Case: Multiple Nodules and Masses on the Hand of a Girl

A 12-year-old girl was visited at our clinic with multiple soft tissue and bony painless swellings over her right hand since she was 2 years old (Figure 1). Soft tissue masses increased in size and number. She was born to non-consanguineous parents. Her early development was normal and she had no other medical problems. There was no family history of similar problem. Examination revealed multiple compressible soft tissue masses and hard nodules of varying size over fingers and manus of the right hand with superficial hyperkeratosis. There was no limb asymmetry. Her height and weight were within normal range. Examination of parents was normal. X-ray of the right hand is shown in figure 2. A biopsy specimen was taken from a skin nodule. What is your diagnosis? Move on to next page for the answer and discussion