Fast growing non-malignant tumour of a finger

Fibro-Osseus Pseudotumor of the Digit: A Case Report and Review of Literature

Introduction

Bony subungual growths arising on the digital tip are uncommon. Among these, subungual exostosis is a common cause.

Case Presentation

We describe a 35-year-old-male patient with a rare occurrence of a fibro-osseus pseudotumor of the digit. It presents with reactive intramembranous ossification, with no continuity with the distal phalanx, helping differentiate it from a subungual exostosis. The patient presented with an asymptomatic subungual growth, lifting up the nail plate distally causing onycholysis. The characteristic clinical, radiological, and histopathological features of the case are described, which helped confirm the diagnosis.

Conclusion

Cases with fibro-osseus pseudotumor of the digit reported in literature are reviewed comprehensively. The factors helping differentiate this from the other bony tumors affecting the distal phalanx, including subungual exostosis, myositis ossificans, and osteosarcoma are also highlighted.

Giant nodular fasciitis originating from the humeral periosteum: A case report

BACKGROUND

Nodular fasciitis (NF) is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia. NF originating from the appendicular periosteum is extremely rare. A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.

CASE SUMMARY

A right axillary mass was found in a 46-year-old man and was initially diagnosed intraoperatively as low-grade sarcoma, but later diagnosed as NF after post-resection histopathological evaluation. Furthermore, fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis. To the best of our knowledge, this is the first case of NF in the humeral periosteum.

CONCLUSION

NF poses a diagnostic challenge as it is often mistaken for sarcoma. Postoperative histopathological examination of whole sections can be combined with immunohistochemical staining and, if necessary, the diagnosis can be confirmed by molecular detection, and thus help avoid overtreatment.

Benign growing mass of the digit presenting as an ulcerated mass - case report and review of the literature

A 68 year-old female presents with an ulcerated mass of the 5th digit, with rapid growth during the previous month to surgery. The mass was excised and covered with a 4th dorsal metacarpal artery perforator flap. The histologic analysis was compatible with the diagnosis of fibro-osseous pseudotumor of the digit.

Fibro-Osseous Pseudotumour of the Digit: An Illustrative Case and Review of the Literature

Fibro-osseous pseudotumour is a rare, benign ossifying tumour of soft tissue that should be considered in the differential diagnosis of any tumour affecting the digits. Clinical diagnosis is difficult and fibro-osseous pseudotumour is often mistaken for malignancy, leading to inappropriate treatment. Knowledge of its clinical and histopathological features thus allows for appropriate primary treatment, sparing the patient from unnecessary radical surgery associated with presumed malignancy. We present the case of a 48-year-old male with fibro-osseous pseudotumour affecting the right ring finger, successfully treated with local excision. This is the second reported Australian case of fibro-osseous pseudotumour, and we present an extensive review of the literature relating to the diagnosis and management of this rare tumour.

Myositis ossificans of the hand in a child: case report

Myositis ossificans of the hand is very rare. We report a case of an obviously post-traumatic case and discuss the value of trauma in the etiology.

Myositis ossificans and fibroosseous pseudotumor of digits: a clinicopathological review of 64 cases with emphasis on diagnostic pitfalls

Myositis ossificans (MO) and fibroosseous pseudotumor of digits (FP) are pseudotumoral mimics of malignancy. A review of 50 cases of MO and 14 cases of FP showed that a malignant diagnosis was suggested by referring pathologists in 23% of MO and 9% of FP. The most common misdiagnosis was osteosarcoma. Awareness of the spectrum of clinicopathological features of MO and FP will help pathologists avoid misdiagnoses. A comparison of the clinicopathological features of MO and FP showed that most features were similar, but FP involved an older age group (p<0.001). MO showed a statistically significant higher tendency to contain fibrinous material (p=0.007), edematous lymphangioma-like areas (p=0.013), and cartilage (p=0.017) and FP to contain excessive immature osteoid (p=0.029). These differences may be related to the site of occurrence.

