Superficial Acral Fibromyxoma



Superficial Acral Fibromyxoma


Thomas Mentzel, MD









Hematoxylin & eosin shows a low-power view of a hypocellular dermal neoplasm in the nail bed region.






Hematoxylin & eosin shows relatively bland spindleshaped tumor cells arranged in loose fascicles and set in a myxoid stroma.


TERMINOLOGY


Abbreviations



  • Superficial acral fibromyxoma (SAF)


Definitions



  • Benign fibroblastic neoplasm with predilection for hands and feet, especially nail bed region


ETIOLOGY/PATHOGENESIS


Environmental Exposure



  • Previous trauma reported only rarely


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Rare


  • Age



    • Mainly adults


  • Gender



    • More frequent in males


Presentation



  • Solitary mass


  • Usually painless lesions


  • Longstanding lesions


  • Dermal subcutaneous neoplasms


  • Arise usually on toe, finger, or palm of hand


  • Majority of cases involve nail bed region


  • Rare on heel


Natural History



  • Local recurrences sometimes seen


  • No reported case of metastasis or progression


Treatment



  • Surgical approaches



    • Complete excision


Prognosis



  • Biologically benign neoplasm


  • Recurrences have been reported in up to 22%


MACROSCOPIC FEATURES


General Features



  • Superficial lesions


  • Lesions may appear dome-shaped, polypoid, or verrucoid


Size



  • Usually < 5 cm


MICROSCOPIC PATHOLOGY


Histologic Features



  • Moderately cellular


  • Nodular, lobular, or infiltrative growth


  • Dermal neoplasms with involvement of deeper structures in some cases


  • Myxoid, myxocollagenous, or predominantly collagenous stroma


  • Numerous blood vessels


  • Rarely contains lipomatous component


  • May contain inflammatory cells (mast cells)


  • Minimal cytologic atypia


  • Rare mitoses


  • Increased cellularity and atypia



    • Have no prognostic influence


Predominant Pattern/Injury Type



  • Storiform


  • Fascicular


Predominant Cell/Compartment Type



  • Spindle



    • Spindled and stellate fibroblast-like cells



    • Multinucleated stromal cells may be present

Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Superficial Acral Fibromyxoma
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