Case Number : Case 2329 - 21 May 2019 Posted By: Uma Sundram

angiofibroma

I favor dermatofibroma, especially given the overlying epidermal hyperplasia. I also thought about interstitial granuloma annulare. Krishnakumar's idea of angiofibroma is interesting. But angiofibromas are usually subcutanous.

What about Multinucleated Giant Cell Angiohistiocytoma?

Agree with Alex Ventura, this is a multinucleated giant cell angiohistiocytoma. Some argues that dermatofibroma does not exist in the fingers, but I have seen one or two cases very similar to it. I would like to know the opinion of the collegues about this.

Ha ha, I thought about multinucleated cell angiohistiocytoma, too. But I shied away from it because I thought there was only one possible multinucleated cell (in the center of the last photo). Not enough multinucleated cells! 

Yes, a case with numerous possibilities. We finally decided on scar like dermatofibroma. Digital DF has been described. This one is unusual because lesional cells are really scarce. There's no wrong answer here; if you can defend it, you can diagnose it! I was also interested in what you all thought about this case.

I was thinking of superficial acral fibromyxoma. 

Not sure if you can get acquired elastotic haemangioma on acral skin but the plaque-like spread of vessels can look like this.

Great additional points. CD34 is negative, arguing against superficial acral fibromyxoma (but the histology is really good for it). I'm not sure how common acquired elastotic hemangiomas are on acral sites, but I think the vessels tend to be bigger and more prominent (perhaps more clearly a vascular process than this lesion seems to be?). 

 I should say, CD34 is negative, somewhat arguing against the diagnosis of superficial acral fibromyxoma, since up to 30% of cases are negative. So, this is a possibility as well.