Fibro-osseous pseudotumor of the digits arising in the subungual region: a rare benign lesion simulating extraskeletal osteosarcoma

A rare case of subungual fibro-osseous pseudotumor of the digits in a 59 year old woman is reported. A painful polypoid mass with ulcerative changes was noted in the subungual portion of the right first toe. Macroscopically, the tumor arose chiefly in the subcutaneous region and was unrelated to the underlying bone tissue. Histologically, the lesion contained fibroblast-like tumor cells producing an extensive osteoid substance in a granulation-like background. Although it was necessary to distinguish the lesion from extraskeletal osteosarcoma, the tumor cells lacked prominent atypical features. It is considered that pathologists and clinicians should add fibro-osseous pseudotumor of the digits to the differential diagnosis of subungual tumor.

[Fibro-osseous pseudo-tumor of the fingers. A little known entity. A case of an 11 year-old girl]

The authors report a case of fibro-osseous pseudo-tumour affecting a long finger. This is a rare tumour difficult to diagnose. Complete excision of the tumour was delayed till two years after its appearance as it's true nature had not been recognised at the time of the initial histopathologic examination. It is a benign tumour with a good prognosis as it does not undergo malignant degeneration and does not recur locally if excision has been complete. Errors in interpretation of the histopathologic picture have, in the past, led to unwarranted amputations of the involved fingers.

Fibro-osseous pseudotumor of the digits: report of a case with immunohistochemical and ultrastructural studies

A polypoid fibro-osseous nodule arising from the soft tissues of a toe of a 17 yr old man is described. Initial partial excision of the nodule led to a wrong diagnosis of pyogenic granuloma. The mistaken diagnosis was based on finding an extensively ulcerated polypoid nodule with a core of fibrovascular tissue which resembled granulation tissue. The fast growing lesion recurred twice within 4 mths following incomplete excisions. Bony destruction of the distal phalanx was noted radiologically at the second recurrence. The rare lesion is an example of fibro-osseous pseudotumor of the digits, sometimes described as pseudomalignant osseous tumor of the soft tissues. It is curable by complete local resection. The importance of recognizing this lesion lies in its potential to be confused with parosteal or extraskeletal osteosarcoma. The fast growth rate of present case led to a strong clinical suspicion of malignancy. Incomplete excisions resulted in local recurrences rendering more extensive surgery necessary. There was no further recurrence 12 mths after the last excision.

Fibro-osseous pseudotumor of the digits

Twenty-one cases of a benign fibro-osseous pseudotumor occurring in the soft tissues of the digits are described. They affected mostly young adults. Twenty of the 21 cases involved the soft tissues of the fingers, especially the proximal portions of the index or middle finger, and one case involved the toe. Microscopically these tumor-like lesions closely resembled myositis ossificans, but unlike this process they involved chiefly the subcutaneous tissue and adjacent fibrous structures and were marked by an irregular multinodular growth pattern without the typical zoning of myositis ossificans. Because of the focal hypercellularity, cellular atypia and increased mitotic activity six of the cases were initially interpreted as being parosteal or extraskeletal osteosarcoma. Follow-up information indicates that this lesion behaves in a nonaggressive fashion and is curable by complete local excision.

Pseudomalignant osseous tumor of soft tissue: a case report and review of the literature

Pseudomalignant osseous tumor of soft tissues is a rare tumor of the hand. Histopathologic differentiation of this benign lesion from malignant lesions is difficult because mitotic figures are common in typical cases, but bizarre pleomorphic and hyperchromatic nuclei never occur. Wide excision is adequate in most cases, but ray resection is indicated when this benign lesion recurs after wide excision, invades the vital structures, or causes severe functional impairment. Review of the literature revealed 15 cases of this lesion in the digits of the hand, including our case. Of these 15 cases, misdiagnosis of malignancy in three cases and loss of function in an additional four cases led to ray resection.

Peripartum pseudomalignant myositis ossificans of the finger

Two cases of pseudomalignant peripartum myositis ossificans of the finger are reported. The benign diagnosis is confirmed by the histologically characteristic zone phenomenon, consisting of a transition from an inner zone of proliferating spindle cells to a middle zone of well-oriented osteoid and finally to an outer zone of mature bone. In Case No. 1, because of the question of malignancy, a ray amputation was performed. In Case No. 2, the patient was observed during the peripartum period to show diminution in the size of the tumor. The lesion was eventually treated by local excision.