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August 2007

Nodule on the Toe—Diagnosis

Author Affiliations
 

MICHAEL E.MINGMD, MSCECARRIE ANN R.CUSACKMDSENAIT W.DYSONMDJACQUELINE M.JUNKINS-HOPKINSMDVINCENTLIUMDKARLA S.ROSENMANMD

Arch Dermatol. 2007;143(8):1067-1072. doi:10.1001/archderm.143.8.1067-e

Histopathologic examination of the biopsy specimen showed a tumor in the dermis and subcutis, with a dense population of mildly pleomorphic clear cells in a highly vascular stroma. Mitotic figures were present. The tumor cells stained positively for epithelial membrane antigen but not for Melan-A, S100 protein, wide-spectrum keratin, CD31, or CD34. These findings supported a diagnosis of metastatic renal cell carcinoma. Radiography showed a soft tissue mass in the right great toe, with punctate calcifications and destruction of the adjacent terminal tuft. Computed tomography showed widespread nodal, pulmonary, and peritoneal metastases.

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