Case for Diagnosis
Rapidly Growing Tumor on the Left Big Toe
Tumor de rápido crecimiento en el primer dedo del pie derecho
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Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor de rápido crecimiento en el primer dedo del pie derecho" ] ] "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" => 748 "Ancho" => 500 "Tamanyo" => 53346 ] ] ] ] "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 71-year-old man presented with a lesion on the first toe of the right foot that had appeared 4 months earlier.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a firm tumor (largest diameter approximately 2<span class="elsevierStyleHsp" style=""></span>cm) that was located on the lateral and plantar aspects of the first toe of the right foot and caused no discoloration of the overlying skin (<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">Histopathology showed a well-defined lesion consisting of nonatypical stellate and fusiform fibroblasts and myofibroblasts on a background of thick, dense collagen, with myxoid areas and sparse capillaries that were neither atypical nor prominent (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These cells were positive for vimentin, focally positive for smooth muscle actin, and negative for CD34, desmin, S100, β-catenin, AE1/AE3, and epithelial membrane antigen (EMA). Ki67 immunostaining revealed a cell proliferation index of 1%.</p><elsevierMultimedia ident="fig0010"></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 (MRI) was requested, and showed a hypointense nodular lesion with smooth and slightly lobulated borders located in the subcutaneous fatty tissue at the level of the distal phalanx. A fat plane was evident between the lesion and adjacent osteotendinous structures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">No enhancement was observed after contrast administration.</p><p id="par0030" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Desmoplastic fibroblastoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">The lesion was completely excised, and there was no evidence of recurrence after 18 months of follow-up.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Desmoplastic fibroblastoma, also known as collagenous fibroma, is a benign soft-tissue tumor that was first described by Evans in 1995.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The largest series (63 patients) was published by Miettinen in 1998.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Incidence of this rare entity is higher in men than women, and the median age at diagnosis is 50 years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It usually manifests as a well-defined, rounded painless mass that grows slowly, although our patient’s tumor was fast-growing. Although typically small, this tumor can reach sizes of over 20<span class="elsevierStyleHsp" style=""></span>cm. It is usually located on the upper limbs, lower limbs, and trunk, although intraoral,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> genital,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and intrathoracic<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> presentations have been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Desmoplastic fibroblastoma originates predominantly in subcutaneous or intramuscular cell tissue and, in rare cases, in bone.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Histologically, it is characterized by low cellularity and the presence of medium-sized fibroblasts on a fibromyxoid background with abundant collagen. The fibroblasts have a reactive appearance, with normochromic nuclei, visible nucleoli, and amphophilic cytoplasm. The borders are well defined, although interdigitation with fat or muscle tissue may be observed. Immunohistochemistry shows diffuse labeling for vimentin, focal positivity for actin, desmin, cytokeratin, and S-100, and negative staining for β-catenin, EMA, and CD34.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The chromosomal translocations t(2,11) and t(11,17), which affect 11q12, have been detected in this tumor. The FOSL1 gene is located nearby (at 11q13.1) and the FOSL1 protein is overexpressed, as evidenced by strong diffuse nuclear immunoreactivity for FOSL1 on immunohistochemistry. This immunoreactivity is useful to differentiate desmoplastic fibroblastoma from other diseases such as tendon sheath fibroma, although unfortunately this technique is currently not routinely available.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The differential diagnosis includes benign and malignant fibrous tumors and reactive processes, the most common of which are nodular fasciitis, extra-abdominal fibromatosis, tendon sheath fibroma, neurofibroma, calcifying fibrous tumor, desmoid tumor, and low-grade fibromyxoid sarcoma.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Treatment consists of complete removal of the lesion, and the incidence of recurrence is low.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 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" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-19" "fechaAceptado" => "2019-03-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alcántara-González J, Carolina Pérez González Y, Rodríguez-Lopez T. Tumor de rápido crecimiento en el primer dedo del pie derecho. Actas Dermosifiliogr. 2021;112:167–168.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 748 "Ancho" => 500 "Tamanyo" => 53346 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1093 "Ancho" => 1500 "Tamanyo" => 436550 ] ] ] ] "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" => "Desmoplastic fibroblastoma: a report of seven cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.L. 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| año/Mes | Html | Total | |
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| 2024 Noviembre | 13 | 14 | 27 |
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| 2024 Septiembre | 124 | 28 | 152 |
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