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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1965 - 11 Dec 2017 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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subungual lesion, 33 yo, right middle finger


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vincenzo polizzi

Posted

Two lesions keep popping up in my head:  reticular perineurioma and glomus tumor. But this tumor in some component seems an adnexal tumor, and I know glomus tumors may sometimes be mistaken for adnexal tumors. The intimate relationship of glomus cells to the vessels in fig 7/8 could be a clue. So my first spot is Subungueal Glomangiomyoma.

 

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Iskander H. Chaudhry

Posted

Interesting case: can I add myoepithelial to the differential 

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The tumor appears to have some lumen which are surrounded by a relatively uniform epithelioid cells, best seen in pictures 7 and 8. The stroma appears myxoid. The question is whether the lumen represents ducts or vessels. If they are ducts, I would consider a mixed tumor in the differential diagnosis. If they are vascular lumen, I would think of myxoid glomus tumor. I guess immunohistochemical studies would help.

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Dr. Mona Abdel-Halim

Posted

I think reticular perineurioma fits better. Difficult!

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Dr. Richard Carr

Posted

Good suggestions. My thought was myoepithelioma/mixed tumour.

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Thank everyone for the insightful discussion.  This is a challenging case, particularly making diagnosis on pictures.  This is an indeed glomus tumor, with unusual myxoid changes. The tumor cells are positive for SMA. 

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