Case Number : Case 2048 - 12 April 2018 Posted By: Raul Perret

microvenular hemangioma

Acanthotic epidermis and proliferation of spindle cells in a fibrous stroma. I think this is a cellular digital fibroma

I thought of MVH too

Agree with Anil...

Here there’s an interstitial(not vascular) fibroblastic/myofibroblastic proliferation, with a prominent vascular network, reminiscent of superficial acral fibromyxoma. Why not a monophasic(fibrous) SAF?

CD34? 

That's the beauty of pathology. To some of us, the vessels are judged to be more relevant, hence microvenular hemangioma. To others, the spindle cell proliferation is more relevant, hence cellular digital fibroma / SAF. Would  CD34 really be helpful and change one' s opinion? 

Nice comment , anh. Would you add one more diagnosis to enhance the beauty ? :--)

Nice thoughts above. I have little to add except who's that handsome devil posting tricky soft tissues?

Thanks for the for the comments. This is indeed cellular digital fibroma (as suggested by some authors) or a cellular variant of superficial acral fibromyxoma. There was a diffuse expression of cd34 in the spindle cells located in the dermis. CD99 is supposed to be positive in SAF and negative in CDF but I think performing this technique is waste of time and money. This tumor may recur if incompletely excised and an important differential diagnosis is DFSP which has a similar phenotype but is generally more cellular, infiltrates the hypodermis and is rarely/never located on acral sites. On the other hand, the presence of abudant capillaries is frequently seen in SAF/CDF, so considering a vascular neoplasm in the differential is not aberrant.

I am sorry for the pale slides but hope you guys liked the case. Thanks again for your comments.

14 hours ago, Dr. Richard Carr said:

Nice thoughts above. I have little to add except who's that handsome devil posting tricky soft tissues?

Haha, just trying to contribute a bit in this site that helped me learn so much and make good friends!