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A 59-year-old women presented with a growth involving the hyponychium, the distal groove and the area distal to the groove in the ulnar portion of the left index finger. This red, pea-size nodule was round and well demarcated (Fig. 1). The past history indicated that the tumour had first appeared 9 years previously. It had been cauterized by a dermatologist, probably using electrosurgery. The tumour recurred after about one year and was treated in the same manner. However, it recurred and began to increase progressively and more rapidly than in the previous 2 years. It was not tender to light pressure but was painful after trauma to the lesion. X-ray was normal, there was no other abnormality and the patient was in good health. After a ring block anaesthesia, the distal third of the nail plate was removed, the tumour was excised using a transverse fusiform incision down to the bone, then sutured. Healing was uneventful. The histology specimen demonstrated a polypoid formation. The lesion has circumscribed multinodular outlines and an array of split-like spaces (Fig. 2). Some areas are cellular with small, epithelioid or short plump spindle cells in a storiform growth pattern. The stroma is composed of variably abundant collagen with focal hyalinization and dilated vascular channels. The mitotic index is low, with neither abnormal mitoses nor necrosis. The vascular network is pronounced. Immunohistochemistry shows negativity for protein S 100, HMB 45, total cytokeratin, Kp1, actin and CD 34. Conversely, vimentin is diffusely expressed and epithelial membrane antigen (EMA) is expressed on 80% of the spindle shaped-cells (Fig. 3). At several sites, the lateral and deep limits of the lesion are not delineated by normal tissue. Further recurrence may therefore be anticipated.

Perineurioma: A Tendon Sheath Fibroma-like Variant in a Distal Subungual Location