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A Protuberant Nodule Under the Foot—Diagnosis

A Protuberant Nodule Under the Foot—Diagnosis Diagnosis: Plantar fibromatosis (Ledderhose disease). Microscopic findings Histologic examination revealed intermingled fascicles of spindle-shaped fibroblasts within the reticular dermis. Tumor cells were of uniform size and shape, with ovoid and elongated nuclei. There was no atypia or mitosis. No invasion to the surrounding structures was noted. Discussion Plantar fibromatosis (PLF) is a benign and superficial form of fibromatosis, characterized by the replacement of the plantar aponeurosis with abnormal fibrous tissue.1-4 The disorder is accepted as the plantar equivalent of palmar fibromatosis (Dupuytren disease); however, PLF is much more rarely encountered.3,5-7 It usually affects men in the fourth to seventh decade of life.1,6 However, the disorder may rarely present in childhood and even at birth.7 The etiology remains unknown. In contrast to Dupuytren disease in which an autosomal dominant inheritance has been firmly established, familial PLF is rare.5 Trauma, infection, neuropathy, biochemical and metabolic imbalance, faulty development, and occupation have been proposed as potential etiological factors.2 We believe that trauma might lead to formation and/or progression of these lesions, at least in patients inherently susceptible to the disorder. Plantar fibromatosis presents as firm, fixed, slowly growing nodules.1,2,8 The usual location is the central or medial aspect of the plantar aponeurosis. However, the proximal aspect may also be involved, as in our case.1,3,9 The lesion(s) may be solitary or multiple.1,2,9 Bilateral involvement is observed in 20% to 50% of cases, and 10% to 65% of patients have concomitant palmar fibromatosis.1,6 Plantar fibromatosis is often asymptomatic at its initial stages, but enlarged lesions may lead to pain by pressure on or by invasion of adjacent muscles or neurovascular structures.1,4,5 The disease was symptomatic in our patient. The diagnosis is based on clinical and histologic findings.3 Radiography, ultrasonography, computed tomography, and magnetic resonance imaging may help to delineate the exact location and extent of the lesions before planning surgery.1-4,6,8,9 The prognosis depends on the infiltration capacity and extent of the lesions.1-3,8 Contractures as a complication of PLF are rare.7,9 Asymptomatic PLF is best treated conservatively by orthopedic footwear.1 A medical treatment option for painful lesions is intralesional triamcinolone injections.5 Wide surgical excision or plantar fasciectomy have been recommended for frankly symptomatic, deeply infiltrating, or rapidly progressive lesions.1,3,9 However, local recurrence is frequent after surgical resection. Postsurgical use of complementary radiation therapy or chemotherapy has been advocated to prevent aggressive recurrences.1,3,4 Return to References 1. Robbin MRMurphey MDTemple HTKransdorf MJChoi JJ Imaging of musculoskeletal fibromatosis. Radiographics 2001;21 (3) 585- 600PubMedGoogle ScholarCrossref 2. Theodorou DJTheodorou SJFarooki SKakitsubata YResnick D Disorders of the plantar aponeurosis: a spectrum of MR imaging findings. AJR Am J Roentgenol 2001;176 (1) 97- 104PubMedGoogle ScholarCrossref 3. Narváez JANarváez JOrtega RAguilera CSánchez AAndía E Painful heel: MR imaging findings. Radiographics 2000;20 (2) 333- 352PubMedGoogle ScholarCrossref 4. Bedi DGDavidson DM Plantar fibromatosis: most common sonographic appearance and variations. J Clin Ultrasound 2001;29 (9) 499- 505PubMedGoogle ScholarCrossref 5. Graells Estrada JGarcia Fernández DBadia Torroella FMoreno Carazo A Familial plantar fibromatosis. Clin Exp Dermatol 2003;28 (6) 669- 670PubMedGoogle ScholarCrossref 6. Ostlere S Imaging the ankle and foot. Imaging 2003;15 (4) 242- 269Google ScholarCrossref 7. Jacob CIKumm RC Benign anteromedial plantar nodules of childhood: a distinct form of plantar fibromatosis. Pediatr Dermatol 2000;17 (6) 472- 474PubMedGoogle ScholarCrossref 8. Yoshida SShidoh M Plantar fibromatosis. Postgrad Med J 2003;79 (929) 158PubMedGoogle ScholarCrossref 9. Griffith JFWong TYWong SMWong MWMetreweli C Sonography of plantar fibromatosis. AJR Am J Roentgenol 2002;179 (5) 1167- 1172PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

