Thread by @PIorfino

This little lesion was a cute surprise. It came in from the finger (radial nail fold) of a 46 yo male, clinically described as either a wart or callus.

Let’s take a little look 👀see🫣shall we?#dermpath #trishtorial #pathtwitter@

Things you can notice at low power:
🔺acral skin with nail☑️,
🔺no epidermal collarette around area of lesion (which appears dermal)☑️,
🔺something looks bluish☑️

So let’s start figuring this out, yes 🙌? Is this a:

A dermal lesion with delicate spindle cells, mast cells, myxoid stroma, some vessels. What stains may help you figure it out?

While I wanted you to say the 3rd option, I think there will be variability here.For example, you may also add an NKIC3 if you’re thinking neurothek. But I think at least the 3stains in option 3 are needed. I didn’t snap a pic of my neg s100 but I did get one of my neg Sox10.

Here are a couple higher power pics:

The lesion has an interesting male predilection and is typically periungual on either fingers or toes.They are frequently asymptomatic and usually present as a solitary nodule. So what’s the final diagnosis? Mine can be found here: instagram.com/p/CnINofbuPvG/…

A quick free synopsis of the clinical and histologic findings as well as consideration of the other major entities in the differential diagnosis can be found here by Dr. Jacqueline Junkins-Hopkins:
dermatologyadvisor.com/home/decision-…

Enjoy the weekend😉 @kis_lorand @david_terrano
@DCSkipperDO @RyanneMDMBA @CarlosMonteag20 @DrAldehyde @TBrennster
@DiegoMoralesN @DrGeeONE
@JMGardnerMD @MightyDermPath @tonitatirado @AlomariDermpath
@SGottesmanMD @pembeoltulu @Dermpathl @ChristineJKoMD
@VHNguyenMD @mccalmo