Enlarging Nodule on Right Middle Finger

Presenter: Valerie Johnson, D.O., Marya Cassandra, D.O., Greg Houck, D.O., Kristin Witfill, D.O., Matt Muellenhoff, D.O., Thi Tran, D.O.
Dermatology Program: Sun Coast Hospital (NOVA Southeastern University)
Program Director: Richard Miller, D.O.
Submitted on: Mar 30, 2004

CHIEF COMPLAINT:  Recurring and rapidly enlarging nodule on right middle finger

CLINICAL HISTORY:

Signs and symptoms:  Cosmetically disfiguring

Previous Treatment:  Previously excised by hand surgeon at age 2 months

Other information:  Mother concerned about the recurrence and prognosis.

PHYSICAL EXAM:

A 7 month-old, healthy appearing, well-nourished male presented with a 0.5cm firm, yellow-pink, dome-shaped nodule was noted on the right, lateral, distal third digit. An adjacent, well-healed scar from previous surgery was also present. There was no evidence of any physical impairment secondary to the growth.

LABORATORY TESTS:

none

DERMATOHISTOPATHOLOGY:

Microscopic description: This is a non-encapsulated tumor composed of spindle-shaped myofibroblasts intermixed with collagen bundles. It may extend from the epidermis down into the subcutaneous tissue. Myofibroblasts have pathognomic eosinophilic, cytoplasmic inclusion bodies, which stain red with Masson’s Trichrome, deep purple with phosphotungstic acid hematoxylin (PTAH). These inclusions are mostly aggregates of actin. (no histopathology available from our case therefore example taken from Bolognia)

DIFFERENTIAL DIAGNOSIS:

1.   Supernumerary digit
2.   Acral angiofibroma
3.   Acral fibrokeratoma
4.   Infantile digital fibroma
5.   None of the Above



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