Aponeurotic fibroma | |
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Other names | Calcifying aponeurotic fibroma, juvenile aponeurotic fibroma |
Histopathology of a calcifying aponeurotic fibroma from a finger, H&E stain. |
Aponeurotic fibroma, also known as calcifying aponeurotic fibroma, and juvenile aponeurotic fibroma is characterized by a lesion that usually presents as a painless, solitary, deep fibrous nodule, often adherent to tendon, fascia, or periosteum, on the hands and feet. [1] The World Health Organization in 2020 reclassified aponeurotic fibroma nodules as a specific benign type of the fibroblastic and myofibroblastic tumors. [2] Aponeurotic fibromas are diagnosed based on histopathology and treated by surgical excision. They are more common in males than females.
Aponeurotic fibroma occurs most frequently in the fingers, palms, and soles of the distal extremities. [3] Typically, the tumor is defined as a smaller than 3 cm diameter, firm, non-tender mass that grows slowly. It is prone to infiltrate the surrounding tissue and, following surgical resection, is more likely to recur locally. [4]
A histological examination is necessary to make a diagnosis. [5] Histologically, the tumor is characterized by fibroblast growth and calcification. [3]
Imaging results include edematous alterations and subcutaneous neoplastic tumors with hazy margins that appear to be encroaching on the surrounding tissues. The fascia and tendon sheath are next to the tumor. While T2WI displays heterogeneous signals, T1WI displays signals that are hypointense to isointense. Additionally, there is heterogeneous contrast enhancement. [6] [7] [8]
The treatment of choice for an aponeurotic fibroma is surgical excision. [5]
Aponeurotic fibroma is a rare tumor. The tumor often manifests in the first or second decade of life, while examples have been documented at birth and 67 years of age. Patients who are male are impacted twice as frequently as those who are female. [4]
A biopsy is a medical test commonly performed by a surgeon, an interventional radiologist, or an interventional cardiologist. The process involves the extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is then fixed, dehydrated, embedded, sectioned, stained and mounted before it is generally examined under a microscope by a pathologist; it may also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous or inflammatory conditions.
Calcinosis cutis is an uncommon condition marked by calcium buildup in the skin and subcutaneous tissues. Calcinosis cutis can range in intensity from little nodules in one area of the body to huge, crippling lesions affecting a vast portion of the body. Five kinds of the condition are typically distinguished: calciphylaxis, idiopathic calcification, iatrogenic calcification, dystrophic calcification, and metastatic calcification.
Plantar fascial fibromatosis, also known as Ledderhose's disease, Morbus Ledderhose, and plantar fibromatosis, is a relatively uncommon non-malignant thickening of the feet's deep connective tissue, or fascia. In the beginning, where nodules start growing in the fascia of the foot, the disease is minor. Over time, walking becomes painful. The disease is named after Georg Ledderhose, a German surgeon who described the condition for the first time in 1894. A similar disease is Dupuytren's disease, which affects the hand and causes bent hand or fingers.
Giant-cell fibroma is a benign localized fibrous mass. It often mimics other fibroepithelial growths and can be distinguished by its histopathology. The exact cause of giant-cell fibromas is unknown however there is no evidence to show that it can be caused by irritation. Giant-cell fibromas can be removed by surgical incision, electrosurgery, or laser excision.
An ameloblastic fibroma is a fibroma of the ameloblastic tissue, that is, an odontogenic tumor arising from the enamel organ or dental lamina. It may be either truly neoplastic or merely hamartomatous. In neoplastic cases, it may be labeled an ameloblastic fibrosarcoma in accord with the terminological distinction that reserves the word fibroma for benign tumors and assigns the word fibrosarcoma to malignant ones. It is more common in the first and second decades of life, when odontogenesis is ongoing, than in later decades. In 50% of cases an unerupted tooth is involved.
Peripheral odontogenic fibroma(PFO) is a fibrous connective tissue mass that is exophytic and covered in surface epithelium that contains odontogenic epithelium. The World Health Organization (WHO) classifies peripheral odontogenic fibroma as a fibroblastic neoplasm with variable amounts of odontogenic epithelium that appears to be dormant. Dentine and/or cementum-like material may be present.
