Superficial acral fibromyxoma: a clinicopathological analysis of 32 tumors including 4 in the heel

Al-Daraji, Wael I.; Miettinen, Markku

doi:10.1111/j.1600-0560.2007.00954.x

Cited by 89 publications

(108 citation statements)

References 28 publications

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“…On the basis of our results, coupled with those published previously, 3,13,23,31 it appears that digital fibromyxoma is a benign tumor with a risk of recurrence upon incomplete excision (up to 24% in our series). Given the proximity to the nailbed, conservative management is reasonable; however, persistent pain and/or local deformity may provoke complete surgical excision.…”

Section: Discussionmentioning

confidence: 53%

Digital Fibromyxoma (Superficial Acral Fibromyxoma)

Hollmann

Bovée

Fletcher

2012

American Journal of Surgical Pathology

127

227

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Digital fibromyxoma (first described by Fetsch and colleagues as superficial acral fibromyxoma) is a distinctive soft tissue tumor with a predilection for the subungual or periungual region of the hands and feet. This report details the histologic, immunophenotypic, and clinical findings in 124 cases of digital fibromyxoma. The study group included 70 male and 54 female patients (1.3:1, M:F), ranging in age from 4 to 86 years (mean, 48 y; median, 49 y). Mean tumor size was 1.7 cm (range, 0.5 to 5 cm; median, 1.5 cm). Nearly half of the patients (41%) presented with a painful mass. Tumors arose on the hands (52%) or feet (45%), with rare tumors arising on the ankle or leg. Most tumors occurred on the digits (94% of hand tumors, 82% of foot tumors), with the majority growing in close proximity to the nail (97% on fingers, 96% on toes). Histologically, 80% of cases were poorly marginated; 70% infiltrated the dermal collagen, 27% infiltrated fat, and 3% invaded bone. In cases in which imaging studies were available, bone involvement by an erosive or lytic lesion was more frequent (9/25, 36%). All tumors were composed of spindle-shaped or stellate-shaped cells with palely eosinophilic cytoplasm and a random or loosely fascicular growth pattern. The tumor cells were separated by dense hyaline collagen alternating with myxoid stroma. Most (86%) of the tumors showed alternating areas of fibrous and myxoid stroma, 11% showed predominantly fibrous stroma, and 3% had predominantly myxoid stroma. Increased mast cells were noted in 88% of tumors. All tumors comprised cells with minimal atypia, occasionally showing scattered larger cells with so-called "degenerative change." Mitotic figures were infrequent, and all tumors lacked necrosis, pleomorphism, or neural/perineural infiltration. Multinucleate stromal cells were occasionally seen. Tumor cells were reactive for CD34 in 42/61 cases (69%), with rare tumors showing focal reactivity for EMA (3/40, 7.5%), smooth muscle actin (5/42, 12%), and desmin (1/18, 6%). All tumors were negative for S100 (0/66), MUC4 (0/11), GFAP (0/10), AE1/AE3 (0/4), Cam5.2 (0/2), PanK (0/2), Claudin (0/4), and NFP (0/3). Follow-up in 47 cases ranged from 1 to 252 months (mean, 35 mo). Ten tumors (24%) recurred locally (all near the nail unit of the fingers or toes) after a mean interval of 27 months. One tumor recurred twice. All recurrent tumors had positive margins on initial biopsy or subsequent excision and no other clinical or pathologic features correlated with recurrence/persistence. To date, no tumor has metastasized. Finally, sequencing of 8 digital fibromyxomas failed to reveal mutations in exon 8 or 9 of GNAS1, in contrast to intramuscular or cellular myxoma.

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Section: Discussionmentioning

confidence: 53%

Digital Fibromyxoma (Superficial Acral Fibromyxoma)

Hollmann

Bovée

Fletcher

2012

American Journal of Surgical Pathology

127

227

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“…Superficial Acral Fibromyxoma (SAF) is a rare tumor of soft tissues, with slow growth and located in the subungual or periungual region of the hands and feet 1-7 (Table 1). However, the heel, palm and ankle can also be affected.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Thus complete removal and follow-up is recommended. Up to this date, malignization has not been described.…”

Section: Discussionmentioning

confidence: 99%

Superficial Acral Fibromyxoma involving the nail's apparatus. Case report and literature review

García

Mendonça

Cejudo

et al. 2014

An. Bras. Dermatol.

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Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

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“…The tumor itself has a striking predilection for the fingers and toes, but occurrence on other portions of the hands and feet including the heel has been reported. [1] Nuclear atypia and mitotic figures are rarely seen. But multinucleate stromal cells are occasionally noted.…”

Section: Discussionmentioning

confidence: 99%