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El Bejjaj I, Mercier A, Mcleer A, Valmary-Degano S. [Fibro-osseous pseudotumor of the digits: An exemple of USP6-related fibroblastic/myofibroblastic tumor]. Ann Pathol 2024; 44:368-371. [PMID: 38341311 DOI: 10.1016/j.annpat.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Fibro-osseous pseudotumor of the digits is a benign tumour closely related to myositis ossificans. It is a rare lesion seldom reported in the literature. We report the case of a 33-year-old woman with lancinating pain in the first phalanx of the second finger of the right hand, associated with inflammation. The histopathological examination of the surgical excision biopsy of the lesion revealed a spindle-shaped proliferation within a sclerosing, hyaline, and osteoid stroma. In our observation, immunohistochemistry and molecular biology are the main elements that helped to establish the diagnosis and eliminate the various differential diagnoses, despite a non-specific histopathological aspect.
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Affiliation(s)
- Iatimad El Bejjaj
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Anaïs Mercier
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Anne Mcleer
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France; Université de Grenoble Alpes, Inserm U1209, CNRS UMR5309, institut pour l'avancée des biosciences, département de pathology, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Séverine Valmary-Degano
- Service d'anatomie et cytologie pathologique, CHU de Grenoble Alpes, 38000 Grenoble, France; Université de Grenoble Alpes, Inserm U1209, CNRS UMR5309, institut pour l'avancée des biosciences, département de pathology, CHU Grenoble Alpes, 38000, Grenoble, France.
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2
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Grover C, Gupta P, Gupta C, Nambiyar K, Goel S. Fibro-Osseus Pseudotumor of the Digit: A Case Report and Review of Literature. Skin Appendage Disord 2023; 9:470-476. [PMID: 38107840 PMCID: PMC10721281 DOI: 10.1159/000532113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/10/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Bony subungual growths arising on the digital tip are uncommon. Among these, subungual exostosis is a common cause. Case Presentation We describe a 35-year-old-male patient with a rare occurrence of a fibro-osseus pseudotumor of the digit. It presents with reactive intramembranous ossification, with no continuity with the distal phalanx, helping differentiate it from a subungual exostosis. The patient presented with an asymptomatic subungual growth, lifting up the nail plate distally causing onycholysis. The characteristic clinical, radiological, and histopathological features of the case are described, which helped confirm the diagnosis. Conclusion Cases with fibro-osseus pseudotumor of the digit reported in literature are reviewed comprehensively. The factors helping differentiate this from the other bony tumors affecting the distal phalanx, including subungual exostosis, myositis ossificans, and osteosarcoma are also highlighted.
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Affiliation(s)
- Chander Grover
- Department of Dermatology and STD, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Pratibha Gupta
- Department of Dermatology and STD, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Chhavi Gupta
- Department of Radiodiagnosis, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Kaniyappan Nambiyar
- Department of Pathology, Guru Teg Bahadur Hospital, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Shitij Goel
- Department of Dermatology, School of Medical Sciences and Research, Sharda University, Greater Noida, India
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3
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Habeeb O, Weigelt MA, Goldblum JR, Ko JS, Habermehl G, Rubin BP, Billings SD. Primary cutaneous extraskeletal osteosarcoma: a series of 16 cases. Pathology 2023; 55:315-323. [PMID: 36567163 DOI: 10.1016/j.pathol.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022]
Abstract
Extraskeletal osteosarcoma (EOS) is a high grade soft tissue tumour characterised by the production of malignant osteoid, without attachment/involvement of underlying bone/periosteum. Rarely, EOS presents as a cutaneous tumour. The clinical behaviour of primary cutaneous EOS (PC-EOS) remains incompletely characterised. Herein we present the largest case series of PC-EOS reported to date. Sixteen PC-EOS cases from the archives/consultation files were retrieved (male:female 1:1; age 31-96 years, mean age 66 years). The tumours measured 1-10 cm (mean 3.2 cm) and were located on the lower extremity (7), head (6), upper extremity (2), and trunk (1). They consisted of pleomorphic, spindled-to-epithelioid cells, with fascicular, nodular, or sheet-like growth patterns and foci of malignant osteoid. Immunohistochemistry did not reveal specific lines of differentiation, and there was no evidence of other tumour types. A literature review was conducted to identify all well characterised cases of PC-EOS. A combined analysis of present and past cases was performed to determine overall trends in clinical characteristics and outcomes. The mean follow-up period was 23.9 months, during which 67.5% of patients experienced progression-free survival and 18% of patients died of disease. Rates of local recurrence and metastasis were 10% and 25%, respectively, approximately double past estimates. These data suggest that the prognosis of PC-EOS is less favourable than previously thought. The differential diagnosis includes benign entities (e.g., ossifying pyogenic granuloma) and malignant neoplasms with heterologous osteosarcomatous differentiation (e.g., carcinosarcoma, transdifferentiated melanoma). Wide excision remains the standard of care, and the role of chemotherapy and radiation remains inconclusive. Recognition of this rare entity can facilitate prompt diagnosis and appropriate treatment.
