Solitary subungual neurofibroma in the right first finger

Background Neurofibromas may occur as part of neurofibromatosis or as a solitary tumor. Solitary subungual neurofibroma appears to be a rare condition. Up until now, less than 10 case reports of solitary subungual neurofibroma have been documented. Solitary subungual neurofibroma is difficult to diagnose, particularly as it is often small and without obvious symptoms. Awareness of the diagnosis is emphasized to prevent unnecessary delay in treatment. So, understanding the differentiation and diagnosis of solitary subungual neurofibroma has a great value. Methods A 32‐year‐old woman presented with a two‐year history of painless thickening and elevation of the nail plate of the right first finger. She was treated with complete surgical excision of the tumor, and we performed pathological examination of the biopsy specimen. Results The final diagnosis of the tumor was solitary neurofibroma. After surgery, the nail regrew with a good cosmetic result. After 10 months of follow‐up, there were no signs of recurrence of the tumor. Conclusion Solitary subungual neurofibroma appears to be a rare condition, and immunohistochemistry is the key to the diagnosis. Complete surgical excision should be considered as the curative treatment of choice for them.     

The rare occurrence of three subungual melanomas in one patient

Subungual melanoma commonly presents with solitary longitudinal melanonychia. Herein, we report the case of a patient with subungual melanoma who developed involvement of three digits by three independent primary melanomas. A 98-year-old male patient presented with a two-year history of longitudinal melanonychia on three different fingernails. Histopathologically, all three lesions were proved to be melanoma. To our knowledge, this is the first reported case in which three subungual melanomas developed in one patient. Our case indicates that that not all examples of multiple longitudinal melanonychia represent benign lesions.     

甲下神经鞘瘤

报告1例发生在右足第2趾甲下的神经鞘瘤。患者男，70岁。右足第2趾肿胀疼痛1个月余，皮肤科检查见右足第2趾甲板不全脱落，末端肿胀，中央可见质软的半透明肿块。肿块组织病理及免疫组化染色检查提示为神经鞘瘤。     

Synchronous subungual glomus tumors in the same finger

The glomus tumor is an uncommon benign neoplasm of glomus cells. In the majority of the cases it is presented as a solitary painful papule in the subungual region. We report a rare case of a patient with two individual synchronous glomus tumors under the nail bed of the same finger.     

头皮局限性神经纤维瘤伴脱发一例

患者,男,22岁。脱发1年余,头皮棕褐色肿物6个月。病理可见毛囊微小化,真皮下部大量细长梭形瘤细胞,波浪状排列。S-100多克隆(+),SOX-10(+),MelanA(+),Vimentin-10(+)。诊断为头皮局限性神经纤维瘤。后行手术治疗,随访中。     

甲下外生骨疣和内生软骨瘤3例

报告3例甲下外生骨疣和内生软骨瘤，临床表现为拇趾远端单发降起性硬结节，其中2例发病前有局部外伤中。放射学检查示单侧拇趾的末节趾骨远端突起一骨组织团块。组织病理学检查显示肿瘤由成熟的骨组织和纤维软骨成分组成。治疗可选择局部切除术。由于本病误诊率高，对于趾（指）远端的增生性肿物，尤其是疣样皮损，应考虑此病的可能。     

Cutaneous Plexiform Schwannoma of the Finger Not Associated with Neurofibromatosis

Plexiform schwannoma is a rare, benign, peripheral nerve sheath tumor that occurs as an uncommon nodular variant of schwannoma. It is important to recognize this tumor because it can be misdiagnosed as plexiform neurofibroma. In contrast to the latter, however, plexiform schwannoma is not associated with neurofibromatosis (von Recklinghausen disease). We report a case of plexiform schwannoma located on the index finger of a 20-year-old male patient with no signs of neurofibromatosis.     

A Case of Recurrent Superficial Acral Fibromyxoma

Superficial acral fibromyxoma (SAFM) is a rare myxoid tumor that was first described in 2001. The presence of a very slow growing solitary tender mass in the subungual area is the typical clinical feature at presentation. Histopathologically, SAFM is composed of stellate cells in a myxocollagenous matrix with a poorly circumscribed margin. This tumor is thought to be benign, but its natural course is not fully understood. We describe a 15-year-old patient with recurrent SAFM and discuss the proper treatment and follow up.     

Intratumoral fat in neurofibroma

Three cases of a solitary neurofibroma showing focal fatty changes are reported. Fatty changes in a neurofibroma are rarely observed and have not been reported, and also, the pathogenesis of neurofibroma has not been clarified. We postulate that the fatty changes in a neurofibroma may be the result of so-called senescent change or chronic injury. The origin of adipose cells may be attributable to fatty infiltration from abutting tissues or to a metaplasia of tumor cells or resident fibroblasts.     

Solitary plexiform neurofibroma

A 35-year-old man with a solitary subcutaneous cord running on the abdomen wall is reported. Histologic examination of the lesion permitted a diagnosis of plexiform neurofibroma. In this patient and in his family no other signs of von Recklinghausen's disease were found. The plexiform neurofibroma considered as pathognomonic of neurofibromatosis may occur in a solitary form.     

