PMC5565780_01
The lesion.
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A 32-year old female presented with a slowly growing (over period of 6 months) subcutaneous mass at the second web space of the left hand (Fig. 1).
MRI showing the tri-lobed lesion (arrow) at the second web.
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An MRI showed a tri-lobed soft tissue lesion with no tendon or bony involvement (Fig. 2).
Intraoperative appearance. The forceps is showing that the normal lumen of the common digital artery has become the bulge of the tumor. In retrospect, the proximal lobe the tumor is the origin from the common digital artery, while the 2 distal lobes represent the extension of the tumor into the digital arteries of the index and middle fingers.
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At the time of surgery, the lesion was found to be within the common digital artery of the second web space (Fig. 3).
The excised lesion.
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Total excision was done (Fig. 4) by transecting the common digital artery 5 mm proximal to the lesion; and by transecting the radial digital artery of the middle finger and the ulnar digital artery of the index finger 5 mm distal to the lesion.
Low power (x10) showing the vascular proliferation (star) and the lymphoid follicles (arrow). H & E stain.
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ALHE with vascular proliferation within the lumen of the artery, multiple lymphoid follicles, and prominent eosinophilic infiltrate (Fig. 5, Fig. 6).