Presentation
Three-year history of a slowly growing swelling of the distal aspect of 2nd right toe.
Patient Data
There is an extrinsic pressure erosion of the cortex of the distal phalanx of the 2nd toe with cortical erosion of the lateral aspect of the middle phalanx of the same toe.
The MRI sequences demonstrate a small soft tissue mass of the anterolateral aspect of the middle and distal phalanx of the 2nd toe of intermediate signal intensity on T1WI, high signal intensity on T2WI with moderate and delayed enhancement on postcontrast sequences. Evidence of extrinsic pressure erosion of the cortex mainly of the distal phalanx.
Case Discussion
A case of a superficial acral fibromyxoma (SAFM), confirmed after excision of the tumor with a histopathological exam and immunohistochemistry.
Superficial acral fibromyxoma is considered a relatively rare mesenchymal tumor of fingers and toes, usually involving the periungual and subungual regions with a predilection for the great toe. It presents as a slow-growing solitary painless firm soft tissue mass, usually less than 5 cm.
Most cases are benign tumors and usually, do not recur after complete excision. However, follow-up is mandatory. Malignant appearance or metastasis has not been reported in the literature.
The differential diagnosis should include:
- solitary superficial acral angiomyxoma
- Glomus tumor
- giant cell tumor
- myxoid neurofibroma
- cutaneous focal mucinosis
- low-grade myxofibrosarcomas
- acral fibrokeratomas
Additional contributor: A Ramdani, MD.
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