Subungual pleomorphic fibroma: a case report and review of the literature

Abstract

We describe an interesting case of pleomorphic fibroma of the subungual region in a middle aged woman who presented with a recurrence of thickening, lateral ridging, and a midline split of the right third fingernail, 20 years after initial excision. Histology of the specimen demonstrated hyperchromatic stellate cells within the superficial corneum, which were CD34 positive, consistent with a pleomorphic fibroma. Pleomorphic fibroma is a rare mesenchymal neoplasm characterized by atypical spindled cells amidst a collagenous stroma. It is a benign, slow growing tumor that has only been reported in the subungual region twice previously. Although histology may show cellular atypia, the slow-growing benign nature of the tumor, reassuring features histologically i.e low cellularity, and lack of myxomatous change in the stroma, make a conservative approach to therapy reasonable.

Pleomorphic acquired digital fibrokeratoma: A novel clinicopathologic entity

“…Despite such mutations, these lesions exhibit benign clinical courses. Similar pleomorphic changes have been reported in other lesions including giant cell fibroblastomas, subungual pleomorphic fibromas, dermatofibromas, sclerotic fibromas, lipomas, and angiofibromas 8–11 . In contrast to pleomorphic fibromas, which stain for CD34 and variably for FXIIIa, 8–11 this case was negative for CD34 and positive for FXIIIa, further distinguishing this as a novel and separate tumor.…”

“…Similar pleomorphic changes have been reported in other lesions including giant cell fibroblastomas, subungual pleomorphic fibromas, dermatofibromas, sclerotic fibromas, lipomas, and angiofibromas 8–11 . In contrast to pleomorphic fibromas, which stain for CD34 and variably for FXIIIa, 8–11 this case was negative for CD34 and positive for FXIIIa, further distinguishing this as a novel and separate tumor. Rb and p53 staining were also negative in lesional cells, consistent with findings previously observed in pleomorphic fibromas 6,7 .…”

A solitary polypoid papulonodule on the knee of a 13‐year‐old girl

“…Middle‐aged to older adults are typically affected 1,5 . While our patient reported a history of trauma similar to a previous subungual PF case report, 2 the association between trauma and PF development remains poorly understood. PF may clinically resemble multiple benign entities including dermatofibromas, neurofibromas, dermal nevi, acrochordons, verrucae, and fibrokeratomas.…”

“…PF classically favors the extremities, although the face and subungual areas can also be affected. [2][3][4] Lesions are usually asymptomatic and slow-growing. Middle-aged to older adults are typically affected.…”

“…PF is usually a solitary, skin‐colored, polypoid or dome‐shaped papule ranging from a few millimeters to 2 centimeters in diameter. PF classically favors the extremities, although the face and subungual areas can also be affected 2–4 . Lesions are usually asymptomatic and slow‐growing.…”