This education series for dermatologists is presented by the Weill Cornell Comprehensive Dermatopathology Service.
Case 1.
A 30-year-old man with a left thumb foreign body (Figures A-F).
a. Acral fibromyxoma
b. Digital mucous cyst
c. Acquired fibrokeratoma
d. Myxoid malignant fibrous histiocytoma
Case 2.
A 58-year-old man with a finger lesion (Figures A-C).
a. Xanthoma
b. Acral fibromyxoma
c. Heberden nodes
d. Digital mucous cyst
Case 3.
A 30-year-old woman with a right fifth dorsal finger (Figures A-L).
a. Perniosis
b. Hypersensitivity vasculitis
c. Acrocyanosis
d. Coumadin necrosis
Case 4.
An 18-month-old healthy girl presents with a firm mobile nodule on the left upper arm present since birth (Figures A-D).
a. Sclerema neonatorum
b. Post-steroid panniculitis
c. Subcutaneous fat necrosis of the newborn
d. Fibrous hamartoma of infancy
To learn the answers, go to page 2
QUIZ ANSWERS
Case 1 — A
Acral Fibromyxoma
Well-differentiated fibromyxomatous neoplasm is most compatible with a superficial acral fibromyxoma. This is a relatively rare acral-based tumor whereby the baseline histomorphology is well exemplified by this case, being a bland spindle cell proliferation embedded in a fibromucinous stromal matrix associated with a distinct phenotypic profile characterized by epithelial membrane antigen and CD34+. This slow-growing tumor is most characteristically found in the periungual and subungual regions of the fingers and toes of adults.
Case 2 — D
Digital Mucous Cyst
Digital mucous cysts are benign cysts that appear on the fingers and sometimes toes. They are usually painless and often do not require treatment.
Case 3 — A
Perniosis
Perniosis is characterized by the development of skin lesions in response to cold exposure. Lesions are erythematous, most commonly occur on the fingers and toes, and range in appearance from macules to nodules. The pathogenesis likely involves cold-induced vasoconstriction with subsequent hypoxia and inflammation. When perniosis occurs in individuals with hematologic disorders, autoimmune disease, or malignancy it is referred to as secondary perniosis. When skin lesions arise in patients with lupus erythematosus, they are referred to as lesions of chilblain lupus erythematosus.
The diagnosis in this case is perniosis with features of the so-called second variant as seen within the spectrum of lupus erythematous (chilblain lupus erythematosus).
Case 4 — C
Subcutaneous Fat Necrosis of the Newborn
Subcutaneous fat necrosis of the newborn is a rare form of panniculitis that generally occurs in term or post-term otherwise healthy newborns within the first 6 weeks of life. Lesions are mostly found on the face, shoulders, back and buttock, may be single or multiple, and appear as erythematous-violaceous plaques/nodules. Resolved lesions appear atrophic. Several postulated predisposing factors include preeclampsia, gestational diabetes, maternal use of calcium channel blockers or cocaine, meconium aspiration, umbilical cord prolapse, Rh incompatibility, hypothermia, obstetric trauma, localized tissue hypoxia, and neonatal asphyxia.
Dr Magro is the director of dermatopathology at Weill Cornell Medicine in New York, NY. For more information, please visit www.weillcornelldermpath.com.
Disclosure: The author reports no relevant financial relationships.
