Case Number : Case 1784 - 30 March - Dr Arti Bakshi Posted By: Guest

Another fine case from Dr Arti Bakshi.

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An acral dome shaped lesion containing fascicles and loose storiform structures of spindle and stellate cells, in abundant myxo-vascular stroma. My first impression is : Superficial Acral Fobromyxoma.  

Acral fibrokeratoma.

cellular digital fibroma (which probably and as we discussed previously is a variant of superficial acral fibromyxoma). here and here

Forgot to add that this is a shave biopsy so should be cautious on the final diagnosis as we cannot see the tumor front.

I would like to add as a differential diagnosis the Sclerotic perineurioma. EMA could be of great help.

My first impression was perineurioma , sclerotic .

Probably CDF and SAFM are the same lesion...however the first is usually reported as a more superficial tumor on dermis, and here, according with Raul, we can't see the tumor front. I favour SAFM because there is a typical alternating pattern of myxoid and collagen stroma, there is a well developed vascular network, and, above all, doesn't look like a DFSP, as CDF does!!!

Perineurioma is another good differential! I confess I hadn't think before.

Agree CDF or SAFM - both probably have a degree of overlap. 

Superficial acral fibromyxoma. CD34 IHC stain helpful.

Agree with the spectrum of superficial acral fibromyxoma / cellular digital fibroma, bearing in mind Raul's caveat this is a partial biopsy.

Sclerosing perineurioma is an excellent differential diagnosis, but its marked predilection for the hands makes it less likely.

I went for Superficial acral fibromyxoma too.

The lesion  was CD34, CD99 and CD10 positive. Perineurioma was my top differential too, but EMA was negative.

Agree with all the comments made regarding overlap with CDF!