PMC10441705_01
Plain radiograph of the left index finger showed no morphological changes in the bone. (a) Anteroposterior view and (b) lateral view.
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A plain radiograph of the left index finger showed no morphological changes in the bone (Figure 1(a) and (b)).
Contrast-enhanced MRI showed a nodular lesion with low intensity on T1, high intensity on T2/STIR, and contrast effect on the ulnar side under the left index finger nail. (a) T1 axial, (b) STIR, and (c) Contrast-enhanced axial.
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Contrast-enhanced MRI showed a nodular lesion with low T1 (Figure 2(a)), high T2/Short tau inversion recovery (STIR) (Figure 2(b)), and contrast effect on the ulnar side under the left index fingernail (Figure 2(c)).
The nail plate and nail bed were lifted and expanded, and a mass of approximately phi3-4 mm was found between the nail bed and the distal phalanx.
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An incision was made along the ulnar margin of the left index fingernail, and the subungual area was dissected to reach the distal phalanx (Figure 3).
(a) Glomus cells with small round nuclei and acidophilic cytoplasm proliferating in alveolar configuration. Hematoxylin and eosin staining, original magnification 100x, 200x (inset). (b) Immunostaining was positive for smooth muscle actin. Immunostaining, original magnification 200x.
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Immunostaining was positive for CD34 and smooth muscle actin (Figure 4(c)), but desmin staining was negative.
Multiple brown macules and soft masses, thought to be cafe-au-lait spots and neurofibroma were observed. (a) Thoracic abdomen, (b) Back, (c) Upper buttock.
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The physical examination revealed numerous well-demarcated brown macules (cafe-au-lait spots), ranging in size from the tip of a little finger to the size of a chicken egg, from the thoracic abdomen to the back (Figure 5(a) and 5(b)). A soft tissue mass (neurofibroma) the size of an index finger was also noted on the left upper buttock (Figure 5(c)).
Anteroposterior plain radiograph shows scoliosis with a Cobb angle of approximately 15 .
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However, multiple iris nodules (Lisch nodules) were observed, and thoracic scoliosis with a Cobb angle of approximately 15  was found (Figure 6).