Indian Dermatology Online Journal

SKINDIA QUIZ
Year
: 2021  |  Volume : 12  |  Issue : 2  |  Page : 366--367

A slow growing firm swelling over proximal nail fold with nail dystrophy


Suman Patra1, Ankita Agrawal1, Jai Chaurashia2, Richa Rupla1,  
1 Department of Dermatology, All India Institute of Medical Sciences, Bhopal - 462 020, Madhya Pradesh, India
2 Department of Pathology, All India Institute of Medical Sciences, Bhopal - 462 020, Madhya Pradesh, India

Correspondence Address:
Suman Patra
Department of Dermatology, All India Institute of Medical Sciences, Bhopal - 462 020, Madhya Pradesh
India




How to cite this article:
Patra S, Agrawal A, Chaurashia J, Rupla R. A slow growing firm swelling over proximal nail fold with nail dystrophy.Indian Dermatol Online J 2021;12:366-367


How to cite this URL:
Patra S, Agrawal A, Chaurashia J, Rupla R. A slow growing firm swelling over proximal nail fold with nail dystrophy. Indian Dermatol Online J [serial online] 2021 [cited 2022 Jan 23 ];12:366-367
Available from: https://www.idoj.in/text.asp?2021/12/2/366/310640


Full Text



A 23-year-old male presented with asymptomatic swelling over the proximal nail fold of the left index finger for the last 6 months [Figure 1] and [Figure 2]. There was gradually associated progressive thinning and triangular-shaped depression at the proximal nail plate. He was a cook by occupation and there was no history of trauma. The swelling was solid and firm on palpation, non-tender, and fixed to the underlying structures. The skin overlying the lesion was movable. The entire lesion was excised with a vertical incision over proximal nail fold. During excision, it was found to be whitish solid mass attached to the extensor tendon. The specimen was sent for histopathology and special stain and findings are demonstrated [Figure 3],[Figure 4],[Figure 5].{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

 Question



What is you diagnosis?

 Answer



Giant cell tumor of the tendon sheath.

 Microscopy and Further Evaluation



Histopathology of the excised specimen revealed a nonencapsulated tumor composed of numerous multinucleated osteoclastic giant cells admixed with mononuclear cells in the background. The mononuclear cells had abundant glassy cytoplasm with round nuclei and prominent nucleoli. The osteoclast-like giant cells had nuclei of variable number ranging from 2 to 12 which were round, folded, or grooved with no discernible nucleoli. Occasional lymphocytes were seen within the lesions, dispersed between the mononuclear cells. Mitotic figures were rarely seen. Pearl's stain revealed hemosiderin-laden histiocytes. The histopathological features were suggestive of giant cell tumor of the tendon sheath. After complete excision, he was kept under follow-up with no recurrence noted till the 8th month of follow-up.

 Discussion



Nail fold tumors usually present with swelling over proximal nail fold with or without longitudinal nail dystrophy. It causes significant diagnostic dilemmas and such tumors could arise from the nail matrix, underlying blood vessels or bone.

Giant cell tumor of tendon sheath is the most common benign neoplasm of hand after ganglion cyst. It is usually found in the fourth and fifth decade of life with the female predisposition. The middle finger is the most common site followed by thumb and index finger.[1] Only 20–30% of giant cell tumors of the tendon sheath are clinically diagnosed before surgery. In such a presentation, like ours, the myxoid cyst is the most common differential diagnosis and histopathology is the only way to reach the diagnosis. Other differentials are glomus tumor, exostosis of bone, squamous cell carcinoma, melanoma, etc. Multinucleated giant cells, histiocytes, and hemosiderin deposits are the consistent findings in histopathology.[2] Excision is the treatment of choice with the recurrence rate ranging from 4 to 44%.[3] Here we present this unusual case of nail fold tumor.

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

1Di Grazia S, Succi G, Fraggetta F, Perrotta RE. Giant cell tumor of tendon sheath: Study of 64 cases and review of literature. G Chir 2013;34:149-52.
2Lanzinger WD, Bindra R. Giant cell tumor of the tendon sheath. J Hand Surg Am 2013;38:154-7.
3Richert B, Andr J. Laterosubungual giant cell tumor of the tendon sheath: An unusual location. J Am Acad Dermatol 1999;41:347-8.