Clinics in diagnostic imaging (195). Plantar fibromatosis.

A 46-year-old man presented with a six-month history of lumps in the sole of his left foot. Physical examination revealed two nodules, one tender and one firm, at the plantar left foot with no overlying skin changes. Although the initial radiographs were normal, magnetic resonance imaging of the left foot demonstrated two nodules along the medial band of the plantar fascia, characteristic of plantar fibromas. The patient opted for surgical excision. There was no further recurrence of symptoms after surgery. We describe the clinical and radiological features of plantar fibromatosis and briefly discuss other causes of lumps and pain in the sole of the foot.

Clinical features and management of superficial fibromatoses.

Fibromatoses are a group of benign connective tissue tumors characterized by the infiltrative, aggressive proliferation of well-differentiated fibroblasts, leading to frequent local recurrence. Within this heterogeneous disease group, superficial fibromatoses show slower growth and more benign infiltration of surrounding tissues than deep fibromatoses. Superficial fibromatoses relevant to dermatology include palmar, plantar, and penile fibromatosis, knuckle pads, pachydermodactyly and infantile digital fibromatosis. They present clinically with subcutaneous nodules or cords that lead to local infiltration and limited mobility of the affected areas. Treatment options vary from watchful waiting, non-invasive methods such as radiotherapy and intralesional corticosteroid/collagenase injections to radical surgical procedures. Early intervention may disrupt disease progression and may even restore functional ability. These disorders should therefore be recognized and treated early in the course of the disease.

Clinical, histological and therapeutic modern approach of Ledderhose disease.

Ledderhose disease or plantar fibromatosis is a rare hyperproliferative disorder of the plantar aponeurosis, clinically characterized by nodules situated especially on the medial border of the foot. It is histopathologically associated with Dupuytren's disease. This disease has some risk factors, like old age, alcohol or nicotine abuse, liver dysfunction, trauma or exposure to vibrations and autoimmune disorders, but the exact etiology is still unknown. Even though it is benign, the local manifestations can be aggressive, leading to debilitating deformities and contractures of the toes. Ultrasound and magnetic resonance imaging are used to confirm the diagnosis and to eliminate other disorders. Whenever is possible, the conservative therapies are recommended. Having a high recurrence, Ledderhose disease can be hard to treat, needing multiple surgical interventions. This paper aims to cover all the important aspects of this disease for daily medical practice, from history to clinical manifestations, diagnostic methods and histopathological features, to conservative and surgical treatment modalities.

Plantar fibromatosis: Surgical approach of a giant bilateral case.

BACKGROUND: Plantar fibromatosis or Ledderhose disease is characterized by a benign fibroblastic proliferation of the plantar fascia. It is an illness with unknown etiology and a complex treatment in its most intense manifestation. OBJECTIVE: The authors describe a surgical option for extensive cases where conservative treatments are not successful. Surgical techniques may vary according to the site and extent of the lesions. METHODS: Surgical treatment with wide resection of the lesion and second intention healing using a hydrocolloid dressing. RESULTS: After a 3-year follow-up with no recurrence, the authors demonstrated an excellent result, which led to an important improvement in the patient's quality of life. CONCLUSION: Surgical treatment can be a good option for plantar fibromatosis. Giant lesions can be treated with wide excisions and second intention healing, with low risk of aesthetic and functional complications.

Plantar Fibromatosis in a Mentally Challenged Man Treated with Intralesional Corticosteroids.

A 21-year-old mentally challenged man presented with a fixed plaque lesion on the right foot, which had been present for 10 years. Dermatologic examination revealed an erythematous, painful, firm, fixed plaque-nodular lesion on the plantar aspect of the right foot (Figure 1A). Nothing of distinction was noted from his family history or his laboratory tests. An incisional biopsy revealed parallel, regular bundles composed of uniform, plump spindle cells. Thin collagen fibers were seen in contact with and located between the spindle cells. This mass was separated from the surrounding soft tissue by an irregular, unclear border (Figure 2A). Immunohistochemically, the spindle cells showed diffuse, strong reactivity to vimentin (Figure 2B) and smooth muscle actin.

Partial fasciectomy is a useful treatment option for symptomatic plantar fibromatosis.

