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  Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 50-52  

Trauma-induced focal nodular mucinoses: A rare entity


1 Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
2 Department of Pathology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India

Date of Web Publication22-Jan-2018

Correspondence Address:
Gunjan Verma
Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_63_17

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   Abstract 


Cutaneous mucinoses refer to disorders with abnormal accumulation of mucin in the skin. Mucin is an amorphous material that is a part of the extracellular matrix in dermis. Cutaneous mucinoses could be primary or secondary. The latter is associated with systemic disorders such as autoimmune diseases, diabetes mellitus, paraproteinemia, or altered thyroid function. Here, we report an adult female patient with trauma-induced cutaneous focal nodular mucinoses on left-sided scapular region. Histology showed replacement of collagen bundles by mucinous deposits in superficial and mid-dermis. Mucinous substance was present in peri-eccrine location on Alcian blue staining.

Keywords: Mucin, mucinoses, solitary nodule


How to cite this article:
Verma G, Mrig PA, Gautam R K, Malhotra P. Trauma-induced focal nodular mucinoses: A rare entity. Indian Dermatol Online J 2018;9:50-2

How to cite this URL:
Verma G, Mrig PA, Gautam R K, Malhotra P. Trauma-induced focal nodular mucinoses: A rare entity. Indian Dermatol Online J [serial online] 2018 [cited 2020 Sep 30];9:50-2. Available from: http://www.idoj.in/text.asp?2018/9/1/50/223727




   Introduction Top


Cutaneous focal nodular mucinosis (CFNM) is a localized form of cutaneous dermal mucinosis clinically presenting as an asymptomatic skin-colored papule or nodule that occurs anywhere on the body. The etiopathogenesis of CFM is unclear but is thought to represent a reactive lesion.[1]


   Case Report Top


A 30-year-old female presented to us with a history of skin-colored lesions over the upper back of 3-year duration. There was a history of blunt trauma at the site 6 months prior to the onset of lesions. There were no systemic complaints. On examination, a solitary erythematous to pigmented plaque of size 4 cm in length and 2 cm in width (4 × 2) cm, ovoid shaped, firm in consistency, irregular surface was present on the right scapular region with a firm rubbery nodule surmounted over the plaque [Figure 1]. The surrounding skin showed follicular prominence. Patient complained of recurring mucinous discharge from the lesion for the last 2 months. Rest of the cutaneous and systemic examination and blood biochemistry were within normal limits. Thyroid function tests showed no abnormality. Antinuclear antibodies and human immunodeficiency virus antibodies were negative. Histopathological examination of biopsy specimen showed normal epidermis with separation and replacement of collagen bundles by mucinous deposits in superficial and mid-dermis (hematoxylin and eosin, ×40) [Figure 2]. There was mild inflammatory infiltrate. Mucinous substance was present in the peri-eccrine location on Alcian blue staining (×200) [Figure 3].
Figure 1: Solitary, ovoid, soft to firm plaque present on left scapular region surrounded by follicular prominences

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Figure 2: Attenuated collagen bundles in dermis widely separated by pools of acellular mucin. (H and E, x40)

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Figure 3: Dermal mucin highlighted (Alcian Blue, x200)

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Based on the above findings, a diagnosis of focal nodular mucinoses was made and the patient was referred to the department of surgery for excision.


   Discussion Top


CFM was first described by Johnson and Helwig in 1966 as an asymptomatic, elevated, whitish papule, plaque, or nodule that is usually solitary and present on the face, trunk, or extremities.[1] CFM has been reported previously in various morphological forms such as fibroma, polyp, plaque, and nodule.[2],[3] In our case, it started as a papule, and within 3 months progressed to form a discharging nodule. CFM is usually not associated with systemic manifestations.

In our case, trauma was the inciting factor which led to CFM. The cause of CFM is unknown but is thought to be a reactive lesion arising as a result of the dysfunction of fibroblasts in a circumscribed area.[4] Several recent studies have examined the relationship of CD44 receptor expression to dermal hyaluronate mucin accumulation. However, multiple focal cutaneous mucinoses have been seen as a side effect of anti-TNF-α therapy in a psoriatic patient.[5] Furthermore, trauma as an inciting factor has been seen in two cases till date which later progressed to CFM.[4]

Histology is essential for the diagnosis and shows replacement of collagen bundles by mucinous deposits in superficial and mid-dermis. The epidermis may be normal or hyperplastic. Systemic investigations such as ANA and thyroid function tests should be done to rule out other diseases with dermal mucinoses such as scleredema, scleremyxedema, and granuloma annulare.

Clinical differential diagnosis considered in our case was scrofuloderma, however, on investigation, chest X-ray was normal and Mantoux test was negative which helped us in ruling out scrofuloderma. Histopathological differential diagnosis of CFM includes scar sarcoidosis and benign and malignant neoplasms characterized by mucinous tumor stroma with angiomyxoma, nerve sheath myxoma, and myxofibrosarcoma.[6],[7],[8]

Intralesional steroid injections could be useful by acting on cytokines pathway. Surgical excision, which is the treatment of choice for CFM, was considered in our case.

In summary, we reported a case of trauma-induced CFM arising on scapular skin in an adult female. Our case depicts an uncommon condition which is induced by trauma and required histopathology for confirmation of diagnosis. Trauma could be an inciting factor in our patient and could have a role in the pathogenesis of disease as it could lead to overproduction of hyaluronic acid by fibroblasts.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gutte R, Garg G, Kharkar V, Khopkar U. Asymptomatic nodule over the shin. Indian J Dermatol Venereol Leprol 2012;78:123.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Chen HH, Chung CJ, Kuo TT, Hong HS. Solitary soft fibroma-like polypoid mucinosis: Report of an unusual case. Dermatol Surg. 2004;30:450-1.  Back to cited text no. 2
    
3.
Yamamoto M, Yamamoto T, Isobe T, Aikawa Y, Tsuboi R. Plaque-type cutaneous focal mucinosis. Int J Dermatol 2011;50:896-8.  Back to cited text no. 3
    
4.
Kempf W, von Stumberg B, Denisjuk N, Bode B, Rongioletti F. Trauma-Induced Cutaneous Focal Mucinosis of the Mammary Areola: An Unusual Presentation. Dermatopathology (Basel) 2014;1:24-8.  Back to cited text no. 4
    
5.
Lesiak A, Włodarczyk M, Sobolewska A, Sieniawska J, Rogowski-Tylman M, Sysa-Jedrzejowska A, et al. Can biologic treatment induce cutaneous focal mucinosis? Postepy Dermatol Alergol 2014;31:413-6.  Back to cited text no. 5
    
6.
Wilk M, Schmoeckel C, Kaiser HW, Hepple R, Kreysel HW et al. Cutaneous angiomyxoma: A benign neoplasm distinct from cutaneous focal mucinosis. J Am Acad Dermatol 1995;33:352-5.  Back to cited text no. 6
    
7.
Fetsch JF, Laskin WB, Hallman JR, Lupton GP, Miettinen M. Neurothekeoma: An analysis of 178 tumors with detailed immunohistochemical data and long-term patient follow-up information. Am J Surg Pathol 2007;31:1103-14.  Back to cited text no. 7
    
8.
Fetsch JF, Laskin WB, Miettinen M. Nerve sheath myxoma: A clinicopathologic and immunohistochemical analysis of 57 morphologically distinctive, S-100 protein- and GFAP-positive, myxoid peripheral nerve sheath tumors with a predilection for the extremities and a high local recurrence rate. Am J Surg Pathol 2005;29:1615-24.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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