Chondroblastoma is a rare, benign, locally aggressive bone tumor that typically affects the epiphyses or apophyses of long bones. It is thought to arise from an outgrowth of immature cartilage cells (chondroblasts) from secondary ossification centers, originating from the epiphyseal plate or some remnant of it.
Angiolipoma is a subcutaneous nodule with vascular structure, having all other features of a typical lipoma. They are commonly painful. Angiolipomas manifest as multiple painful subcutaneous nodules commonly on the upper limbs. The can occur sporadically, with a family history or after trauma. Angiolipomas can be seen on CT scans and MRI but are diagnosed based of histopathology. Total excision or liposuction is used to treat angiolipomas. They are more common in med and usually appear in third and second decades of life.
Collagenous fibroma, also known as desmoplastic fibroblastoma, is a slow-growing, deep-set, benign fibrous tumor, usually located in the deep subcutis, fascia, aponeurosis, or skeletal muscle of the extremities, limb girdles, or head and neck regions. The World Health Organization in 2020 reclassified desmoplastic fibroblastoma/collagenous fibroma as a specific benign tumor type within the broad category of fibroblastic and myofibroblastic tumors.
Cutaneous meningioma, also known as heterotopic meningeal tissue, and rudimentary meningocele is a developmental defect, and results from the presence of meningocytes outside the calvarium.
Chondroid lipomas are deep-seated, firm, yellow tumors that characteristically occur on the legs of women. They exhibit a characteristic genetic translocation t(11;16) with a resulting C11orf95-MKL2 fusion oncogene.
A cutaneous myxoma, or superficial angiomyxoma, consists of a multilobulated myxoid mass containing stellate or spindled fibroblasts with pools of mucin forming cleft-like spaces. There is often a proliferation of blood vessels and an inflammatory infiltrate. Staining is positive for vimentin, negative for cytokeratin and desmin, and variable for CD34, Factor VIIIa, SMA, MSA and S-100.
Onychomatricoma is a cutaneous condition characterized by a distinctive tumor of the nail matrix.
Sebaceoma, also known as a sebaceous epithelioma, is a cutaneous condition that appears as a yellow or orange papule.
A superficial acral fibromyxoma is a type of myxoma and is a rare cutaneous condition characterized by a mesenchymal neoplasm that typically occurs on the digits of middle-aged adults.
Fibroma of tendon sheath is a benign tumor that presents as a small subcutaneous nodule that slowly increases in size. This is a notably uncommon condition. According to case report literature, the tumors often have a multinodular growth pattern, with individual nodules being composed of bland, slender, spindle-shaped cells (myofibroblasts) in a dense, fibrous matrix.” A common microscopic finding is the presence of elongated, slit-like blood vessels. The lesions nearly always arise in the distal portions of the extremities. They often occur on the fingers, hands, toes, or feet. Although they are benign, they may recur after surgical excision in up to 40% of people.
Extraskeletal chondroma is a cutaneous condition, a rare benign tumor of mature cartilage.
Infantile hemangiopericytoma is a cutaneous condition characterized by single or multiple dermal and subcutaneous nodules that may be alarmingly large at birth or grow rapidly.
Fibroblastic and myofibroblastic tumors (FMTs) develop from the mesenchymal stem cells which differentiate into fibroblasts and/or the myocytes/myoblasts that differentiate into muscle cells. FMTs are a heterogeneous group of soft tissue neoplasms. The World Health Organization (2020) defined tumors as being FMTs based on their morphology and, more importantly, newly discovered abnormalities in the expression levels of key gene products made by these tumors' neoplastic cells. Histopathologically, FMTs consist of neoplastic connective tissue cells which have differented into cells that have microscopic appearances resembling fibroblasts and/or myofibroblasts. The fibroblastic cells are characterized as spindle-shaped cells with inconspicuous nucleoli that express vimentin, an intracellular protein typically found in mesenchymal cells, and CD34, a cell surface membrane glycoprotein. Myofibroblastic cells are plumper with more abundant cytoplasm and more prominent nucleoli; they express smooth muscle marker proteins such as smooth muscle actins, desmin, and caldesmon. The World Health Organization further classified FMTs into four tumor forms based on their varying levels of aggressiveness: benign, intermediate, intermediate, and malignant.
The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin. Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma and odontogenic sarcoma. Cahn LR and Blum T, believed in "maturation theory", which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.