Acral Fibrokeratoma

 More cellular than acral fibrokeratoma

image Fascicles of spindled cells

image Lacks vertically oriented collagen bundles

image CD34(+)

• Superficial acral fibromyxoma
image More cellular lesion

image Loose storiform to fascicular growth pattern

image Lacks vertically oriented collagen bundles

image CD34(+)

• Supernumerary digit
image Clinically resembles acral fibrokeratoma

image Disorganized nerve bundles in dermis

• Dermatofibroma
image Also more cellular than acral fibrokeratoma

image Storiform pattern

image Peripheral collagen trapping

image Lacks vertically oriented collagen bundles

Acral Fibrokeratoma at Low Magnification
Acral fibrokeratoma is a protuberant, pedunculated lesion covered by a hyperkeratotic, variably acanthotic epidermis.

Superficial Portion of Acral Fibrokeratoma
The epidermis overlying acral fibrokeratoma demonstrates thick, compact hyperkeratosis image. In the superficial dermis, there may be dilated blood vessels image. Note the absence of adnexal structures.

Dermal Spindle Cells in Acral Fibrokeratoma
Acral fibrokeratoma is characterized by a relatively hypocellular fibroblastic proliferation and thickened, vertically oriented collagen bundles image in the dermis.

Acral Fibrokeratoma at High Magnification
High-power examination demonstrates the bland fibroblasts and vertically oriented, thickened collagen bundles.



• Acquired digital fibrokeratoma

• Acquired periungual fibrokeratoma

• Garlic clove fibroma

• Subungual fibroma of tuberous sclerosis


• Benign, dome-shaped, relatively hypocellular mesenchymal tumor that usually presents on digits


Genetic Syndrome

• Subset of cases associated with tuberous sclerosis

• Mutation of TSC1 or TSC2

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Apr 24, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Acral Fibrokeratoma

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