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
Autor para correspondencia
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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 7 | 20 |
| 2024 Octubre | 96 | 36 | 132 |
| 2024 Septiembre | 101 | 18 | 119 |
| 2024 Agosto | 142 | 66 | 208 |
| 2024 Julio | 115 | 26 | 141 |
| 2024 Junio | 88 | 26 | 114 |
| 2024 Mayo | 85 | 27 | 112 |
| 2024 Abril | 83 | 26 | 109 |
| 2024 Marzo | 80 | 31 | 111 |
| 2024 Febrero | 76 | 34 | 110 |
| 2024 Enero | 81 | 33 | 114 |
| 2023 Diciembre | 67 | 25 | 92 |
| 2023 Noviembre | 89 | 29 | 118 |
| 2023 Octubre | 87 | 22 | 109 |
| 2023 Septiembre | 89 | 24 | 113 |
| 2023 Agosto | 77 | 16 | 93 |
| 2023 Julio | 88 | 42 | 130 |
| 2023 Junio | 90 | 37 | 127 |
| 2023 Mayo | 119 | 25 | 144 |
| 2023 Abril | 82 | 45 | 127 |
| 2023 Marzo | 51 | 40 | 91 |
| 2023 Febrero | 79 | 22 | 101 |
| 2023 Enero | 47 | 33 | 80 |
| 2022 Diciembre | 59 | 63 | 122 |
| 2022 Noviembre | 28 | 27 | 55 |
| 2022 Octubre | 31 | 21 | 52 |
| 2022 Septiembre | 34 | 41 | 75 |
| 2022 Agosto | 39 | 32 | 71 |
| 2022 Julio | 37 | 42 | 79 |
| 2022 Junio | 27 | 32 | 59 |
| 2022 Mayo | 83 | 38 | 121 |
| 2022 Abril | 116 | 35 | 151 |
| 2022 Marzo | 114 | 59 | 173 |
| 2022 Febrero | 125 | 30 | 155 |
| 2022 Enero | 112 | 42 | 154 |
| 2021 Diciembre | 70 | 37 | 107 |
| 2021 Noviembre | 93 | 42 | 135 |
| 2021 Octubre | 79 | 58 | 137 |
| 2021 Septiembre | 66 | 40 | 106 |
| 2021 Agosto | 81 | 28 | 109 |
| 2021 Julio | 56 | 22 | 78 |
| 2021 Junio | 73 | 40 | 113 |
| 2021 Mayo | 66 | 44 | 110 |
| 2021 Abril | 212 | 45 | 257 |
| 2021 Marzo | 138 | 24 | 162 |
| 2021 Febrero | 130 | 36 | 166 |
| 2021 Enero | 80 | 25 | 105 |
| 2020 Diciembre | 80 | 17 | 97 |
| 2020 Noviembre | 77 | 13 | 90 |
| 2020 Octubre | 94 | 10 | 104 |
| 2020 Septiembre | 75 | 12 | 87 |
| 2020 Agosto | 80 | 29 | 109 |
| 2020 Julio | 79 | 17 | 96 |
| 2020 Junio | 65 | 23 | 88 |
| 2020 Mayo | 55 | 21 | 76 |
| 2020 Abril | 43 | 28 | 71 |
| 2020 Marzo | 45 | 17 | 62 |
| 2020 Febrero | 6 | 7 | 13 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 8 | 4 | 12 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 8 | 2 | 10 |
| 2019 Agosto | 4 | 4 | 8 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 3 | 13 | 16 |
| 2019 Mayo | 5 | 8 | 13 |
| 2019 Abril | 2 | 8 | 10 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 2 | 2 | 4 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 1 | 5 | 6 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 30 | 1 | 31 |
| 2018 Enero | 42 | 4 | 46 |
| 2017 Diciembre | 45 | 6 | 51 |
| 2017 Noviembre | 45 | 1 | 46 |
| 2017 Octubre | 44 | 4 | 48 |
| 2017 Septiembre | 32 | 3 | 35 |
| 2017 Agosto | 24 | 4 | 28 |
| 2017 Julio | 52 | 8 | 60 |
| 2017 Junio | 47 | 15 | 62 |
| 2017 Mayo | 37 | 7 | 44 |
| 2017 Abril | 32 | 8 | 40 |
| 2017 Marzo | 41 | 25 | 66 |
| 2017 Febrero | 55 | 5 | 60 |
| 2017 Enero | 33 | 8 | 41 |
| 2016 Diciembre | 43 | 3 | 46 |
| 2016 Noviembre | 68 | 20 | 88 |
| 2016 Octubre | 55 | 15 | 70 |
| 2016 Septiembre | 72 | 7 | 79 |
| 2016 Agosto | 53 | 6 | 59 |
| 2016 Julio | 24 | 8 | 32 |
| 2016 Junio | 6 | 4 | 10 |
| 2016 Mayo | 4 | 7 | 11 |
| 2016 Abril | 3 | 6 | 9 |
| 2016 Marzo | 2 | 1 | 3 |
| 2016 Febrero | 7 | 3 | 10 |
| 2016 Enero | 8 | 0 | 8 |
| 2015 Diciembre | 6 | 1 | 7 |
| 2015 Noviembre | 20 | 4 | 24 |
| 2015 Octubre | 24 | 4 | 28 |
| 2015 Septiembre | 9 | 1 | 10 |
| 2015 Agosto | 7 | 2 | 9 |
| 2015 Julio | 47 | 19 | 66 |
| 2015 Junio | 32 | 3 | 35 |
| 2015 Mayo | 44 | 10 | 54 |
| 2015 Abril | 23 | 7 | 30 |
| 2015 Marzo | 32 | 2 | 34 |
| 2015 Febrero | 23 | 5 | 28 |
| 2015 Enero | 31 | 4 | 35 |
| 2014 Diciembre | 37 | 11 | 48 |
| 2014 Noviembre | 27 | 10 | 37 |
| 2014 Octubre | 38 | 4 | 42 |
| 2014 Septiembre | 37 | 6 | 43 |
| 2014 Agosto | 31 | 6 | 37 |
| 2014 Julio | 26 | 4 | 30 |
| 2014 Junio | 41 | 5 | 46 |
| 2014 Mayo | 37 | 7 | 44 |
| 2014 Abril | 31 | 2 | 33 |
| 2014 Marzo | 45 | 9 | 54 |
| 2014 Febrero | 26 | 9 | 35 |
| 2014 Enero | 29 | 14 | 43 |
| 2013 Diciembre | 30 | 6 | 36 |
| 2013 Noviembre | 13 | 4 | 17 |
| 2013 Octubre | 9 | 2 | 11 |
| 2013 Septiembre | 3 | 6 | 9 |
| 2013 Agosto | 1 | 12 | 13 |
| 2013 Julio | 6 | 2 | 8 |
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