Abstract
Background & Aims
A 29-year-old male presented to a university podiatry clinic, complaining of a slow growing mass under the right hallux nail. The growth was mostly asymptomatic except for mild discomfort in footwear. The clinical appearance of the tumour resembled a subungual exostosis, but on examination the mass was not deemed to be osteophytic and an x-ray was arranged. The radiographic report confirmed no significant bony protuberance in the hallux which supported clinical diagnosis that this was not an exostosis, but instead a soft-tissue neoplasm. Following pre-operative assessment, the patient was scheduled for total nail avulsion surgery with view to excising the subungual tumour and confirming diagnosis. Vascular and neurological findings were unremarkable and there were no contraindications to surgery. The surgical practitioner, a Podiatrist and Senior Lecturer, had recently undertaken extended scope training in Skin Surgery and the procedure was performed at the university teaching clinic.
Method
Following successful analgesia and total nail avulsion, a semi-solid spherical mass was exposed. Longitudinal excision through the lesion revealed a well-circumscribed neoplasm which macroscopically resembled connective tissue. On revealing the depth of the lesion and confirming no cartilage or bone involvement, the mass was excised in two halves using a 15 blade and skin forceps. Any remaining fibrotic debris was curetted from the nail bed. The excised specimen was sent for histopathology analysis.
Results
Microscopy revealed a circumscribed but nonencapsulated dermal tumour measuring 20x10x5mm and 18x10x5mm, comprising of bland spindle and stellate cells within a myxoid stroma and with prominent vessels. There were no malignant features, but margins were not clear of the tumour. In view of histopathological features and immunochemistry findings (Positive staining: CD34 stains blood vessels and lesional tissue, SMA stains blood vessels only. Negative staining: CD99, S100, BCL2, EMA), the lesion was diagnosed as Digital Fibromyxoma.
Discussion
Digital fibromyxoma is a rare, benign fibromyxoid neoplasm, presenting as a slow-growing, nodular tumour of the subungual or periungual region. The clinical presentation, age and gender of the patient, and histological features support the diagnosis. This case highlights the benefit of the described approach in ruling out malignancy such as fibromyxoid sarcoma. The case further highlights the benefits to podiatrists in undertaking extended scope Skin Surgery training and reducing referral waiting times
A 29-year-old male presented to a university podiatry clinic, complaining of a slow growing mass under the right hallux nail. The growth was mostly asymptomatic except for mild discomfort in footwear. The clinical appearance of the tumour resembled a subungual exostosis, but on examination the mass was not deemed to be osteophytic and an x-ray was arranged. The radiographic report confirmed no significant bony protuberance in the hallux which supported clinical diagnosis that this was not an exostosis, but instead a soft-tissue neoplasm. Following pre-operative assessment, the patient was scheduled for total nail avulsion surgery with view to excising the subungual tumour and confirming diagnosis. Vascular and neurological findings were unremarkable and there were no contraindications to surgery. The surgical practitioner, a Podiatrist and Senior Lecturer, had recently undertaken extended scope training in Skin Surgery and the procedure was performed at the university teaching clinic.
Method
Following successful analgesia and total nail avulsion, a semi-solid spherical mass was exposed. Longitudinal excision through the lesion revealed a well-circumscribed neoplasm which macroscopically resembled connective tissue. On revealing the depth of the lesion and confirming no cartilage or bone involvement, the mass was excised in two halves using a 15 blade and skin forceps. Any remaining fibrotic debris was curetted from the nail bed. The excised specimen was sent for histopathology analysis.
Results
Microscopy revealed a circumscribed but nonencapsulated dermal tumour measuring 20x10x5mm and 18x10x5mm, comprising of bland spindle and stellate cells within a myxoid stroma and with prominent vessels. There were no malignant features, but margins were not clear of the tumour. In view of histopathological features and immunochemistry findings (Positive staining: CD34 stains blood vessels and lesional tissue, SMA stains blood vessels only. Negative staining: CD99, S100, BCL2, EMA), the lesion was diagnosed as Digital Fibromyxoma.
Discussion
Digital fibromyxoma is a rare, benign fibromyxoid neoplasm, presenting as a slow-growing, nodular tumour of the subungual or periungual region. The clinical presentation, age and gender of the patient, and histological features support the diagnosis. This case highlights the benefit of the described approach in ruling out malignancy such as fibromyxoid sarcoma. The case further highlights the benefits to podiatrists in undertaking extended scope Skin Surgery training and reducing referral waiting times
| Original language | English |
|---|---|
| Publication status | Published - 23 Nov 2023 |
| Event | Royal College of Podiatry annual conference: Podiatry 2023 - ACC, Liverpool, United Kingdom Duration: 23 Nov 2023 → 25 Nov 2023 |
Conference
| Conference | Royal College of Podiatry annual conference |
|---|---|
| Country/Territory | United Kingdom |
| City | Liverpool |
| Period | 23/11/23 → 25/11/23 |
Keywords
- fibromyxoma
- skin surgery
- podiatry