Presenter: Sean Branch, DO., Tanya Ermolovich, DO, Filomena Scola, DO
Dermatology Program: Lehigh Valley Hospital/ PCOM
Program Director: Stephen Purcell, DO
Submitted on: April 5, 2013
CHIEF COMPLAINT: Enlarging lesion on the 3rd digit of her right hand x 3 years
CLINICAL HISTORY: Patient presented with an enlarging lesion on the third digit of her right hand that has been there for approximately three years. The patient states the lesion is otherwise asymptomatic. She has tried topical 17% salicylic acid for three weeks then discontinued due to significant irritation and bleeding.
PHYSICAL EXAM:
There is a large, firm, pink, pedunculated tumor measuring 4.5 x 4.5 cm emanating from the proximal nail fold on the 3rd digit of the right hand.
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY:
On H&E sections the mass is sparsely populated by bland spindle cells with dense collagenization with focal myxoid areas. The overlying skin is unremarkable. Immunohistochemical stains are negative for CD34, S100, EMA, and SMA.
DIFFERENTIAL DIAGNOSIS:
1. Solitary fibrous tumor
2. Fibroma of the tendon sheath
3. Fibromyxoid sarcoma
4. Sclerotic fibroma
5. Nodular fasciitis
