Superficial Acral Fibromyxoma involving the nail's apparatus. Case report\nand literature review
We present a 43-year-old woman, without any known allergies whose personal history\nreports beta thalassemia. She referred having had cutaneous changes not associated with\nany trauma for 8 years, consisting of swelling, partial nail loss and distal ulcerations\nwith occasional bleeding on the 5th toe of the right foot. When the patient\nwore open shoes it was painless; however, it hurt and bled when she wore closed shoes.\nUpon examination, the distal end of the 5th toe presented a central ulcer\nwith blood remains and partial onycholysis ().\nAntero-posterior and oblique X-rays were requested of both feet, which showed\nsubluxation of the distal phalanges of the 5th toes without signs of bone\ninfiltration and a diagnostic biopsy was performed.\nHistological results showed neoplastic dermal proliferation of fusiform cells without\nany relevant atypia, immersed in a myxoid stroma with collagenized areas and a prominent\nvascular weave (). Immunohistochemical\nstudies reported positive results for CD34 and negative for S100, AME and AML (). The proliferation index, valued with Ki67\nwas low (less than 1%). These findings led to the diagnosis of Superficial Acral\nFibromyxoma.\nThe subsequent therapeutic approach included complete removal of the tumor as well as\nthe nail in order to avoid recurrence.\nHistological examination of the surgical piece was similar to the previously described.\nThe tumor was extirpated with wide margins, including the nail matrix, respecting the\ndistal phalanx (). Resection margins were\nreported as tumor-free.\nAfter a 22-month follow-up there was no recurrence of the tumor.