Non-malignant fibrosing tumors in the pediatric hand: a clinicopathologic case review

Update on Dupuytren Disease: Pathogenesis, Natural History, Treatment, and Outcomes

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand the current molecular biology of Dupuytren disease. 2. Critically evaluate the functional outcomes of treatment. 3. Confidently use any of the commonly used treatments. 4. Provide patients with appropriately selected treatment choices.

SUMMARY

Dupuytren disease is a fibroproliferative disease of the palmar fascia that results in debilitating digital contractures. Despite medical advances, the measurement of disease severity, functional deficits, and treatment outcomes remains challenging. Treatment options vary widely, yet practitioners often use only a small number of modalities. These options range from minimally invasive office procedures to extensive surgery, with adjuncts such as radiation and soft-tissue flaps. A thorough understanding of disease pathophysiology and treatment options can help surgeons offer more individualized care for this elusive disease.

Orthopedic Dermatopathies: Skin Manifestations in Orthopedic Conditions

Orthopedic diseases often present with dermatological symptoms that require prompt identification for appropriate treatment. Understanding these dermatologic presentations is crucial for accurate diagnosis and effective management. This article critically reviewed the dermatological manifestations observed in general and regional pathologies, followed by treatment-related manifestations. An extensive literature search was performed and limited to manifestations in orthopedic disease, excluding those pertaining to infection or syndromes. Case reports and case series documenting unusual and rare dermatologic presentations of orthopedic conditions were examined, providing novel perspectives on both prevalent and uncommon illnesses. The identified pathologies are discussed in detail, including their clinical features and diagnosis, while treatment approach varies depending on the severity of the condition, ranging from self-care to surgical intervention. The findings emphasize the need for interdisciplinary collaboration and highlight the importance of careful diagnosis and appropriate management to eliminate unnecessary approaches and ensure optimal outcomes for patients with orthopedic diseases and dermatologic symptoms.

Infantile Digital Fibromatosis/Inclusion Body Fibromatosis: A Comprehensive Literature Review

Infantile digital fibromatosis (IDF), or inclusion body fibromatosis, is a rare benign tumor that commonly presents as a solitary nodule composed of spindle cells within the dermis on the digits of infants and children. Evaluation often includes a biopsy and typical therapies include observation, intralesional corticosteroid injections, and complete surgical resection. Given the rarity of IDF, few clinicians have direct or extensive experience diagnosing or treating it. Here we present a comprehensive review of the presentation, diagnosis, and treatment for IDF.

Myxolipoma of hand in a child: case report of a rare tumor

Lipomatous tumors account for less than 10% of tumors in the pediatric population. Myxolipomas (a subset of lipoma characterised by mature adipose tissue and abundant mucoid substance) are found to be even rarer. There are a few case reports in different body parts like heart, kidney, oral cavity, epiglottis, cervical and mediastinal regions. However, there are no case reports on the involvement of the hands in any age group. High resolution ultrasound is the imaging modality of choice for the initial evaluation of superficial soft tissue tumors, their site, nature and extent. In conjunction with clinical findings and age of presentation, it helps in narrowing down the differential diagnosis and planning the management. Hyperechoic fatty tumors in the pediatric hand are mostly benign and includes lipomas, lipoblastomas and fibrous hamartomas of infancy as the main differentials. A definitive diagnosis is based on a histo-pathological and molecular cytogenetic examination. This article presents a never before reported case of a rare, large, myxolipoma of the hand in a 22-month-old boy.

