Wednesday, September 4, 2013

Blue Nevus

I had a biopsy done on 8/9/13. Pathology report confirms it is a benign blue nevus!

Dermatopathology Report

Clinical Data: A-C: Mass Right Hallux, approximately 5-6 MM symmetrical, oval, elliptical blackened area without fungating surface, or ulceration.

Specimen:
     A: Nail, right toe
     B: BX Tibial border, leading edge, right hallux
     C: BX Fibular border, right hallux

Diagnosis:
     A: Toenail, right hallux removal
          Fragments of benign nail plate and nail bed/matrix epithelium with onychomycosis, verrucous hyperplasia of nail bed epithelium, and intracorneal hemorrhage.

     B: Skin, right hallux nail bed lesion, tibial border,leading edge, biopsy: compatible with blue nevus.

     C: Skin, right hallux nail bed lesion, fibular border, leading edge biopsy: compatible with blue nevus.

Note: A. There is no melanocytic nevus, atypical melanocytic proliferation or evidence of malignancy.   Clinical correlation is recommended. Abundant septate fungal hyphae are evident within the nail plate in the H&E stained sections.

B&C. There are no atypical features or evidence of malignancy; nonetheless, clinical correlation is recommended to excluded the possibility of sampling error. The context of the clinical impression of a 5 to 6 mm elliptical lesion of the nail bed without ulceration or conspicuous extension into the nail folds, the histologic changes in these sections are entirely consistent with a benign blue nevus, which can occasionally occur in the nail unit, including in a subungual location (Causeret AS et al. Subungual blue nevus. J Am Acad Dermatol. 2003 Aug;49:310-2).

Gross Description:

A. Received in formalin a 1.5 x 1.5 x 0.2 cm aggregate of tan to dark red-brown rough firm thickened portions of unguis.

B. Received in formalin a single 0.5 x 0.3 with a greatest depth of 0.2 cm irregular tan to dark gray-brown rough mottled pigmented lesion.

C. Received in formalin a single 0.2 x 0.2 cm circular dark gray-brown rough mottled wrinkled pigmented lesion, with a depth of 0.25 cm.


Tuesday, June 25, 2013

Toe MRI

I got the MRI report and films of my toe. Unfortunately the radiologist did not give a diagnoses. Still so confused on what this is. Any thoughts?

MR examination of the right foot without and with contrast,
06/24/2013.

Technique: Axial proton density and T2, sagittal STIR, coronal T1,
sagittal T1, sagittal fat-suppressed post gadolinium T1, coronal
fat-suppressed post gadolinium T1, axial fat-suppressed post
gadolinium T1-weighted images were obtained.

Findings: There are postsurgical changes of a bunionectomy with some
magnetic susceptibility artifact obscuring the marrow in the first
proximal phalanx. There is prominent subungual soft tissue on the
dorsal surface of the first distal phalanx with homogeneous
enhancement measuring approximately 3 mm in thickness and 8 mm in
length and 9 mm in width. This is slightly hyperintense on the STIR
images and low to intermediate signal intensity on the pregadolinium
T1-weighted images. No tendon or ligamentous disruptions are
identified. No other significant marrow signal abnormalities are
noted. No other abnormal masses or fluid collections are noted.

Impression:
1. 8 x 9 x 3 mm great toe subungual soft tissue mass along the dorsal
surface of the first distal phalanx with homogeneous enhancement. This
appearance is nonspecific. Clinical correlation would be helpful.
2. No underlying bone marrow signal abnormalities are seen in this
region.
3. There are postsurgical changes of a bunionectomy with some magnetic
susceptibility artifact in the first proximal phalanx.










UPDATE:  Biopsy confirms it is a blue nevus!!!

Monday, June 24, 2013

Ultrasound of Toe

Duplex color-flow Doppler Ultrasound examination of the right great
toe, 06/06/2013.

Findings: There is slightly increased soft tissue with
hypervascularity in the subungual region of the right great toe. This
is asymmetric when compared to the left. The examination is otherwise
unremarkable.

Impression: Asymmetric hypervascular increased subungual soft tissue
in the right great toe compared to the left. This appearance is
nonspecific. Clinical correlation would be helpful. A vascular tumor
could have this appearance. If indicated, an MR examination may be
helpful in further evaluation.




UPDATE:  Biopsy confirms it is a blue nevus!!!

wtf is wrong with my toe???

Seriously, WTF is wrong with my toe??? Subungual bluish raised mass under my right big toenail. It's been there for over 15 years, since my mid twenties, maybe only getting slightly larger during this time. A dermatologist told me 15 years ago it was a hematoma, though I had no recollection of injury and it had been there for a long time (maybe a year or two at that point). The same dermatologist told me a month ago it was a bad case of onychomycosis, a proceeded to cut my toenail about half way down, and it did bleed some. He told me to soak it in vinegar daily, and wrote me a prescription that I took back to his office to be ground up and water added for me to put one drop on my toe at night. The nail looked really gross for a while, warning graphic pictures! I diligently soaked my feet in straight vinegar daily for 30-60 minutes, and filled away on the top of the nail a little bit everyday. The vinegar was surprisingly refreshing and felt so good to soak my feet in. I just got a plastic container big enough for my feet and filled with straight white vinegar until my toe nails were completely submersed. After soaking I use one of those foot cheese grader looking things to scrub the bottom and sides of my feet. My feet have never looked or felt better in a long time. However with my constant filing away of the top of the nail, the subungual bluish mass became more prominent and seemed separate and different from the onychomycosis. Shortly before my one month followup with the dermatologist, I wondered if it could possibly be a tumor. At my appointment with the dermatologist, he glanced at my toe and said it looked much better. I then brought up my concern it might be a tumor, he looked at it briefly again and said he highly doubted it was a tumor and that it is a hematoma. Really, a hematoma lasting over 15 years, I had my doubts!!

I starting doing a bunch of research online and have come up with a list of possibilities. Maybe it is an AVM (Arteriovenous Malformation or Arterio Venous Malformation) or as it was described in my 16 year old daughters pathology report as Arteriovenous Hemangioma that was surgically removed from her hand and visually presented itself as a painful raised bluish lump between her index finger and thumb for over 5 years due to misdiagnosis as ganglion cyst. Could it possibly be Acral Lentiginous Melanoma? I'm part Sioux Indian, and darker ethic populations have a higher incidence of Melanoma of the nail.  I'm really quite fair skinned with freckles, but do tan easily. I did spend my entire childhood until late teens barefoot constantly every summer. Or, maybe it is a Glomus tumor? I do have nerve damage in my toe from bunion surgery when I was 16, a regretful unnecessary surgery. At this point I'm not totally sure what is wrong with my toe.

I went to my primary care doctor last week convinced that it is a AVM Arteriovenous Malformation / Arteriovenous Hemangioma. The doctor actually agreed with me and diagnosed it as a vascular tumor / Hemangioma. I asked for it to get MRI'ed, but the doctor worried my insurance might deny the imagery, so I suggested they order an Ultrasound instead as it would show vascularity on the color doppler.  I got the ultrasound of my toe last week. I think it was the technician's first time using an ultrasound on a toe. She was having difficulty getting an image at first, so I suggested she use copious amounts of the gel as I read online was best for ultrasound of the toenail. She got good imagery, and I will post the ultrasound pictures that shows a hypervascular soft tissue mass in my big toe.

MRI is scheduled for tomorrow morning with the report and images available by the next day. The MRI should definitely let me know exactly WTF is wrong with my toe!!!!!!!!!!!!!!!

Here is a recent picture of my toe:

UPDATE:  Biopsy confirms it is a blue nevus!!!