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Affiliation(s)
- Omar Habeeb
- Department of Histopathology, Middlemore Hospital, Auckland, New Zealand
| | | | - John R Goldblum
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Brian P Rubin
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Steven D Billings
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.
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4
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Broski SM, Wenger DE. Multimodality imaging features of USP6-associated neoplasms. Skeletal Radiol 2023; 52:297-313. [PMID: 35962835 DOI: 10.1007/s00256-022-04146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Since the discovery of USP6 gene rearrangements in aneurysmal bone cysts nearly 20 years ago, we have come to recognize that there is a family of USP6-driven mesenchymal neoplasms with overlapping clinical, morphologic, and imaging features. This family of neoplasms now includes myositis ossificans, aneurysmal bone cyst, nodular fasciitis, fibroma of tendon sheath, fibro-osseous pseudotumor of digits, and their associated variants. While generally benign and in many cases self-limiting, these lesions may undergo rapid growth, and be confused with malignant bone and soft tissue lesions, both clinically and on imaging. The purpose of this article is to review the imaging characteristics of the spectrum of USP6-driven neoplasms, highlight key features that allow distinction from malignant bone or soft tissue lesions, and discuss the role of imaging and molecular analysis in diagnosis.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA.
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA
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5
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Fellmann A, Calcagni M, Besmens IS. [Fibro-osseous Pseudotumor of the first Web Space - an interesting Case]. HANDCHIR MIKROCHIR P 2022; 54:72-73. [PMID: 35168270 DOI: 10.1055/a-1655-8940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
FallberichtEin 52-jähriger Patient stellte sich nach Zuweisung durch seinen Hausarzt aufgrund einer schmerzhaften, größenprogredienten Schwellung in der ersten Kommissur seiner linken adominanten Hand in der handchirurgischen Sprechstunde vor. Er gab an, die Schwellung vor fünf Wochen erstmals bemerkt zu haben und dass sie zunehmend schmerzhaft und funktionell einschränkend sei. Ein aktuell auslösendes Trauma wurde verneint; allerdings habe er sich vor drei Jahren bei einem Fahrradsturz im Bereich der betroffenen 1. Kommissur verletzt. Die Familienanamnese war bzgl. maligner Erkrankungen blande.
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6
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Li P, Zhou H, Lu H. Fibro-osseous pseudotumor of the digit: a case report. Transl Cancer Res 2022; 10:3877-3882. [PMID: 35116687 PMCID: PMC8799321 DOI: 10.21037/tcr-21-333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/06/2021] [Indexed: 11/06/2022]
Abstract
Fibro-osseous pseudotumor is a poorly reported benign ossifying tumor. Due to its aggressiveness and lack of specificity, the lesion has previously been mistaken for a malignant lesion, leading to unnecessary radical treatment. Our case warns our readers of the aggressiveness of the tumor and rational surgical planning. In our case, a 25-year-old male patient presented with a painless, enlarging mass in the left index finger that had developed over the course of 5 months. The lesion was first partially surgically removed for biopsy, which confirmed the lesion to be fibro-osseous pseudotumor. Considering the possibility of skin necrosis from complete excision, complete removal was postponed until the second surgery. However, the residual lesion rapidly progressed, reaching its original size within 4 months. Another lesionectomy was performed to thoroughly remove the recurrent lesion surrounding the joint capsules. The intraoperative frozen section again supported the initial diagnosis and recurrence. During the 2-year follow-up, there were no signs of recurrence, and the function of the finger was fully recovered. Fibro-osseous pseudotumor should be considered in the differential diagnosis of rapidly progressive lesions affecting the digits. Complete surgical excision is the treatment of choice. However, the surgical strategy should be cautiously planned because of the aggressiveness of fibro-osseous pseudotumor and the possibility of saving the involved digit.
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Affiliation(s)
- Pengfei Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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7
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Isaac AL, Siddiqui S, Vieweger D, Adams BW, Mirkin G, Hao X. Fibro-Osseous Pseudotumor Arising From Nail Bed of the Great Toe: A Rare Case of Recurrence. J Foot Ankle Surg 2022; 61:218-220. [PMID: 34686420 DOI: 10.1053/j.jfas.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/27/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
A fibro-osseous pseudotumor (FOPT) is a rare, rapidly enlarging, benign soft-tissue neoplasm that presents with localized pain, swelling, and redness. It typically presents in the hands and much less frequently in the feet. FOPT is characterized histologically by foci of osseous differentiation within the proliferated fibroblasts. This must be differentiated from other benign and malignant lesions. FOPT of the toes has been described in a few reports, but recurrence, following surgical excision, is extremely rare. Here we report a young, healthy female patient who presented with a rapidly growing FOPT of the left great toe. This unusual case had recurred twice following surgical excision, all within a 2-month period of time. The lesion was again completely excised, with no recurrences at follow-ups of 18 and 36 months. In conclusion, FOPT is a rare soft tissue lesion of the toes. It features fibroblastic proliferation and osseous differentiation, which needs to be differentiated from other benign and malignant tumors. The standard treatment is complete surgical excision with an excellent prognosis.