An Algorithmic Approach to the Management of Infantile Digital Fibromatosis: Review of Literature and a Case Report

Objective: Infantile digital fibromatosis is a rare benign childhood tumor, infrequently cited in the literature. Hallmarks include nodular growths exclusive to fingers and toes and the presence of eosinophilic cytoplasmic inclusions on histology. This article aims to exemplify diagnoses of infantile digital fibromatosis and possible treatment options. Methods: A computerized English literature search was performed in the PubMed/MEDLINE database using MeSH headings "infantile," "juvenile," "digital," and "fibromatosis." Twenty electronic publications were selected and their clinical and histological data recorded and used to compile a treatment algorithm. Results: A 9-month-old male child was referred for a persistent, symptomatic nodule on the third left toe. A direct excision with Brunner-type incisions was performed under general anesthesia. The procedure was successful without complications. The patient has no recurrence at 2 years postsurgery and continues to be followed. Histological examination revealed a proliferation of bland, uniformly plump spindle cells with elongated nuclei and small central nucleoli without paranuclear inclusions consistent with fibromatosis. Conclusions: Asymptomatic nodules should be observed for spontaneous regression or treated with nonsurgical techniques such as chemotherapeutic or steroid injection. Surgical removal should be reserved for cases with structural or functional compromise.

Spontaneous involution (regression) of a solitary cutaneous myofibroma in an adult patient

Myofibromas are unusual benign tumors most commonly seen in infant children. Clinical involution of the tumor often occurs within the first few years of life. Solitary cutaneous myofibroma is the synonymous adult counterpart of infantile myofibromatosis. Although solitary myofibromas have been reported in patients of all ages, only the infantile variant is believed to regress spontaneously. There are only a few case reports of adolescent and young adult patients with regressing solitary lesions that have been described in the literature to date. We report a 71-year-old male with spontaneous regression of solitary cutaneous myofibroma. The residual lesion was excised and to date has not recurred. This report describes the historical, clinical and histopathological features of adult myofibromas and a novel manifestation that may guide future clinical considerations when approaching solitary tumors with regressive features.

Calcifying aponeurotic fibroma in children: our experience and a literature review

Calcified aponeurotic fibroma is a rare benign fibrous tumour with characteristic histopathological features commonly observed in children and adolescents. It usually involves the most distal part of the extremities. Despite being a benign tumour, it has a high risk of local recurrence. We report our experience treating four children with calcifying aponeurotic fibroma who underwent surgical excision of the tumour. Two of them developed a local recurrence: one required a surgical revision, whereas the other currently continues to be under observation. The incidence found over a 5-year period (2010-2015) may lead us to consider that this condition is not as rare as reported and may often be misdiagnosed.

Six Cases of Myofibroma--The Adult Counterpart of Infantile Myofibromatosis: Case Report

The adult counterpart of infantile myofibromatosis is rare and is known as myofibroma. Cases are rare, and previous ones have been reported as isolated case reports; hence, there has been no consensus regarding the clinical presentation, surgical reconstruction, histological features, and recurrence of hand myofibromas. Over a 10-year period, the senior author treated 6 patients. We review our cases as well as 6 previously reported cases. The presentation is usually a single hand mass in a young adult. The tumor may arise from the lower dermis or from deeper fibrous structures of the hand including the palmar fascia. Tumors that arise from the dermis are best treated by skin excision to ensure complete excision. Histologically, the tumor is composed of highly cellular myofibroblast proliferation and is strongly positive to smooth muscle actin immune stain. The recurrence rate after excision is low.

Recent Strategies in Tissue Engineering for Guided Peripheral Nerve Regeneration

The repair of large crushed or sectioned segments of peripheral nerves remains a challenge in regenerative medicine due to the complexity of the biological environment and the lack of proper biomaterials and architecture to foster reconstruction. Traditionally such reconstruction is only achieved by using fresh human tissue as a surrogate for the absence of the nerve. However, recent focus in the field has been on new polymer structures and specific biofunctionalization to achieve the goal of peripheral nerve regeneration by developing artificial nerve prostheses. This review presents various tested approaches as well their effectiveness for nerve regrowth and functional recovery.

Nodular fasciitis of the hand: excision preserving 'vital' structures

Nodular fasciitis is an extremely rare benign fibrous tumour of the hand. Although benign, the tumour is frequently adherent to tendons/nerves and joints of the hand. However, the tumour may spontaneously regress and does not tend to recur following excision with histologically positive margins. For the last 20 years, the author has adopted a specific management approach for these and other benign fibrous tumours of the hand. Following the clinical/radiological diagnosis, tumour excision is done preserving 'vital' structures within the hand. The diagnosis is confirmed histologically and by immune stains, and the patient is then followed up for local recurrence. Over a 20-year period, the author has treated four cases of nodular fasciitis of the hand using this management approach. Despite the positive margins in all cases, there were no recurrences at a minimum follow-up interval of 3 years.

