Key result
Pseudomyogenic hemangioendothelioma mimics whitlow and can metastasize to the skin post-amputation.
Pseudomyogenic hemangioendothelioma can rarely present as whitlow-like nodules and subsequently metastasize to the skin.
Biopsy warranted for atypical persistent whitlow; leaves open metastatic risk and management of this rare tumor.
A 30‐year‐old male developed bloody nodules on the fingertips that clinically mimicked whitlow. Biopsy revealed a vascular tumor showing a sheet‐like proliferation of large spindle cells and polygonal atypical cells with pleomorphic nuclei and abundant eosinophilic cytoplasm, including rhabdoid cells. Immunohistochemical analysis demonstrated positive staining for CD31, FOSB, AE1/AE3, ERG, INI‐1, and BRG, whereas negative staining for CAMTA1, confirming the diagnosis of pseudomyogenic hemangioendothelioma. Digital amputation was performed, but 2 years later, a solitary reddish nodule appeared on the forearm, and histopathological examination revealed features similar to those of the primary digital lesion. Pseudomyogenic hemangioendothelioma presents with various clinical features; however, nodules with a whitlow‐like appearance are rare. In addition, this type of tumor is a low‐grade malignancy, and rarely metastasizes to lymph nodes or distal sites. Skin metastasis of pseudomyogenic hemangioendothelioma is extremely rare.
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Irie et al. (2026) studied this question. Pseudomyogenic hemangioendothelioma can mimic whitlow clinically, and though rare, it may metastasize to the skin as demonstrated by a forearm nodule 2 years post-amputation.
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