%,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> and surgery is therefore the treatment of choice. Our case is consistent with this decision, given that no recurrence was observed after a year of follow-up even though the deep margin was still affected after excision.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, in this new case of myopericytoma, a rare tumor associated with a history of trauma, the finger remained free of recurrence a year after incomplete excision. We have also described the dermoscopic appearance of the lesion. The only other reference to dermoscopic features we found in the literature differed from the ones we saw. More cases of myopericytoma should be reported and should include the appearance of these lesions under a dermoscope so that the characteristic patterns can be established.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Boix-Vilanova J, del Pozo Hernando LJ, Rodrigo Lara H, Corral-Magaña O. Miopericitoma digital distal: estudio dermatoscópico de un caso. Actas Dermosifiliogr. 2020;111:338–341.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1346 "Ancho" => 900 "Tamanyo" => 84051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) The hyperkeratotic lesion on the pulp of the finger. B) Dermoscopic image showing hemorrhagic areas and hyperkeratosis against a pinkish-orange background.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 571 "Ancho" => 1500 "Tamanyo" => 146305 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Hemorrhagic areas in the stratum corneum of the epidermis. Hematoxylin-eosin (HE) ×20. B) Perivascular myoid cells can be observed in the center. HE ×40.</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" => 1126 "Ancho" => 1500 "Tamanyo" => 465506 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry staining positive for A) caldesmon (×40), B) actin (×40), C) CD31 (×20), and D) CD34 (×40). C and D also show myoid cells arranged concentrically around endothelial cells.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO classification of tumours of soft tissue and bone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.D.M. Fletcher" 1 => "J.A. Bridge" 2 => "P.C.W. Hogendoorn" 3 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 9 | 12 |
| 2024 October | 76 | 30 | 106 |
| 2024 September | 67 | 28 | 95 |
| 2024 August | 99 | 51 | 150 |
| 2024 July | 74 | 26 | 100 |
| 2024 June | 66 | 31 | 97 |
| 2024 May | 60 | 30 | 90 |
| 2024 April | 76 | 21 | 97 |
| 2024 March | 79 | 28 | 107 |
| 2024 February | 75 | 39 | 114 |
| 2024 January | 52 | 33 | 85 |
| 2023 December | 56 | 13 | 69 |
| 2023 November | 77 | 41 | 118 |
| 2023 October | 72 | 20 | 92 |
| 2023 September | 68 | 33 | 101 |
| 2023 August | 59 | 15 | 74 |
| 2023 July | 59 | 34 | 93 |
| 2023 June | 56 | 25 | 81 |
| 2023 May | 68 | 27 | 95 |
| 2023 April | 44 | 28 | 72 |
| 2023 March | 75 | 28 | 103 |
| 2023 February | 66 | 22 | 88 |
| 2023 January | 48 | 26 | 74 |
| 2022 December | 58 | 31 | 89 |
| 2022 November | 44 | 36 | 80 |
| 2022 October | 30 | 24 | 54 |
| 2022 September | 44 | 38 | 82 |
| 2022 August | 31 | 39 | 70 |
| 2022 July | 35 | 64 | 99 |
| 2022 June | 34 | 37 | 71 |
| 2022 May | 73 | 36 | 109 |
| 2022 April | 64 | 29 | 93 |
| 2022 March | 71 | 57 | 128 |
| 2022 February | 60 | 38 | 98 |
| 2022 January | 79 | 39 | 118 |
| 2021 December | 71 | 38 | 109 |
| 2021 November | 68 | 39 | 107 |
| 2021 October | 77 | 58 | 135 |
| 2021 September | 58 | 40 | 98 |
| 2021 August | 64 | 31 | 95 |
| 2021 July | 49 | 23 | 72 |
| 2021 June | 40 | 24 | 64 |
| 2021 May | 54 | 30 | 84 |
| 2021 April | 162 | 36 | 198 |
| 2021 March | 81 | 31 | 112 |
| 2021 February | 58 | 17 | 75 |
| 2021 January | 46 | 20 | 66 |
| 2020 December | 38 | 15 | 53 |
| 2020 November | 26 | 9 | 35 |
| 2020 October | 35 | 20 | 55 |
| 2020 September | 34 | 26 | 60 |
| 2020 August | 36 | 23 | 59 |
| 2020 July | 47 | 13 | 60 |
| 2020 June | 69 | 35 | 104 |
| 2020 May | 53 | 23 | 76 |
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