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Affiliation(s)
- Adam L Isaac
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
| | - Sarwat Siddiqui
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
| | - David Vieweger
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
| | | | - Gene Mirkin
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD
| | - Xingpei Hao
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD.
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8
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Liu D, Qi B, Huang Z, Pan Z. Fibro-Osseous Pseudotumor. Orthopedics 2021; 44:e713-e718. [PMID: 34618638 DOI: 10.3928/01477447-20211001-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fibro-osseous pseudotumor is an extremely rare subcutaneous benign ossifying lesion associated with bone formation that is most commonly seen in the hands, followed by the toes. Because the tumor has a certain degree of invasiveness, it is often mistaken for malignancy, which leads to radical, excessive treatment. Our case involved a 32-year-old man with lesions on the left index finger. We documented the detailed data of diagnosis, treatment, and follow-up. We also conducted a review and summarized the published cases to advance our understanding of the disease, provide more accurate diagnostic criteria, and avoid inappropriate surgical procedures. [Orthopedics. 2021;44(6):e713-e718.].
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9
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Zalacain-Vicuña AJ, de Planell-Mas E, Espada-Martín N, Planas-Ortega L, Subero-Tomás ME. Fibro-osseous Pseudotumor of the Distal Phalanx. J Am Podiatr Med Assoc 2021; 111. [PMID: 34861692 DOI: 10.7547/20-173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fibro-osseous pseudotumor of the digit is an unusual benign tumor that appears on the extremities. A 45-year-old, human immunodeficiency virus-positive man presented with a painful lesion on the tip of the fourth toe of his right foot. The tumor was completely excised without any connection to the underlying bone being observed, although the phalanx had to be extirpated. Histopathology confirmed the diagnosis of fibro-osseous pseudotumor. At the follow-up visit, 12 months later, no abnormalities were found.
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10
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Nunes Pombo J, Nixon Martins A, Paias Gouveia C, Pena B, López-Presa D, Ribeiro G. Benign growing mass of the digit presenting as an ulcerated mass - case report and review of the literature. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:121-129. [PMID: 34409128 PMCID: PMC8366670 DOI: 10.1080/23320885.2021.1962718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 68 year-old female presents with an ulcerated mass of the 5th digit, with rapid growth during the previous month to surgery. The mass was excised and covered with a 4th dorsal metacarpal artery perforator flap. The histologic analysis was compatible with the diagnosis of fibro-osseous pseudotumor of the digit.
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Affiliation(s)
- J Nunes Pombo
- Plastic, Reconstructive and Aesthetic Surgery, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
| | - A Nixon Martins
- Plastic, Reconstructive and Aesthetic Surgery, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
| | - C Paias Gouveia
- Plastic, Reconstructive and Aesthetic Surgery, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
| | - B Pena
- Anatomic Pathology, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
| | - D López-Presa
- Anatomic Pathology, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
| | - G Ribeiro
- Plastic, Reconstructive and Aesthetic Surgery, Hospital de Santa Maria (Centro Hospitalar Lisboa Norte), Lisbon, Portugal
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11
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Tuzzato G, Vita F, Bianchi G, Tosi D, Adani R. Fibro-osseous pseudotumor of the hand: a case report of a 22-year-old young woman. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Dermawan JK, Kilpatrick SE. Ossifying pyogenic granuloma: A rare variant usually not recognized. J Cutan Pathol 2021; 48:954-957. [PMID: 33694169 DOI: 10.1111/cup.14007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
Pyogenic granuloma (PG) represents a polypoid and lobular, capillary lesion, resembling granulation tissue, usually occurring on skin or mucosal surfaces. The occurrence of metaplastic ossification is extremely rare in PG. We present three cases of PG with metaplastic ossification. All three patients were men, aged 18-66 years. In all cases, the lesions occurred on the digits, particularly in or around the nail bed. Histopathologically, these superficial dermal-based tumors were characterized by classic features of PG, namely circumscribed, exophytic to polypoid proliferations of capillary-sized blood vessels in a lobular arrangement. The characteristic vascular component also was intimately associated with spicules and trabeculae of metaplastic bone formation rimmed by osteoblasts and osteoclasts. This osseous component was diffusely distributed in two cases and more localized in another. We speculate that ossification in PGs possibly represents a reactive process in response to chronic injury. We believe that ossifying PG is likely under-recognized and often mistaken for other entities also arising in the extremities and characterized by osseous metaplasia.
