Superficial Acral Fibromyxoma: A Rare Entity - A Case Report

Abstract

Superficial acral fibromyxoma (SAF) is a rare lesion initially described by Fetsch as a tumour with histological and immunohistochemical features located at acral sites. It is a benign slow-growing soft tissue lesion occurring in males. Patients generally look for late medical help as it is generally painless. The lesion consists of spindled and stellate-shaped cells in the myxocollagenous stroma with immunohistochemical positivity for CD34, CD99 and vimentin. Treatment is surgical excision with regular follow-up. Here we present a case of a superficial acral fibromyxoma of the left index finger which radiologically showed features of vascular anomaly on MRI. The lesion was surgically excised and histopathology revealed features suggestive of superficial fibromyxoma with positive immunohistochemistry for CD34 and negative for S-100.

Keywords: Asymptomatic; Benign; Immunohistochemistry; Surgical excision.

[Table/Fig-1]:

Clinical photograph showing the lesion – dorsal view.

[Table/Fig-2]:

Clinical photograph showing the lesion – palmar view.

[Table/Fig-3]:

Plain radiograph of the left hand showing the lesion in the radial aspect of the left index finger.

[Table/Fig-4]:

T1 weighted image of MRI showing hypointense lesion with fine fibrous septations.

[Table/Fig-5]:

T2 weighted image of MRI revealing the with hyperintense lesion.

[Table/Fig-6]:

MRI showing intense enhancement on contrast administration.

[Table/Fig-7]:

Specimen following excision.

[Table/Fig-8]:

Defect following excision.

[Table/Fig-9]:

Photograph showing the defect covered with a full thickness skin graft.

[Table/Fig-10]:

Proliferation of spindle (red arrow) and stellate-shaped (black arrow) cells in a myxoid stroma (green arrow) (H&E 40X).

[Table/Fig-11]:

Immunohistochemical staining showing positivity for CD 34 (H&E x400 magnification).