A rare case of neurothekeoma on the top of finger in an elderly woman with a review of literature.

R. De Vitis1, R. Vitiello1, G. Taccardo1

1 Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia – Università Cattolica del Sacro Cuore, Roma

 

Neurothekeomas are unusual asymptomatic benign tumours of nerve sheath origin. Were first described in 1969 by Harkin and Reed who called them nerve sheath myxomas. Gallager and Helwig later re-named this tumor neurothekeoma. These are usually small, slow growing tumours, tipically solitary very rarely multiple, commonly located on the head and neck, rarely intracranial, trunk, and on the shoulder and upper extremities, but very rarely on hand or finger  or lower extremities and foot. It is a typical tumor of adolescents and younger patients, with a remarkable predilection for the female population, rare it presented in infants and older patients. Histologic variants include myxoid, cellular and mixed tumors, in fact, are currently distincted three subtypes of neurothekeoma recognized, based on cellularity of the tumor, growth pattern, and stromal mucin: (a) the myxoid type with hypocellularity, distinctly lobulated growth pattern and abundant myxoid stroma, (b) the cellular type with a fascicular growth pattern, high cellularity and scant mucin and (c) the mixed type that shares features of both. An immunohistochemical pattern enables a differentiation between myxoid neurothekeoma, melanocytic and nervous system tumors. The treatment for neurothekeoma is a complete surgical excision and a recurrence is possible only with no surgical treatment or for an incomplete excision. We present a case report of rare myxoid neurothekeoma in an eighty-five years old woman on the top of the third finger of the right hand and review the literature about this lesion discovering that this case is the first in an as old woman and in this site.

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