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Affiliation(s)
- Josephine K Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine, Cleveland Clinic, Ohio, USA
| | - Scott E Kilpatrick
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine, Cleveland Clinic, Ohio, USA
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Nakayama S, Nishio J, Aoki M, Koga K, Nabeshima K, Yamamoto T. Ubiquitin-specific Peptidase 6 ( USP6)-associated Fibroblastic/Myofibroblastic Tumors: Evolving Concepts. Cancer Genomics Proteomics 2021; 18:93-101. [PMID: 33608306 DOI: 10.21873/cgp.20244] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/28/2022] Open
Abstract
Ubiquitin-specific peptidase 6 (USP6) is a hominoid-specific gene residing on chromosome 17p13 and serves as a deubiquitinating enzyme with a diverse set of functions including intracellular trafficking, inflammatory signaling, cell transformation and protein turnover. USP6 rearrangements were first identified in aneurysmal bone cysts, resulting in promoter swapping and over-expression of wild type USP6. Several morphologically overlapping fibroblastic/myofibroblastic tumors are known to harbor USP6 rearrangements, including nodular fasciitis, cellular fibroma of tendon sheath, myositis ossificans and fibro-osseous pseudotumor of digits. Over the past few years, fusions involving the USP6 gene and various partner genes have been described in these neoplasms. The current World Health Organization Classification of Tumors of Soft Tissue suggests that USP6-rearranged lesions are typically benign and usually self-limited in their growth. This review provides an updated overview of the clinical, histological and molecular genetic features of USP6-associated fibroblastic/myofibroblastic tumors and discusses how these lesions should be best classified.
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Affiliation(s)
- Shizuhide Nakayama
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jun Nishio
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan;
| | - Mikiko Aoki
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Tomori Y, Nanno M, Takai S. Acute calcific periarthritis of the proximal phalangeal joint on the fifth finger: A case report and literature review. Medicine (Baltimore) 2020; 99:e21477. [PMID: 32756172 PMCID: PMC7402791 DOI: 10.1097/md.0000000000021477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Acute calcium deposits, including acute calcific periarthritis or acute calcific peritendinitis, are benign calcifying soft tissue lesions that have a self-resolving course. These calcifying lesions usually develop in the shoulder, while acute calcific periarthritis in the digits is uncommon. When acute calcific periarthritis involves the digits, the lesion occasionally mimics other benign calcifying or ossifying lesions and can easily be misdiagnosed, resulting in unnecessary diagnostic studies and treatment. We present a rare case of acute calcific periarthritis around the proximal phalangeal joint of the left fifth finger that took a long time to spontaneously resolve, and review previous reports of similar cases. PATIENT CONCERNS A 69-year-old woman complained of longstanding pain and swelling of the fifth finger of the left hand. She had visited several clinics and hospitals and had been treated with analgesics and splinting for more than 2 months, but the pain in the finger had gradually worsened. DIAGNOSES Blood chemistry analysis showed no signs of inflammation or other abnormalities. Radiographs revealed a well-defined subcutaneous calcifying lesion without bony destruction, suggesting a benign calcification process. Computed tomography and magnetic resonance imaging led to a diagnosis of acute calcific periarthritis of the proximal interphalangeal joint of the fifth finger. INTERVENTIONS An excisional biopsy was recommended to achieve a definitive diagnosis, but this was declined by the patient. Thus, no invasive treatments were administered, and she was treated with analgesics and encouraged to massage the affected finger. OUTCOMES The pain gradually improved, and follow-up radiographs showed complete disappearance of the calcifying mass 6 months after the initial visit to our hospital, without recurrence during a follow-up period of more than 2 years. LESSONS Acute calcific periarthritis is diagnosed based on history, clinical examination, and imaging findings, which provide evidence for the diagnosis of calcium deposition in the digits even if the lesions have been present for a long time. Watchful observation is an appropriate treatment strategy for acute calcific periarthritis of the digits.
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Affiliation(s)
- Yuji Tomori
- Departments of Orthopaedic Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa
- Departments of Orthopaedic Surgery, Ukima Central Hospital
| | - Mitsuhiko Nanno
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Departments of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Abstract
INTRODUCTION Fibro-osseous pseudotumor of the digit is a rare benign lesion of subcutaneous tissue that typically arises in the parabone site of the proximal phalanx in young adult females. The lesion is histopathologically characterized by fibroblastic proliferation and osteoid formation. Good prognosis following complete surgical excision of the tumor has been reported, with a very low recurrence rate and no reports of malignant transformation. Despite its benign clinical behavior, the lesion can be mistaken for a malignant neoplasm, such as an extraskeletal or parosteal osteosarcoma, in case of rapid growth, thereby rendering the diagnosis challenging. PATIENT CONCERNS We report the case of a 30-year-old right-handed male who presented to our hospital with a rapidly growing mass on the dorsal aspect of the right little finger. DIAGNOSIS The patient was suspected to have soft tissue tumor of the little finger. The lesion could be considered a malignant tumor on the basis of clinical findings. INTERVENTIONS The patient underwent surgery for exploration and excision of the mass. OUTCOMES The excised mass was diagnosed to be fibro-osseous pseudotumor of the digit upon histological assessment. Postoperatively, the wound healed without complications. At postoperative 6 months, there were no signs or symptoms of recurrence, and the patient returned to his premorbid functional status. CONCLUSION Following the detection of a soft tissue mass with clinicopathological features of pseudomalignancy in the digit, clinicians should consider fibro-osseous pseudotumor of the digit as a possible diagnosis, thereby avoiding unnecessary aggressive surgery.