Plantar fibromatosis is a rare, benign fibroproliferative disorder of the plantar fascia. It is considered as a low-grade tumour and it can be locally aggressive. It can present as painful swelling with impairment of local function. Upon failure of non-operative management, surgical treatment options include total fasciectomy or partial fasciectomy. Although surgical excision is the mainstay of treatment, recurrence rate can be up to 60%. The aim of this study was to determine the recurrence and complication rates of surgically treated plantar fibromatosis. A retrospective study was conducted involving patients who had a confirmed diagnosis and excision of plantar fibromatosis treated in our institution between 2011 and 2016. Demographic data, follow-up duration, recurrence and complications were reviewed. Eighteen patients underwent 19 operations. Mean age was 41.3 years (20-57). There were 12 male patients. The main presenting features were pain, swelling and impairment of function. They were investigated by ultrasound scan (12 feet, 63%) and/or magnetic resonance imaging (8 feet, 42%). Two patients (11%) had prior surgery at other institutions whilst 3 patients (17%) had multiple nodules at presentation. All patients underwent partial fasciectomy of the plantar fibromatosis. At up to 5 years follow-up, one patient (6%) had a recurrence in our series whilst 3 patients (17%) had scar related problems (2 patients with scar pain and one patient had hypersensitive scar that resolved after 12 months). Symptomatic plantar fibromatosis can be effectively treated with partial plantar fasciectomy.

Extraskeletal Myxoid Chondrosarcoma of the Foot Clinically Mimicking Plantar Fibromatosis.

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma usually presenting in proximal extremities of middle-aged men. The authors discuss a unique case of EMC, localized in the plantar foot of a 76-year-old woman, clinically suspected as plantar fibromatosis. It is important to avoid misdiagnosis of EMC because of their propensity for late recurrence and their metastatic potential.

Fibromatose digital infantil: relato de caso / Infantile digital fibromatosis: case report

Introdução: A fibromatose digital infantil é uma proliferação nodular, assintomática, rara e benigna do tecido fibroso, que ocorre quase exclusivamente na região dorsal e lateral dos dedos das mãos e pés. O artigo relata um caso de fibromatose digital infantil, também conhecida como tumor de Reye. Relato de Caso: Trata-se de um caso diagnosticado por meio de exames clínico, de imagem e histopatológico. O paciente apresentou-se ao Setor de Ortopedia do Hospital, queixando-se de uma lesão nodular, eritematosa, indolor, no segundo pododáctilo do pé esquerdo, existente havia quatro anos. Durante o exame físico, notava-se uma deformidade no II pododáctilo, causada por uma lesão nodular, eritematosa, indolor, de aproximadamente 1,5 cm, que não acarretava alterações funcionais. O exame de ultrassom revelou a presença de uma imagem nodular sólida, hipoecogênica, envolvendo o tendão do extensor do II pododáctilo na falange média. O diagnóstico inicial era de fibroma ou sinovioma. Pelas características clínicas da lesão, por seu tempo de evolução e pelos achados de imagem, a equipe optou por uma biópsia. No entanto, devido ao pequeno tamanho da lesão, sendo a biópsia aberta, realizou-se a exérese cirúrgica. O exame histopatológico confirmou o diagnóstico de fibromatose digital infantil. Conclusão: Esse tumor constitui uma entidade clínica rara, que deve ser diferenciada de outras lesões encontradas nos dedos das mãos e dos pés. O diagnóstico correto raramente é feito antes da operação, devido, principalmente, à falha em reconhecer essa entidade. Por essa razão, é essencial considerar essa lesão em diagnósticos diferenciais.

Introduction: Infantile digital fibromatosis, also known as Reye tumor, is a rare, asymptomatic, benign nodular proliferation of fibrous tissue, which occurs almost exclusively in the dorsolateral region of the fingers and toes. This article reports a case of infantile digital fibromatosis. Case report: This case was diagnosed by clinical, imaging, and histopathological examination. The patient presented at the rthopedic Department of our hospital, with a 4-year history of a painless, erythematous nodular lesion on the econd toe of the left foot. On physical examination, a deformity of the second toe caused by a nodular, erythematous, painless lesion of approximately 1.5 cm diameter was noted; the lesion did not result in functional changes. Ultrasound examination revealed a solid, hypoechoic nodule involving the extensor tendon in the middle phalanx of the second toe. The initial diagnosis was fibroma or synovioma. Due to the clinical characteristics of the lesion, its evolution, and the imaging findings, the team chose to perform a biopsy. However, due to the small size of the lesion, upon open biopsy, surgical excision was performed. Histopathological examination confirmed the diagnosis of infantile digital fibromatosis. Conclusion: Infantile digital fibromatosis is a rare clinical entity, which should be differentiated from other lesions found in the fingers and toes. The correct diagnosis is rarely made pre-operatively, due mainly to a failure to recognize this entity. For this reason, it is essential to onsider this lesion in the differential diagnosis of digital nodules.