The Japanese Journal of Dermatology
Online ISSN : 1346-8146
Print ISSN : 0021-499X
ISSN-L : 0021-499X
Case Reports
Three Cases of Onychomatricoma
Naoko KuboAkiko KishiMio FukuiSayuri MiyakeAki YoshidaNobukazu HayashiKuniaki Ohara
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2022 Volume 132 Issue 1 Pages 57-67

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Abstract

We experienced three cases of onychomatricoma with a the chief complaint of thickened nail. Case 1 was a 59-year-old female whose right thumb nail had been thickened for 13 years, with a width of 4 mm at the lamellar tip. Case 2 was a 48-year-old female whose right index fingernail had been thickened for 10 years; the width was 8 mm. The tip of the nail resembled a sieve. Case 3 was a 47-year-old male whose left middle fingernail had been thickened like a pillar for 4 years; the width was 8 mm. The tip of the nail a brain-like appearance.

All three cases had common features; the entire nail was thickened, the nail had a pillar-like appearance, and there was pain during nail cutting. Dermoscopic findings showed yellow-whitish lines, brown lines, hemorrhage-like splinters, and longitudinal grooves. Magnetic resonance imaging of Case 2 and 3 revealed crest-shaped tumors with low density on T1-weighted and high density on T2-weighted and diffuse images.

Pathological examinations revealed continuously growing papillary tumors with sieve-like cavities extending form the nail matrix to the tip. The tumors consisted of spindle cells with nuclei of various sizes, accompanied by giant cells. In addition, collagen fibers proliferated in the interstitial tissue.

The above findings led to the diagnosis of onychomatricoma in all three cases. They all underwent surgical treatment, and no recurrence has been noted. On the basis of our experience, we conclude that magnetic resonance imaging demonstrating a saw-tooth like appearance is very characteristic of onychomatrichoma and helps to diagnose it. This should be an important parameter assessed in all such patients to establish the diagnosis of onychomatrichoma.

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© 2022 Japanese Dermatological Association
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