PMC4777460_01
Clinical picture: subungual nodular tumor.
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Physical examination of the toe nail revealed a 15 mm, firm, painful, reddish- yellow nodule that destroyed the distal nail plate, partial yellow-brown nail discoloration, and thickening of the nail (Figure 1a). Dermoscopy (DermLite DL3N- 3Gen USA) revealed structureless brown discoloration, structureless homogeneous red, whitish and yellow areas (Figure 1b).
Dermoscopy: star-structureless homogeneous red area within the tumor: arrow - structureless brown discoloration of the nail.
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B-mode gray ultrasonography (US) showed a nodular, hypoechoic, inhomogeneous, 12.7/20.2 mm structural lesion that distorted the nail and presented a cranial hypoechoic extension (Figure 2a). On Color Doppler examination the lesion presented variable vascularity and necrotic zones (Figure 2b). Strain elastography showed variations in hardness with intermediate rigidity predominating (Figure 2c).
B-mode gray US: nodular, hypoechoic, inhomogeneous tumour that distorts the nail. Star-cranial hypoechoic extension.
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A diagnostic biopsy was performed and revealed a polypoid, ulcerated, and well vascularised neoplastic dermal tumor (Figure 3a). A proliferation of fusiform cells immersed in a myxoid stroma with no relevant atypia was described (Figure 3b).
Color Doppler: variable vascularity. Star- necrotic zones.
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Immunohistochemical (IHC) study reported positive results for CD34 (Figure 4a), CD99 (Figure 4b), CD10 (Figure 4c) and was negative for EMA.