Case: An 8-year-old boy with no history of trauma presented with a lump on his right lumbar back that had appeared 1 week before. The lump was a 12 × 10 mm flat nodule with a smooth surface and good mobility and could be moved against the foundational structure. At the 4-month follow-up, the lump had expanded to 20 mm. A biopsy revealed a relatively well-defined basophilic region from the deep dermis to the superficial subcutaneous fat. The lesion mostly comprised spindle-shaped cells, with dense and substantial nuclei in the darkly stained areas, a storiform or cartwheel distribution in the lightly stained areas, as well as sparse mitotic figures, lymphocytic infiltration, and extravasated red blood cells. The fatty tissues were not divided into honeycomb-like sections, but increased in a compressible manner. It was strongly positive for α-SMA, but negative for Desmin, ALK, S100, CD34, and Factor XIIIa; thus, the diagnosis of nodular fasciitis was made. The nodule all but disappeared 5 months after the biopsy, and no recurrence was observed for 1.5 years. Nodular fasciitis is a benign lesion characterized by rapid growth and often spontaneous resolution. In children, the mean age of onset was 8.3 years, slightly more common in boys, and the predominant site of onset was the head and neck region. Nodular fasciitis should be considered when examining rapidly growing subcutaneous nodules, even in children.

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Case Presentation: An 81-year-old Japanese man presented with multiple itchy erythematous patches and papules on his trunk and extremities, which had been present for 4 months. He also reported experiencing fatigue and nausea. The patient’s skin color was noted to be yellow all over his body, except for his ocular conjunctiva. His bilirubin levels were found to be normal. He had been taking Chlorella, a dietary supplement, for 9 months and also regularly consuming vegetable juice and “tsukudani” (a type of seaweed dish). Blood tests revealed carotenemia. One month after discontinuing the use of Chlorella and vegetable juice, the erythema and papules disappeared and his yellowish skin color began to improve. Conclusions: Recently, many people have started taking various supplements for health reasons. Unlike medications, the side effects of supplements are not well-known. To avoid health risks associated with supplements, it is important to raise awareness about precautions to take when consuming them.

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Poromas are benign adnexal tumors most commonly present on the lower extremities, especially in the palmoplantar area among middle-aged individuals. They rarely appear under the nails, where fewer sweat glands are present. Here, we report a case of subungual poroma in a 60-year-old man. The patient visited our consultation with a complaint of a 5-mm reddish nodule that developed below the nail plate of the left big toe 6 months ago. The mass had gradually increased in size and bled easily. Dermoscopy showed reddish-white globular-like structures, glomerular and hairpin vessels, and flower-like vessels surrounded by a whitish-pink network. Histopathological examination revealed a well-circumscribed lesion composed of collections of poroid cells connected to the epidermis and scattered luminal structures surrounded by cuticular cells. Although this was a rare case of a subungual tumor, the dermoscopic findings typical of poromas were confirmed through the preoperative removal of a portion of the nail from the lesion. Only nine cases, including ours, of subungual poromas have been reported in Japan and abroad; all seven toenail cases involved the big toe. Therefore, we considered the possibility that the onset of subungual poroma might be associated with mechanical stress. In addition, we focused on the plantar area of the foot, which is particularly loaded during walking and exposed to a large amount of mechanical stress. Furthermore, we examined the associations between the sites of plantar poroma and loading. The results showed that poromas most frequently occurred on the heel, which is the most loaded area, and not in the arch area. These findings suggest that mechanical stress might be a trigger for the occurrence of poromas.

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Glomus tumors are generally benign tumors that are located in the nail beds and other peripheral areas of the extremities and are often painful, but there are ones with findings suggestive of malignancy, such as atypical mitotic figures and infiltrative growth. The patient is a 69-year-old woman. About 8 years ago, she was diagnosed with papillary thyroid cancer and underwent a total thyroidectomy. At that time, multiple lung metastases were found, and thyroid stimulating hormone suppressive therapy was administered. About one month before her first visit, she was admitted to the Department of Gastroenterology because of increased lung metastasis, progressive anemia, and black stools. A gastric endoscopy was performed, and an elevated lesion was found on the gastric wall. At the same time, she was referred to our department for consultation because of a 15-mm sized, smooth-surfaced, easily hemorrhagic red nodule on the ventral side of the right middle finger. Cutaneous metastasis was suspected following simple excision for diagnostic purposes. Grossly, the tumor was a dense mass covered with a thin capsule, and pathologically, it was densely proliferating in the dermis layer with atypical cells with round nuclei and weakly acidic, relatively broad reticulum, and many atypical mitotic figures were seen. Immunostaining showed that tumor cells were negative for CD34, CD68, AE1/AE3, CK7, CK20, TTF-1, thyroglobulin, LCA, S-100, HMB-45, CEA, GCDFP-15, desmin, weakly positive for Melan-A, positive for α-SMA, vimentin, and MIB-1 labeling index of about 40%. Based on these results, a diagnosis of malignant glomus tumor was made. Malignant glomus tumor is a rare disease, and the clinical course and pathological findings required differentiation from thyroid cancer or skin metastasis of gastric leiomyosarcoma in our case.

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