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Am Fam Physician. 2022;105(4):425-426

Author disclosure: No relevant financial relationships.

A 65-year-old man presented with an erythematous mass on his thumb that had been slowly enlarging over 10 years. The mass was nontender but bled occasionally and increasingly interfered with daily activities. The patient did not have fever, chills, or night sweats.

Physical examination revealed a large, semifirm, mobile mass on the volar aspect of the right thumb (Figure 1). The lesion was not ulcerated. There was no lymphadenopathy. The affected hand had normal strength, sensation, and range of motion.

Plain radiography showed a soft tissue mass without evidence of a foreign body. Magnetic resonance imaging showed an exophytic superficial soft tissue mass measuring 3.7 × 3.0 × 3.7 cm without evidence of internal fat, cystic nature, foreign body, or involvement of the underlying tendon. The mass was excised, and pathologic examination showed diffuse subcutaneous fibrosis and granulomatous inflammation comprised of epithelioid histiocytes.

Question

Based on the patient’s history, physical examination findings, and additional testing, which one of the following is the most likely diagnosis?

  • A. Actinomycetoma.

  • B. Dermatofibroma.

  • C. Foreign body granuloma.

  • D. Giant cell tumor of the tendon sheath.

  • E. Invasive squamous cell carcinoma.

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The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to afpphoto@aafp.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz

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