Intradermal spindle cell/pleomorphic lipoma of the vulva: case report and review of the literature

BACKGROUND: Spindle cell/pleomorphic lipoma (SC/PL) is a benign adipose tissue tumor that usually affects the subcutaneous tissues of shoulders, backs, and neck region of middle-aged male patients. Histologically, it is characterized by the presence of primitive CD34-positive spindle cells arranged in short fascicles, bizarre floret-like multinucleated giant cells, mature adipocytes, and a small number of lipoblasts. Recently, an intradermal subset has been described, which mainly affects female patients and presents a wider antomical distribution when compared to the classical variant of SC/PL. METHODS: We report a case of intradermal SC/PL affecting the labium majus of a 56-year-old female patient. RESULTS: The histological examination disclosed the typical histological features, however the lesion showed poorly demarcated and infiltrative borders, as well as involvement of dermal nerves. The immunohistochemical analysis according to streptovidin-biotin-peroxidase technique showed immunoreactivity for CD34 and vimentin in the spindle cells, as well as S100 protein and vimentin in the adipocytic cells. CONCLUSIONS: To the best of our knowledge, this is the first case of intradermal SC/PL affecting the vulvar region. Care must be taken not to misdiagnosis this rare tumor as well-differentiated liposarcoma, cellular angiofibroma, solitary fibrous tumor, and cutaneous neurofibroma.     

Juvenile xanthogranuloma underneath a toenail

A 1 1/2-year-old boy developed a dystrophic toenail shortly after trauma to the foot. At the age of three years, it was recognized that the nail deformity was caused by a subungual tumor. The tumor proved to be a juvenile xanthogranuloma. The lesion was solitary, and no systemic associations or visceral involvement were found.     

Subungual squamous cell carcinoma in Darier's disease

We report the first case of subungual squamous cell carcinoma in a patient with Darier's disease (keratosis follicularis). The presence of human papiliomavirus DNA was confirmed, consistent with its probable role in carcinogenesis at this site. The role of an altered immune state is discussed as an additional factor. Squamous cell carcinomas may be overlooked when they occur among the other cutaneous manifestations and complications of Darier's disease. A solitary, ulcerating nail bed lesion warrants biopsy to exclude squamous cell carcinoma.     

A Case of Solitary Fibrous Tumor of Subungual Region

Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.     

Pigmented neurofibroma

A 24-year-old male patient suffering from a large-coconut-sized neurofibroma is described. In the tumor, sharply demarcated areas of melanin containing cells were seen. These cells were identified as melanin producers by the premelanosomes seen by electron microscope. Although the coexistence of neurofibroma with another melanin-producing tumor, such as cellular blue nevus, could not be ruled out, this tumor shows the close relationship between tumors of the peripheral nervous system and melanocytic malformations or pigmented nevi. These observations are relevant to the controversy over the histiogenesis of these pigmented lesions and support Masson's view that nerve sheath cells are capable of melanogenesis.     

Subunguales Plattenepithelkarzinom

A 63-year-old patient presented with a 12-month history of a subungual tumor on the right middle finger. The patient had had a similar lesion involving his left index finger 5 years ago, which was identified as a subungual squamous cell carcinoma. Except for hypertension and hyperlipidemia, the patient was in good health. Ablation of the nail plate, the nailbed and the matrix was performed. Histopathology confirmed another subungual squamous cell carcinoma. The patient received a full thickness skin graft. Subungual squamous cell carcinomas are among the most frequently reported types of subungual malignancies. However, subungual squamous cell carcinomas arising in more than one digit have been reported only rarely. The cause of subungual squamous cell carcinoma has not been clearly identified. Subungual squamous cell carcinoma has been associated with radiation, chronic infection, arsenic ingestion, HPV infection and trauma. None of these could be identified in our patient.     

Inhibition of the proliferation of a malignant peripheral nerve sheath tumor cell line by gamma interferon gene transfection

A solitary malignant peripheral nerve sheath tumor was resected, and a tumor cell line was obtained using an explant culture. The morphology of this cell line was quite similar to those of cell lines of dermal neurofibromas of neurofibromatosis 1, except for the fact that the malignant peripheral nerve sheath tumor cell line could be cultured for more than two months. When the tumor cell line was transfected with human gamma interferon gene, the growth rate was remarkably abolished, as previously observed in neurofibroma cell lines transfected with the gamma interferon gene. This new finding suggests the potential for treating either solitary or neurofibroma-related, inoperable, malignant peripheral nerve sheath tumors by local gamma interferon gene transfection in vivo.     

Unilateral subungual hyperkeratosis following a cerebrovascular incident in a patient with psoriasis

The prevalence of nail abnormalities in psoriasis is reported to be between 50 and 90% of affected adults. These include pitting, nail discoloration, onycholysis and subungual hyperkeratosis. Although nail changes may be associated with neurological disease, there are no previous reports of psoriatic nail changes following cerebrovascular events. We report the first case to our knowledge of unilateral subungual hyperkeratosis in a psoriatic patient which developed following a cerebrovascular event.     

A meissnerian neurofibroma: Case report of a rare neurofibroma variant

Structures resembling Meissner corpuscles have been described in various nerve sheath tumors, including schwannomas and neurofibromas. When present, they are focal or scattered, and rarely a prominent feature of the lesion. Here, we report a case of a 39-year-old female who presented with an isolated lesion on her abdomen. Histopathologically, the tumor was almost exclusively composed of Meissner corpuscle-like structures (pseudo-meissnerian bodies). At a small edge of the tumor, there were features of a classic neurofibroma, with a mixture of Schwann cells, fibroblast-like cells, and interspersed mast cells. We propose the term “meissnerian neurofibroma” for this extremely rare variant of neurofibroma.     

Extradigital glomus tumor: dermoscopic description and histopathological correlation

Glomus tumors are rare benign neoplasms arising from the neuromyoarterial structure called glomus body. They present as angiomatous papules, soft and painful, especially to cold and pressure. In general, they are solitary and affect the extremities, located mainly the subungual bed. Extradigital lesions are rare and can constitute a diagnostic challenge. This is the report of a patient with an extradigital lesion on the left arm, and its dermoscopic aspects, including angiomatous lagoons circumscribed by a pale halo, a structure not previously described in the two reports of extradigital glomus tumor with dermoscopic features, found in the literature.