Congenital and infantile benign skin lesions affecting the hand and upper extremity, part 2: nonvascular neoplasms

This article is part 2 of a 2-part series presented to aid the hand surgeon in becoming familiar with dermatological lesions that may be present on the upper extremity during infancy. The discussion focuses on nonvascular neoplasms grouped into the following categories: epithelial, melanocytic, histiocytic, dermal, fibroblastic, and adipocytic neoplasms. Diagnostic tips are offered, including clinical photographs, to help differentiate between these lesions. In addition, the recommended treatment for each is discussed.

Skin hamartoma on the hand of a newborn infant

Skin hamartoma is an extremely rare disease on the hand in newborn infants. Reported herein is the case of a newborn infant who presented with a skin hamartoma on the hand. The patient was a girl born at 37 weeks of gestational age. The mass was seen on her proximal left thumb at birth. The mass had a spherical diameter of 4 cm and was pedunculated. One the day after birth, the stalk on the mass was ligated in the neonatal intensive care unit. The mass was diagnosed as skin hamartoma on histopathology. At 1 year of age, the child had good hand function, and no recurrence of the neoplasia was evident.

Intra-lesional steroid for the management of symptomatic Infantile Digital Fibromatosis

BACKGROUND

Infantile Digital Fibromatosis (IDF) is a benign, often asymptomatic nodular proliferation of fibrous tissue occurring almost exclusively on the extremities. Conventional treatment has included radical surgery but this is associated with a high level of recurrence. Whilst some authors suggest a strictly conservative approach, this is unacceptable when lesions become symptomatic from pain, contracture formation or functional deformity

METHODS

We present a retrospective analysis of 12 symptomatic lesions of which 7 were treated with a novel technique of intra-lesional steroid. From 2004-2009, a total of ten patients received treatment for symptomatic IDFs. Patients were followed-up for an average of 5 years 9 months (range 8-131 months).

RESULTS

Corticosteroid was well tolerated with no significant complications and was associated with lower morbidity that compared with surgery. There was no significance difference between rate of recurrence (1/7 vs. 5/10) for those treated with corticosteroid than compared to those patients who underwent surgery (p = 0.3) but the study is underpowered.

CONCLUSIONS

This is the first ever study to look at the role of intra-lesional steroid in the management of IDF. Whilst the majority of asymptomatic Infantile Digital Fibromatoses can be safely observed until natural resolution, intra-lesional corticosteroid is a safe and well-tolerated alternative to surgery for all symptomatic digital fibromatoses of infancy. We suggest it replaces surgery as first-line treatment but look forward to a large multicentre trial to allow comparison.

Infantile digital fibromatosis: our experience and long-term results

Infantile fibromatosis is an uncommon benign proliferation of myofibroblasts in the dermal tissue on the digits and toes with a marked tendency for recurrence. Inclusion bodies in the cytoplasm of neoplastic fibroblasts are a characteristic histologic feature of this condition. The tumor may often resolve spontaneously. There is very little written in the literature on this subject, with only a few or isolated cases having been described. We report our experience of seven cases of recurrent infantile fibromatosis that underwent surgical treatment.

[Solid, asymptomatic nodules on several toes in a child]

The term infantile digital fibromatosis describes a benign tumor of the group of fibromatoses. The prevalence rate is approximately 2.5% of all fibromatoses. The etiopathogenesis of infantile digital fibromatosis is unknown. These tumors can appear already at birth, but usually manifest during the first 3 years of life as solid, pink or skin-colored asymptomatic nodules on one or several fingers or toes. Because of the postoperative recurrence rate of 50-75% and the possibility of spontaneous regression, excision is not recommended according to currently available evidence.