A Protuberant Nodule Under the Foot—Diagnosis

Archives of Dermatology , Volume 144 (4) – Apr 1, 2008

A Protuberant Nodule Under the Foot—Diagnosis

Abstract

Diagnosis: Plantar fibromatosis (Ledderhose disease). Microscopic findings Histologic examination revealed intermingled fascicles of spindle-shaped fibroblasts within the reticular dermis. Tumor cells were of uniform size and shape, with ovoid and elongated nuclei. There was no atypia or mitosis. No invasion to the surrounding structures was noted. Discussion Plantar fibromatosis (PLF) is a benign and superficial form of fibromatosis, characterized by the replacement of the plantar...
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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.144.4.547-e
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Plantar fibromatosis (Ledderhose disease). Microscopic findings Histologic examination revealed intermingled fascicles of spindle-shaped fibroblasts within the reticular dermis. Tumor cells were of uniform size and shape, with ovoid and elongated nuclei. There was no atypia or mitosis. No invasion to the surrounding structures was noted. Discussion Plantar fibromatosis (PLF) is a benign and superficial form of fibromatosis, characterized by the replacement of the plantar aponeurosis with abnormal fibrous tissue.1-4 The disorder is accepted as the plantar equivalent of palmar fibromatosis (Dupuytren disease); however, PLF is much more rarely encountered.3,5-7 It usually affects men in the fourth to seventh decade of life.1,6 However, the disorder may rarely present in childhood and even at birth.7 The etiology remains unknown. In contrast to Dupuytren disease in which an autosomal dominant inheritance has been firmly established, familial PLF is rare.5 Trauma, infection, neuropathy, biochemical and metabolic imbalance, faulty development, and occupation have been proposed as potential etiological factors.2 We believe that trauma might lead to formation and/or progression of these lesions, at least in patients inherently susceptible to the disorder. Plantar fibromatosis presents as firm, fixed, slowly growing nodules.1,2,8 The usual location is the central or medial aspect of the plantar aponeurosis. However, the proximal aspect may also be involved, as in our case.1,3,9 The lesion(s) may be solitary or multiple.1,2,9 Bilateral involvement is observed in 20% to 50% of cases, and 10% to 65% of patients have concomitant palmar fibromatosis.1,6 Plantar fibromatosis is often asymptomatic at its initial stages, but enlarged lesions may lead to pain by pressure on or by invasion of adjacent muscles or neurovascular structures.1,4,5 The disease was symptomatic in our patient. The diagnosis is based on clinical and histologic findings.3 Radiography, ultrasonography, computed tomography, and magnetic resonance imaging may help to delineate the exact location and extent of the lesions before planning surgery.1-4,6,8,9 The prognosis depends on the infiltration capacity and extent of the lesions.1-3,8 Contractures as a complication of PLF are rare.7,9 Asymptomatic PLF is best treated conservatively by orthopedic footwear.1 A medical treatment option for painful lesions is intralesional triamcinolone injections.5 Wide surgical excision or plantar fasciectomy have been recommended for frankly symptomatic, deeply infiltrating, or rapidly progressive lesions.1,3,9 However, local recurrence is frequent after surgical resection. Postsurgical use of complementary radiation therapy or chemotherapy has been advocated to prevent aggressive recurrences.1,3,4 Return to References 1. Robbin MRMurphey MDTemple HTKransdorf MJChoi JJ Imaging of musculoskeletal fibromatosis. Radiographics 2001;21 (3) 585- 600PubMedGoogle ScholarCrossref 2. Theodorou DJTheodorou SJFarooki SKakitsubata YResnick D Disorders of the plantar aponeurosis: a spectrum of MR imaging findings. AJR Am J Roentgenol 2001;176 (1) 97- 104PubMedGoogle ScholarCrossref 3. Narváez JANarváez JOrtega RAguilera CSánchez AAndía E Painful heel: MR imaging findings. Radiographics 2000;20 (2) 333- 352PubMedGoogle ScholarCrossref 4. Bedi DGDavidson DM Plantar fibromatosis: most common sonographic appearance and variations. J Clin Ultrasound 2001;29 (9) 499- 505PubMedGoogle ScholarCrossref 5. Graells Estrada JGarcia Fernández DBadia Torroella FMoreno Carazo A Familial plantar fibromatosis. Clin Exp Dermatol 2003;28 (6) 669- 670PubMedGoogle ScholarCrossref 6. Ostlere S Imaging the ankle and foot. Imaging 2003;15 (4) 242- 269Google ScholarCrossref 7. Jacob CIKumm RC Benign anteromedial plantar nodules of childhood: a distinct form of plantar fibromatosis. Pediatr Dermatol 2000;17 (6) 472- 474PubMedGoogle ScholarCrossref 8. Yoshida SShidoh M Plantar fibromatosis. Postgrad Med J 2003;79 (929) 158PubMedGoogle ScholarCrossref 9. Griffith JFWong TYWong SMWong MWMetreweli C Sonography of plantar fibromatosis. AJR Am J Roentgenol 2002;179 (5) 1167- 1172PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 2008

Keywords: foot

References