A ten-year-old boy, who was known to be infected with the human immunodeficiency virus, was seen because of a painful mass in the right (dominant) hand. The child had been born prematurely after twenty-six weeks of gestation. He had received multiple transfusions while in the neonatal intensive-care unit and was presumed to have contracted the virus through a transfusion with contaminated blood. The patient had numerous manifestations of the disease, including lymphocytic interstitial pneumonitis, oral candidiasis, lymphadenopathy, recurrent fevers, and a chronic cough. At the time, the patient was receiving INH (isoniazid), prednisone, AZT (azidothymidine), and griseofulvin.
Physical examination revealed a reddish, well circumscribed, nodular lesion, seven millimeters in diameter, in the center of the right palm (Fig. 1). The lesion was tender to palpation; it had increased in size over the previous nine months and had become symptomatic within the past two months. No other masses were detected in the hand or the upper extremity. No epitrochlear or axillary adenopathy was evident. The findings of a neurovascular examination were normal. A radiograph of the chest demonstrated lymphocytic interstitial pneumonitis. The histological analysis of a biopsy specimen that had been obtained with a three-millimeter-diameter punch showed benign spindle-cell proliferation, and the patient was referred to us for excision of the lesion.
With use of general anesthesia and tourniquet hemostasis, a marginal excision of the lesion was performed. An elliptical incision was made transversely in line with the flexion creases of the palm. A thin cuff of subcutaneous fat was resected with the specimen. All bleeding vessels were meticulously cauterized, and the wound was closed primarily with use of non-absorbable monofilament suture.
Pathological analysis of the specimen revealed a smooth, discrete nodule in the dermis. The nodule was blue-pink and had a firm, rubbery consistency. It was seven millimeters in diameter. Histological examination demonstrated a storiform architecture, composed of spindle cells with elliptical nuclei (Fig. 2 and 3). The specimen had the typical microscopic appearance of a leiomyoma. Intertwining bundles of smooth-muscle cells surrounded numerous vascular channels, and mitotic figures were scarce. No tumor was evident below the deep dermal tissue or in the margins of the specimen.
At the three-month follow-up examination, there was no evidence of local recurrence and there was no pain at the site of the excision. The patient had a full range of motion of the wrist and the fingers. There was no evidence of other masses elsewhere in the body.