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Soft Tissue Pathology 

Pathology of Superficial Acral Fibromyxoma

Dr Sampurna Roy MD              

Dermatopathology Quiz Case 148

Diagnosis: Superficial Acral Fibromyxoma




Superficial acral fibromyxoma is a rare soft tissue tumour that was first described by Fetsch et al. in 2001.

The tumour involves superficial soft tissues of acral extremities in middle-aged adults.

It is particularly noted in the nail bed region.

Pathology findings :


The tumour is non-encapsulated, moderately circumscribed,  and extends through the whole dermis.

It is composed of spindle and stellate cells with slight nuclear atypia arranged in a loose storiform, partly fascicular growth pattern.

Occasional multinucleated stromal cells are present.

The neoplastic cells are embedded in a myxoid stroma.

There is an increased numbers of small blood vessels.

A few mast cells are noted. There are occasional mitotic figures.

Differential diagnosis: 

Includes benign and malignant myxoid and spindle cells tumours such as:

Fibrous Histiocytoma ;

Dermatofibrosarcoma Protuberans  ;

Acquired (digital) fibrokeratoma ;

Myxoid neurofibroma; Neurofibroma and variants

Sclerosing Perineurioma ;

Cutaneous myxoma (superficial angiomyxoma),and

Acral myxoinflammatory fibroblastic sarcoma.

Immunohistochemical finding:

The tumour cells may show focal positivity with CD34, EMA and CD99 may be positive in some and negative in others.

The tumour is usually negative for S-100 protein, HMB45 and alpha-smooth muscle actin and cytokeratin.

Alcian blue staining reveals abundant mucinous material within the stroma.

Recurrence rate of this tumor may be more than 20%.

Further reading:

Superficial acralfibromyxoma on the palm.

Superficial acral fibromyxoma in a sub-matricial location: An unusual variant .

Superficial acral fibromyxoma: a CD34+ periungual tumor.

Superficial acral fibromyxoma: a clinicopathological and immunohistochemical analysis of 12 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.

Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.

Superficial acral fibromyxoma of finger: report of a case with review of literature.

Superficial acral fibromyxoma: immunohistochemical and ultrastructural analysis of a case, with literature review.

Superficial acral fibromyxoma: a clinicopathological analysis of 32 tumors including 4 in the heel.

Superficial acral fibromyxoma of the toe, with erosion of the distal phalanx. A clinical report.

Superficial acral fibromyxoma: clinical and pathological features.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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