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Hiemcke-Jiwa LS, van Gorp JM, Fisher C, Creytens D, van Diest PJ, Flucke U. USP6-Associated Neoplasms: A Rapidly Expanding Family of Lesions. Int J Surg Pathol 2020; 28:816-825. [PMID: 32635781 DOI: 10.1177/1066896920938878] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nearly 20 years ago, the first description of a translocation involving chromosome 17 on which USP6 resides was described. Since then, not only the culprit gene but also many fusion partners, leading to transcriptional activation of USP6, have been detected. The first neoplasm known to harbor USP6 rearrangements was aneurysmal bone cyst. Since then, other entities like nodular fasciitis, myositis ossificans, fibro-osseous pseudotumor of digits, and a subgroup of fibromas of tendon sheath, probably representing tenosynovial nodular fasciitis, have been added to the list of USP6-rearranged lesions. Remarkably, all of them share clinical as well as morphological characteristics, and authors have suggested that these entities actually belong to the same spectrum. This review summarizes the current knowledge regarding USP6-rearranged lesions and further elaborates on how these neoplasms relate to one another. We propose to call these lesions UAN (Usp6-associated neoplasm).
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Affiliation(s)
- Laura S Hiemcke-Jiwa
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Utrecht University Hospital, Utrecht, The Netherlands
| | | | - Cyril Fisher
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Creytens
- Ghent University and Ghent University Hospital, Ghent, Belgium
| | | | - Uta Flucke
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
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Rela M, Bantick G. Fibro-osseous pseudotumour of the digit-a diagnostic challenge. J Surg Case Rep 2020; 2020:rjaa125. [PMID: 32509267 PMCID: PMC7263759 DOI: 10.1093/jscr/rjaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 11/12/2022] Open
Abstract
A 60-year-old right-hand dominant woman presented to the emergency department with a 3-week history of pain and swelling in her right thumb. The X-ray showed evidence of erosion at the tip of the distal phalanx. Her initial management included surgical debridement with bone biopsies and intravenous antibiotics. The initial working diagnosis was a soft tissue infection of the thumb tip, causing osteomyelitis of the distal phalanx. The X-ray findings also raised the suspicion of a possible bone tumour. She was treated as having osteomyelitis and attended ambulatory care for daily intravenous antibiotics for 2 weeks. Initial histology was reported as a spindle cell tumour; however, following discussion at the sarcoma MDT, a diagnosis of a fibro-osseous pseudotumour of the digit was made. This is a benign lesion that was managed non-operatively in this patient. This case emphasises the importance of considering all differential diagnoses, even in a common presentation.
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Affiliation(s)
- Mariam Rela
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
| | - Giles Bantick
- Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
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Fibro-osseous pseudotumor of digits and myositis ossificans show consistent COL1A1-USP6 rearrangement: a clinicopathological and genetic study of 27 cases. Hum Pathol 2019; 88:39-47. [DOI: 10.1016/j.humpath.2019.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/05/2018] [Accepted: 02/04/2019] [Indexed: 01/29/2023]
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Idiopathic aggressive myositis ossificans of the hand infiltrating the flexor sheath/checkrein ligament, obliterating the common digital artery, and attenuating the digital nerve: A case report. Int J Surg Case Rep 2018; 53:424-428. [PMID: 30567060 PMCID: PMC6262803 DOI: 10.1016/j.ijscr.2018.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022] Open
Abstract
Myositis ossificans of the hand is extremely rare. These tumors do not usually infiltrate adjacent structures. We present a case with infiltration of adjacent structures. Complete excision was curative.
