甲下浅表性肢端纤维粘液瘤1例

Superficial acral fibromyxoma:A case report

报告甲下浅表性肢端纤维粘液瘤1例。患者女,74岁,因右足拇趾甲下肿物2个月就诊。皮肤科检查:右足拇趾甲床部位见一大小约3.0 cm×2.0 cm×1.0 cm的红色肿物,质韧,压痛(+),甲板缺如。体表肿物超声:拇趾探及范围约21 mm×20 mm低回声包块,内回声不均,呈囊实混合性。右足DR:拇趾软组织肿胀,骨质未见明显异常。皮损组织病理示:表皮角化过度、角化不全,部分棘层增厚,真皮浅层水肿,小血管增多,见梭形细胞及星状增生,纤维组织增多,血管周围少量淋巴细胞浸润。阿辛蓝染色(+)。免疫组化:CD34局灶性阳性、Vimentin弥漫性阳性,S-100、Desmin、Actin、CD31、HHV-8均阴性。诊断:甲下浅表性肢端纤维粘液瘤。予手术切除肿物,术后甲床愈合良好,随访未见复发。

We report a case of subungual superficial acral fibromyxoma in a 74-year-old woman,who had a subungual neoplasm on the right big toe for 2 months.Dermatological examination revealed a red tumor about 3.0 cm×2.0 cm×1.0 cm in size at the nail bed of the right big toenail and onychomadesis.Ultrasound examination of the tumor showed a hypoechoic mass about 21 mm×20 mm in size with an uneven internal echoes of mixed cysts and solids under the right big toe.Digital Radiography of the right foot showed swollen soft tissue of the right big toe,with no changes in bone.Histological changes included epidermal hyperkeratosis and parakeratosis,and partial thickening of spinous layers along with edema of the superficial dermis.There were increases in small blood vessels,fibrous tissue,spindle cells and stellate cells,in addition to perivascular infiltrates of lymphocytes.Alcian blue staining was positive.Immunohistochemistry showed positive for CD34 and Vimentin,and negative for S-100,Desmin,Actin,CD31 and HHV-8.Diagnosis was superficial acral fibromyxoma.The nail bed was healed well after surgical removal of the tumor,and no recurrence was observed.