Case and Research Letters
Acral Nodular Lesion Following Trauma
Lesión nodular acral tras traumatismo
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Células fusiformes inmersas en un estroma mixoide. Vasos de pequeño tamaño y paredes finas junto con algún mastocito aislado (hematoloxilina-eosina<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200). b. Inmunorreactividad para CD34 de las células neoplásicas (×<span class="elsevierStyleHsp" style=""></span>200).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Martínez-Leboráns, A. Martínez-Aparicio, V. Alegre de Miguel" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Martínez-Leboráns" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Aparicio" ] 2 => array:2 [ "nombre" => "V." 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Martínez-Leboráns, A. Martínez-Aparicio, V. Alegre de Miguel" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Martínez-Leboráns" "email" => array:1 [ 0 => "lorenamarleb@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Martínez-Aparicio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Alegre de Miguel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión nodular acral tras traumatismo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1750 "Ancho" => 575 "Tamanyo" => 87785 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nodule in contact with soft tissue. No bone involvement is observed on the radiograph.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 37-year-old man with no personal history of interest who came to our department with a lesion on the dorsum of the distal phalanx of the third finger of his right hand. The lesion had first appeared after an injury a few months earlier. It had deformed the nail and was painful on palpation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a solid subungual tumor that deformed the nail in such a way that the curvature was increased both longitudinally and transversally (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A punch biopsy of the lesion was performed after avulsion of the nail plate. Staining with hematoxylin-eosin revealed a well-defined nodular tumor in the dermis that spared the Grenz zone. Greater magnification revealed that the tumor was composed of a very dense population of spindle-shaped cells that were stellate in appearance with an eosinophilic cytoplasm and surrounded by a myxoid stroma with abundant vessels and isolated mastocytes. The vessels were small and had fine walls lined by endothelial cells with no atypia. Immunohistochemical staining for CD34, S100, and epithelial membrane antigen was only positive for CD34 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The correlation between clinical and histology findings confirmed the diagnosis of superficial acral fibromyxoma.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A plain radiograph taken before surgery revealed a nodule attached to the soft tissue, with no bone involvement (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Once the diagnosis was confirmed, the lesion was removed completely. First, the area was anesthetized using digital block with mepivacaine. Second, after application of local ischemia at the base of the finger, a small transverse incision was made in the eponychium in order to better visualize the extent of the lesion. Third, the lesion was dissected carefully and removed. Finally, curettage was performed on the nail bed and the eponychium was sutured. The patient continues to be followed in our department. No recurrence of the tumor has been observed, and the cosmetic outcome is good.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Superficial acral fibromyxoma is a benign tumor that was first described by Fetsch et al. in 2001.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It is more common on the fingers and toes of middle-aged men. Clinically, it presents as a solid, well-defined, solitary nodule. The nail is involved in as many as 50% of cases.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a> Diagnosis is usually delayed because of the slow growth of this type of lesion.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathology reveals a well-defined, nonencapsulated tumor affecting the dermis and, sometimes, the subcutaneous cellular tissue. In most lesions, a Grenz zone is visible with no involvement of the epidermis. The tumor is composed of spindle-shaped cell bundles with pale eosinophilic cytoplasm and basophilic nuclei. These cells are immersed in areas of dense hyaline collagen and other areas of myxoid stroma. In most cases, we can see mastocytes and small vessels. Cellular necrosis and lymphovascular invasion are not usually present.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1–8</span></a> Immunohistochemical staining is positive for CD34, CD99, and epithelial membrane antigen and negative for S-100, muscle-specific actin, and glial fibrillary acidic protein.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically, it is important to differentiate this tumor from cellular digital fibroma, a CD34-positive tumor composed of spindle-shaped cells with a less myxoid stroma than in acral fibromyxoma that does not show immunoreactivity for epithelial membrane antigen or CD99. The differential diagnosis also includes myxoid neurofibroma, superficial angiomyxoma, fibrous histiocytoma, dermatofibrosarcoma protuberans, and onychomatricoma, owing to the histological characteristics shared by these tumors (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment is based on surgical removal, although the tumor can recur in as many as 20% of cases if the excision is not complete.