Infantile pedal papules

Asymptomatic Plantar Nodules in a Toddler

Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a rare benign skin lesion that typically presents at birth, or within the first several years of life, as single or multiple asymptomatic skin-colored papules or nodules on the plantar heels. We present a classic case of PCFH in a 3-year-old child. This uncommon entity has no reported malignant features or malignant transformations. We demonstrate how this diagnosis can be made clinically without subjecting pediatric patients to potentially painful, traumatizing, costly skin biopsies and unnecessary imaging.

Muscle herniation as a cause of superficial lumps on the legs of a healthy teenager

Muscular hernias, focal protrusions of muscle through fascial weaknesses, are uncommon in pediatric patients. When diagnosed, they are usually found on the legs from protrusions of tibialis anterior muscle in young male athletes. Here, we present a case of a healthy 16-year-old boy who developed asymptomatic nodules on the bilateral feet and lateral lower legs, which were confirmed by ultrasound to be focal muscle herniations. Our case highlights a rare example of bilateral muscle herniation in a pediatric patient and the utility of ultrasound as a diagnostic modality for this uncommon condition.

Precalcaneal congenital fibrolipomatous hamartoma: Rare or under-reported?

Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a benign under-reported condition of infancy characterized by the presence of soft nodules on precalcaneal plantar surface of the heel. These lesions are usually bilateral solitary and asymptomatic. We present a 2-month-old infant with solitary skin-colored nodules present on precalcaneal plantar aspect of bilateral heels.

Cutaneous fibrolipomatous hamartoma: Report of 2 cases with retrocalcaneal location

Precalcaneal congenital fibrolipomatous hamartoma is an underreported benign entity that has been described in the literature under different names. We present two cases of unilateral fibrolipomatous hamartoma (FLH) appearing in a unique location: on the posterior aspect of the foot overlying the heel. We propose the term "FLH of the skin" as a more inclusive and less confusing term for this condition, thus allowing distinction with FLH arising from neural tissue. High-frequency ultrasonography appears to be a useful diagnostic tool that may avoid unnecessary biopsies for this condition.

A piezogenic papule with histopathologic features simulating angiomyxolipoma

Piezogenic papules are lesions that occur on the feet and wrists because of the herniation of fat through the dermis. These papules can be painful or completely asymptomatic. Poor compartmentalization of fat occurs because of thinner than normal fibrous trabeculae and contributes to the formation of piezogenic papules. On histological examination, fat is evident extending through the dermis. We report a case of a piezogenic papule simulating angiomyxolipoma on histological examination. The presented case suggests the possibility of an association between herniated fat tissue and mucin deposition with vascular proliferation.

Precalcaneal congenital fibrolipomatous hamartoma: report of 2 cases

Precalcaneal congenital fibrolipomatous hamartoma is a benign condition of infancy that is possibly underdiagnosed because of the lack of reports in the literature. Lesions become evident after the first months of life and may be troublesome to parents and physicians. Patients are frequently referred to the pediatric surgeon for evaluation. We report and discuss 2 typical cases.

Precalcaneal congenital soft-tissue lesions in children: A case report of fibrous hamartoma of infancy and an approach to differential diagnosis

Precalcaneal soft-tissue lesions are uncommon in the pediatric population and can present a diagnostic challenge. Fibrous hamartoma of infancy (FHI) is relatively rare in this location. We report an interesting case of FHI in a 3-years-and-10-months-old boy in the precalcaneal location that was present since birth. We describe the imaging findings of FHI on X-ray, ultrasound, and MRI and discuss the differential diagnoses. It is important to consider FHI during differential diagnosis and be aware of the imaging features of other common possible diagnoses in the precalcaneal region for appropriate management.

Anteromedial plantar nodules of the heel in childhood: a variant of the normality?

Localized, bilateral, painless, nonpruritic and symmetric papuloid lesions in the posteromedial part of the foot are the clinical features of benign plantar nodules of the heel in children. They are probably congenital; they are asymptomatic and benign. We present 18 children with posteromedial nodules of the heel, 15 bilateral. Mean age was 45.31+/-53.49 months. The reason for the consultation was the lump itself in 10 of the cases. Thirteen were asymptomatic and five presented transient tenderness to pressure. Radiographs were nonspecific in all cases. Sonography showed an accumulation of tissue similar to subcutaneous cell tissue, compatible with fat. MRI was performed in one case, showing an accumulation of fatty tissue similar to subcutaneous cell tissue. Follow-up time was 5.44+/-3.78 years (range 2-16 years). At the end of follow-up, all the patients are asymptomatic with normal functional outcome and with the lump persisting in all but one. In conclusion, a sonographic study is sufficient to diagnose this type of mass, without the need for biopsy and/or surgical exeresis to distinguish fatty tissue from another type of consistency. Subsequent studies should aim at showing piezogenic, hamartomatous or congenital fat herniation aetiology of these typical lumps, probably normal variant of normality.

Precalcaneal congenital fibrolipomatous hamartoma

Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a condition that is seldom reported in the paediatric literature and rarely in the dermatological literature. It has other disparate and confusing names and as histology is rarely obtained, the condition may be under-reported. We describe this disorder in the male twin of a pair of nonidentical twins.

Update on syndromes with cutaneous manifestations and new diagnoses in dermatology

Systemic syndromes with cutaneous manifestations represent a continually evolving entity. New syndromes are described, while improved understanding of others, with new features of disease or enhanced genetic understanding of the disease are discovered. This review highlights the latest information on syndromes with cutaneous manifestations and presents several newly described dermatologic diagnoses.