A 21-year-old male patient presented with a slightly painful, slow growing, and hard, fusiform swelling of the left middle finger for the last 3 months. There was no history of fever and other routine investigations revealed only mild normocytic normochromic anemia and slightly raised erythrocyte sedimentation rate. On radiography, at the base of the middle phalanx of the left middle finger a lytic, radiolucent, lobulated lesion was seen with cortical expansion, a sclerotic rim, and septations. No calcification or periosteal reaction was noted [Figure 1]. In view of the high prevalence of tuberculosis in the region an initial clinicoradiological diagnosis of tubercular dactylitis of short bones of the hand which is referred to as spina ventosa was made. However, tuberculin test, chest radiogram, sputum for acid fast bacilli, and serum adenosine deaminase revealed negative results. Attempts of aspiration of the lesion yielded inadequate material. Hence, curettage was performed. On gross pathological examination fragments of gray-white lobulated mass with heterogeneous cut-surface was seen.
Histopathology revealed a tumor having a lobular pattern of growth of spindle shaped and stellate cells, with abundant myxoid and chondroid intercellular material [Figure 2]. The lobules had a hypocellular center and a hypercellular periphery with scattered benign multinucleated giant cells and hemosiderin-laden macrophages [Figure 3]. One portion of the tumor showed pleomorphic large bizarre cells with irregular-shaped nuclei and a smudgy chromatin pattern indicative of pseudomalignant features [Figure 4]. The lamellar bony trabeculae showed no significant pathology [Figure 2 inset]. A final diagnosis of chondromyxoid fibroma was made.
Excisional curettage along with bone grafting was done and the patient is doing well 2 months after the treatment.