Enlarging tumor on the finger

Presenter: Sean Branch, DO., Tanya Ermolovich, D.O., Filomena Scola, D.O.
Dermatology Program: Lehigh Valley Hospital/ PCOM
Program Director: Stephen Purcell, D.O.
Submitted on: Apr 5, 2013

CHIEF COMPLAINT:  Enlarging lesion on the 3rd digit of her right hand for approximately three years

CLINICAL HISTORY:

Signs and symptoms:  Asymptomatic, pt only reports increased size

Previous Treatment:  Topical 17% salicylic acid x three weeks then discontinued due to significant irritation and bleeding

Other information:

PHYSICAL EXAM:

There is a large, firm, pink, pedunculated tumor measuring 4.5 x 4.5 cm emanating from the proximal nail fold on the 3rd digit of the right handB

 

Lateral view

 

Dorsal view

 

Post op

LABORATORY TESTS:

None

DERMATOHISTOPATHOLOGY:

On H&E sections the mass is sparsely populated by bland spindle cells with dense collagenization with focal myxoid areas. The overlaying skin is unremarkable. Immunohistochemical stains are negative for CD34, S100, EMA and SMA.

 

Low power (2x): The mass is sparsely populated by bland spindle cells with dense collagenization with focal myxoid areas

 

High power (20x)

DIFFERENTIAL DIAGNOSIS:

1.   Solitary fibrous tumor
2.   Fibroma of the tendon sheath
3.   Fibromyxoid sarcoma
4.   Sclerotic fibroma
5.   Nodular fasciitis


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