Introduction Myositis ossificans of the hand is extremely rare and tumors do not usually infiltrate adjacent structures. We present a very unusual case with a tumor infiltrating adjacent structures. Report of a case A 30-year-old female presented with a 5-week history of a painful rapidly-growing mass over the proximal phalanx of the right ring finger. The mass infiltrated the entire flexor sheath over the proximal phalanx as well as the checkrein ligament of the proximal interphalangeal joint. The common digital artery of the 3rd web space was obliterated by the tumor. The radial digital nerve of the ring finger was stretched and attenuated. Total excision was done and histology confirmed the diagnosis of myositis ossificans. No recurrence was seen at the one-year follow-up. Discussion Myositis ossificans of the hand is extremely rare. We report our case to document the unique feature of tumor infiltration of adjacent structures. We also document that excision is curative despite the infiltrative nature of the tumor. Conclusion Our case is unique because of the infiltrative nature of tumor. There is no indication for amputation even for infiltrative tumors. We demonstrate that complete excision is curative with good regain of function even in infiltrative lesions.
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Kontogeorgakos VA, Papachristou DJ, Varitimidis S. Fibro-Osseous Pseudotumor of the Hand. J Hand Surg Asian Pac Vol 2018; 21:269-72. [PMID: 27454646 DOI: 10.1142/s2424835516720127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.
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Affiliation(s)
- Vasileios A Kontogeorgakos
- 1 Department of Orthopaedic Surgery, ATTIKON University General Hospital of Athens, National and Kapodistrian University of Athens, Greece
| | - Dionysios J Papachristou
- 2 Department of Anatomy-Histology-Embryology, University of Patras School of Medicine, University Campus, Building of Preclinical Studies, Rion-Patras, Greece
| | - Sokratis Varitimidis
- 3 Department of Orthopaedic Surgery, School of Health Sciences, University Hospital of Thessalia, Larissa, Greece
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21
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Jawadi T, AlShomer F, Al-Motairi M, Al-Qahtani A, Alfowzan M, Almeshal O. Fibro-osseous pseudotumor of the digit: Case report and surgical experience with extensive digital lesion abutting on neurovascular bundles. Ann Med Surg (Lond) 2018; 35:158-162. [PMID: 30310678 PMCID: PMC6176746 DOI: 10.1016/j.amsu.2018.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue characterized by fibroblastic proliferation and osteoid formation. Herein, we present a case of massive FOPD lesion in the base of ring finger with extensive involvement of the neurovascular bundles with challenging surgical approach. Case description A 27-year old female patient, presented with 7-months history of a progressively enlarging mass on her left hand. Upon assessment, the mass was located over the proximal phalanx of the left ring finger with extensive involvement of the 4th web space. Her neurovascular examination was normal. Radiological investigations showed partial involvement of the radial sided bundle together with complete involvement of the ulnar sided neurovascular bundle. The patient was bothered by the mass being painful with overlying skin ulceration. She was taken afterwards to the operating room where the mass was dissected freely from those bundles while preserving the radial and ulnar structures. The resected margins were however, positive for residual lesions due to the extensive nature of the mass. The patient was informed about the need for close follow-ups for both clinical and radiological signs of lesion recurrence pending early surgical intervention. Conclusion FOPD although benign, a soft tissue osteosarcoma is one of the differential diagnosis. Meticulous attention to the clinical, pathological and histological features of FOPD is required. Early diagnosis and treatment of FOPD is very crucial in optimizing the overall outcome. Pre-operative planning with various radiological modalities was of great help anticipating the surgical course. Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue. The differential diagnosis includes: myositis ossificans, extraskeletal osteosarcoma, parosteal osteosarcoma. Meticulous pre-operative planning is of great importance to optimize patient outcome. Fibro-osseous pseudotumor (FOPD) although benign, complete excision assure lack of recurrence. Meticulous histological assessment for any features of malignancy assure proper patient outcome.
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Affiliation(s)
- Tariq Jawadi
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Feras AlShomer
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Muhammed Al-Motairi
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Abdullah Al-Qahtani
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Mohammad Alfowzan
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Obaid Almeshal
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
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22
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Flucke U, Shepard SJ, Bekers EM, Tirabosco R, van Diest PJ, Creytens D, van Gorp JM. Fibro-osseous pseudotumor of digits - Expanding the spectrum of clonal transient neoplasms harboring USP6 rearrangement. Ann Diagn Pathol 2018; 35:53-55. [DOI: 10.1016/j.anndiagpath.2018.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 02/03/2023]
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Al-Qattan MM, Al-Fahdil L, Al-Shammari HM, Joarder AI. Management of Myositis Ossificans of the Hand: A Case Report and a Review of the Literature. J Hand Surg Am 2017; 42:576.e1-576.e4. [PMID: 28385291 DOI: 10.1016/j.jhsa.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
Myositis ossificans is a rare form of self-limiting heterotopic ossification of muscles. Most cases are seen in the thigh; the standard approach to these cases has been nonsurgical management awaiting spontaneous resolution. We report on a rare case of myositis ossificans of the hand with severe symptoms treated with early marginal excision without a trial of nonsurgical management.
