CLINICAL HISTORY:

Signs and symptoms:  Cosmetically disfiguring

Previous Treatment:  Previously excised by hand surgeon at age 2 months

Other information:  Mother concerned about the recurrence and prognosis.

PHYSICAL EXAM:

A 7 month-old, healthy appearing, well-nourished male presented with a 0.5cm firm, yellow-pink, dome-shaped nodule was noted on the right, lateral, distal third digit. An adjacent, well-healed scar from previous surgery was also present. There was no evidence of any physical impairment secondary to the growth.

LABORATORY TESTS:

none

DERMATOHISTOPATHOLOGY:

Microscopic description: This is a non-encapsulated tumor composed of spindle-shaped myofibroblasts intermixed with collagen bundles. It may extend from the epidermis down into the subcutaneous tissue. Myofibroblasts have pathognomic eosinophilic, cytoplasmic inclusion bodies, which stain red with Masson’s Trichrome, deep purple with phosphotungstic acid hematoxylin (PTAH). These inclusions are mostly aggregates of actin. (no histopathology available from our case therefore example taken from Bolognia)

DIFFERENTIAL DIAGNOSIS:

1.   Supernumerary digit
2.   Acral angiofibroma
3.   Acral fibrokeratoma
4.   Infantile digital fibroma
5.   None of the Above

SCROLL DOWN FOR ANSWER AND DISCUSSION.

CORRECT DIAGNOSIS:

Infantile digital fibroma

DISCUSSION:

Infantile digital fibromas are also commonly referred to as recurring digital fibrous tumor of childhood and inclusion body fibromatosis. This is a benign, asymptomatic growth which appears on dorsolateral fingers or toes during the first year of life typically sparing the thumb and great toe. Most tumors spontaneously regress within 2-3 years. However, functional impairment or deformity of the digit may require earlier surgical intervention, although greater than 50% may recur.

TREATMENT:

Actual treatment for this patient: Due to the recurrence and rapid growth of the tumor, we referred our patient to an orthopedic hand surgeon for re-excision.

Other Treatment options: Depending on the special circumstances and physical findings of each patient, the spectrum of treatment options include: reassurance and observation, wide-local excision, or even amputation in extenuating cases. However, the role of surgical intervention is controversial due to the high post-op recurrence rate (50%) and the potential for spontaneous resolution.

REFERENCES:

1. Bolognia JL, Jorizzo JL, et. al. Fibrous Proliferations of Skin and Tendons. Dermatology. 1st Ed. Elsevier Limited, 2003. 1872.

2. Schachner LA, Hansen RC. Fibroblastic and Myofibroblastic Tumors. Pediatric Dermatology. 3rd Ed. Elsevier Limited, 2003. 869.

3. Weedon D. Tumors and Tumor-like Proliferations of Fibrous and Related Tissues. Skin Pathology. 2nd Ed. Elsevier Limited, 2002. 925.

4. Elder D, et al. Tumors of Fibrous Tissue Involving the Skin. Lever’s Histopathology of the Skin. 8th Ed. Lippincott-Raven 1997. 869-70.

5. Hurwitz S. Cutaneous Tumor of Childhood. Clinical Pediatric Dermatology. 2nd Ed. W.B. Saunders, 1993. 229-30.

Additional Comment:

© Copyright 2003-2006 by AOCD Grand Rounds

Top of Page