A 27-year-old African American man presented to an orthopedic surgeon with a painful mass on his left fourth toe, which impaired ambulation and the wearing of closed footwear. His medical history was notable for juvenile hyaline fibromatosis diagnosed at age 4 years and for multiple prior operations to remove symptomatic masses on his face and extremities. Physical examination revealed multiple masses of varying size on his face and all extremities (Figure A), with a large mass on the distal aspect of the fourth toe on the right foot that had eroded into the distal phalanx and another painful mass on his medial hallux (Figure B).
A previously well female teenager presented with acute paraparesis. She reported a 2-month history of atraumatic back pain. Four days before admission, she progressed from walking independently to inability to mobilize. She had fecal incontinence and micturition difficulty. On examination, she had T8 sensory level with pinprick (including perineum) with reduced power (mostly 2-3/5, worse on the right) and lower limb hyperreflexia.