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Affiliation(s)
- Mohammad M Al-Qattan
- Department of Surgery at King Saud University, Riyadh, Saudi Arabia; Department of Surgery at Riyadh Care Hospital, Riyadh, Saudi Arabia.
| | - Lenah Al-Fahdil
- Department of Surgery at Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Amin I Joarder
- Department of Pathology at King Saud Medical Complex, Riyadh, Saudi Arabia
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Gómez-Zubiaur A, Pericet-Fernández L, Vélez-Velázquez MD, Cabrera-Hernández A, Piteiro-Bermejo AB, Beá-Ardebol S, Medina-Montalvo S, Trasobares-Marugán L. Fibro-Osseous Pseudotumor of the Digits Mimicking Pyogenic Granuloma. Pediatr Dermatol 2017; 34:e126-e127. [PMID: 28318050 DOI: 10.1111/pde.13087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fibro-osseous pseudotumor of the digits is a benign neoplasm that originates in the soft tissue adjacent to the short bones of the hands and feet. We present a case in a 13-year-old girl that was initially misdiagnosed as pyogenic granuloma. Familiarity with this entity and imaging and histologic studies are necessary to avoid incorrect diagnoses and aggressive surgical interventions.
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Affiliation(s)
- Alba Gómez-Zubiaur
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Laura Pericet-Fernández
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Dolores Vélez-Velázquez
- Department of Pathology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Alicia Cabrera-Hernández
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ana Belen Piteiro-Bermejo
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Sonia Beá-Ardebol
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Susana Medina-Montalvo
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Lidia Trasobares-Marugán
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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25
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Singal A, Gogoi P, Pandhi D, Bhatt S. Subungual fibro-osseous pseudotumour of the digit: a rare occurrence. Int J Dermatol 2016; 56:e11-e13. [PMID: 27650931 DOI: 10.1111/ijd.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Archana Singal
- Departments of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Priyanka Gogoi
- Department of Pathology, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Deepika Pandhi
- Departments of Dermatology & STD, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences & GTB Hospital (University of Delhi), Delhi, India
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Abstract
This group of biologically diverse entities is united by topographic localization to the hands and feet. Categorizing tumors by body site narrows the differential into a short list of possibilities that can facilitate accurate and rapid diagnosis. The goal of this review is to provide a practical approach to soft tissue tumors of acral locations for clinicians, pathologists, and researchers alike. What ensues in the following text is that tight coupling of the clinical picture and histopathologic findings should produce the correct diagnosis, or at least an abbreviated differential. The salient clinicopathologic, immunohistochemical, and molecular features are presented alongside current treatment recommendations for each entity.
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Affiliation(s)
- Kristen M Paral
- Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Vesna Petronic-Rosic
- Section of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, IL.
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27
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Duque SG, Lopez DM, de Méndivil AO, Fernández JD. Calcifying pseudoneoplasms of the neuraxis: Report on four cases and review of the literature. Clin Neurol Neurosurg 2016; 143:116-20. [DOI: 10.1016/j.clineuro.2016.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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28
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Zhou J, McLean C, Keating C, Finkemeyer J, Morsi A. Fibro-Osseous Pseudotumour of the Digit: An Illustrative Case and Review of the Literature. ACTA ACUST UNITED AC 2015; 20:458-62. [PMID: 26388010 DOI: 10.1142/s0218810415720193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fibro-osseous pseudotumour is a rare, benign ossifying tumour of soft tissue that should be considered in the differential diagnosis of any tumour affecting the digits. Clinical diagnosis is difficult and fibro-osseous pseudotumour is often mistaken for malignancy, leading to inappropriate treatment. Knowledge of its clinical and histopathological features thus allows for appropriate primary treatment, sparing the patient from unnecessary radical surgery associated with presumed malignancy. We present the case of a 48-year-old male with fibro-osseous pseudotumour affecting the right ring finger, successfully treated with local excision. This is the second reported Australian case of fibro-osseous pseudotumour, and we present an extensive review of the literature relating to the diagnosis and management of this rare tumour.
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Affiliation(s)
- Jieyun Zhou
- * Plastic and Reconstructive Surgery Unit, Western Health, Australia
| | - Catriona McLean
- † Head of Unit, Department of Anatomical Pathology, Alfred Health, Australia
| | - Cameron Keating
- * Plastic and Reconstructive Surgery Unit, Western Health, Australia
| | - James Finkemeyer
- * Plastic and Reconstructive Surgery Unit, Western Health, Australia
| | - Adel Morsi
- * Plastic and Reconstructive Surgery Unit, Western Health, Australia.,‡ Plastic, Hand and Faciomaxillary Surgery Unit, Alfred Health, Melbourne, Australia
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29
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Fibro-osseous pseudotumour of the digit: the importance of correct diagnosis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Meani RE, Bloom RJ, Battye S, Chamberlain AJ. Subungual fibro-osseous pseudotumour of the toe. Australas J Dermatol 2015; 57:e57-60. [PMID: 25990793 DOI: 10.1111/ajd.12346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Abstract
Subungual fibro-osseous pseudotumour of the toe is a rare osseous soft tissue tumour of which only six cases have been described in the literature. We present a case in a teenage boy that posed an instructive diagnostic challenge and discuss the distinguishing features of the various differential diagnoses. The subungual location is very rare. For such tumours, radiology is as vital as histopathology in making a diagnosis and excluding neoplasia. Accurate diagnosis requires careful clinico-pathological and radiological correlation. These sorts of lesions may present to the dermatologist, not always the foot surgeon.