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></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: Martínez-Leboráns L, Martínez-Aparicio A, Alegre de Miguel V. Lesión nodular acral tras traumatismo. Actas Dermosifiliogr. 2015;106:841–843.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 800 "Tamanyo" => 132173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Longitudinal and transverse deformity of the nail plate on the third finger of the right hand.</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" => 657 "Ancho" => 1751 "Tamanyo" => 705522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Spindle-shaped cells immersed in a myxoid stroma. Small, fine-walled vessels together with occasional mastocytes (hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200). B, CD34 immunoreactivity in neoplastic cells (×<span class="elsevierStyleHsp" style=""></span>200).</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" => 1750 "Ancho" => 575 "Tamanyo" => 87785 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nodule in contact with soft tissue. No bone involvement is observed on the radiograph.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: EMA, epithelial membrane antigen; HMB, human melanoma black.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Clinical Findings \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Histology \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Superficial acral fibromyxoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Solitary nodule in the distal area of the extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spindle-shaped cells immersed in a myxoid stromaPositive for CD34, CD99, and EMANegative for S-100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cellular digital fibroma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Small nodule on the fingers and toes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">More cellular tumorDense collagen in the dermisPositive for CD34 and factor XIIIaNegative for EMA and S-100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatofibrosarcoma protuberans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Variable appearance depending on time since onset.Acral presentation is extremely rare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spindle-shaped cells with a storiform patternPositive for CD34, actin, and vimentinNegative for S100, HMB-45, and factor XIIIa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Superficial angiomyxoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flesh-colored papule or nodule found mainly on the trunk and lower extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multilobulated, poorly defined tumor formed by spindle-shaped cells with a myxoid stroma. Inflammatory infiltrate with neutrophilsPositive for actin and vimentinNegative for S100 and factor XIIIa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Benign fibrous histiocytoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brown nodule or papule, pink on lower limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Poorly defined tumor. Bundles of spindle-shaped cells in a myxoid stroma. Collections of hyalinized collagen in the dermisPositive for factor XIIIaNegative for CD34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onychomatricoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Longitudinal and transverse thickening of the nail plate. Splinter hemorrhages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nail plate with fibrovascular projections covered with keratinizing epithelium in the matrix, together with empty cavities \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab957384.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Differential Diagnosis of Superficial Acral Fibromyxoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "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" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. 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| año/Mes | Html | Total | |
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| 2021 Diciembre | 30 | 36 | 66 |
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| 2021 Agosto | 37 | 29 | 66 |
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| 2020 Noviembre | 26 | 13 | 39 |
| 2020 Octubre | 24 | 18 | 42 |
| 2020 Septiembre | 43 | 9 | 52 |
| 2020 Agosto | 25 | 19 | 44 |
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| 2020 Abril | 32 | 27 | 59 |
| 2020 Marzo | 37 | 16 | 53 |
| 2020 Febrero | 1 | 1 | 2 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Agosto | 4 | 0 | 4 |
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| 2019 Junio | 4 | 0 | 4 |
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| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 8 | 0 | 8 |
| 2018 Diciembre | 8 | 0 | 8 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 1 | 7 |
| 2018 Agosto | 0 | 2 | 2 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 44 | 1 | 45 |
| 2018 Enero | 25 | 4 | 29 |
| 2017 Diciembre | 65 | 8 | 73 |
| 2017 Noviembre | 23 | 1 | 24 |
| 2017 Octubre | 30 | 5 | 35 |
| 2017 Septiembre | 17 | 4 | 21 |
| 2017 Agosto | 25 | 3 | 28 |
| 2017 Julio | 11 | 9 | 20 |
| 2017 Junio | 25 | 11 | 36 |
| 2017 Mayo | 29 | 7 | 36 |
| 2017 Abril | 26 | 10 | 36 |
| 2017 Marzo | 25 | 40 | 65 |
| 2017 Febrero | 15 | 7 | 22 |
| 2017 Enero | 16 | 5 | 21 |
| 2016 Diciembre | 28 | 7 | 35 |
| 2016 Noviembre | 32 | 11 | 43 |
| 2016 Octubre | 25 | 23 | 48 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Junio | 1 | 1 | 2 |
| 2016 Mayo | 0 | 1 | 1 |
| 2016 Abril | 0 | 2 | 2 |
| 2016 Enero | 0 | 4 | 4 |
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