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Affiliation(s)
- Rowena E Meani
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc, Melbourne, Victoria, Australia
| | | | | | - Alex J Chamberlain
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Glenferrie Dermatology, Melbourne, Victoria, Australia
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31
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Lee SS, Baker BL, Gapp JD, Rosenberg AE, Googe PB. Ossifying plexiform tumor. J Cutan Pathol 2014; 42:61-5. [DOI: 10.1111/cup.12449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/30/2014] [Accepted: 04/11/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Solomon S. Lee
- Department of Pathology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
| | | | | | | | - Paul B. Googe
- Department of Pathology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
- Knoxville Dermatopathology Laboratory; Knoxville TN USA
- Department of Pathology; Vanderbilt University; Nashville TN USA
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32
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Imaging findings of an extradigital fibro-osseous pseudotumor. Jpn J Radiol 2014; 32:613-7. [DOI: 10.1007/s11604-014-0341-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/05/2014] [Indexed: 12/27/2022]
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33
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Hashmi AA, Faridi N, Edhi MM, Jafri A, Khan M. Fibro-osseous pseudotumor of the digit presenting as an ulcerated lesion: a case report. Int Arch Med 2014; 7:4. [PMID: 24405807 PMCID: PMC3898666 DOI: 10.1186/1755-7682-7-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
Fibro-osseous pseudotumor of the digit is rare benign lesion of subcutaneous tissue which is thought to be reactive process as a result of repeated trauma. We report a case of an ulcerated lesion of skin of middle finger, clinically thought to be leishmaniasis which after punch biopsy followed by excision turned out to be fibrosseous pseudotumor. Diagnosis of fibro-osseous pseudotumor requires immense precision as it can clinically mimic unungal exostosis and can sometimes be misinterpreted clinically and radiologically as myositis ossificans. We suggested an algorithimic approach for histopathologic assessment of fibro-osseous soft tissue lesions with evaluation of both stromal and osseous components. Bland fibroblastic stroma, mature osseous component with prominent osteoblastic rimming and absence of zonation pattern will support the diagnosis of fibro-osseous pseudotumor especially if located at a superficial and distal location.
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34
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Gao Z, Wang J, Wang Z, Meng Q. Florid reactive periostitis of the metacarpal and phalanx: 2 case reports. J Hand Surg Am 2013; 38:2134-7. [PMID: 24206975 DOI: 10.1016/j.jhsa.2013.08.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 02/02/2023]
Abstract
Florid reactive periostitis is a rare benign fibro-osseous proliferative lesion of soft tissue and is mainly composed of fibrous connective tissue and mature bone. The lesion usually occurs in the finger and seldom in the metacarpal. The lesion mimics malignant and infectious disorders, thus often leading to inappropriate treatment. Radiography usually shows an ossified mass attached to the underlying hand bones without interruption of the cortex. We report 1 case of florid reactive periostitis with unossified mass and underlying bone marrow edema in the metacarpal of hand and 1 case with adjacent cortical destruction in the phalanx. In addition, we describe the imaging findings of computed tomography CT and magnetic resonance imaging MRI and discuss their diagnostic values compared with routine radiographic examination.
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Affiliation(s)
- Zhenhua Gao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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35
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Cornec D, Le Nen D, Saraux A. Fibro-osseous pseudotumour of the digit in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2013; 52:779. [PMID: 23307833 DOI: 10.1093/rheumatology/kes394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Divi Cornec
- Rheumatology Unit, Hôpital de la Cavale Blanche, BP 824, F 29609 Brest cedex, France.
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36
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An unusual association of calcifying pseudoneoplasm of the neuraxis with interhemispheric lipoma and agenesis of corpus callosum. Pathology 2012; 44:657-9. [DOI: 10.1097/pat.0b013e32835a00ef] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Javdan M, Tahririan MA. Fibro-osseous pseudotumor of the digit. Adv Biomed Res 2012; 1:31. [PMID: 23210090 PMCID: PMC3507031 DOI: 10.4103/2277-9175.98565] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 12/26/2011] [Indexed: 11/19/2022] Open
Abstract
Fibro-osseous pseudotumor of the digit is an unusual ossifying soft tissue lesion, which is usually an ill-defined soft tissue mass in radiography, with focal calcification, especially in the proximal phalanx. It predominantly affects young adults and, unlike myositis ossificans, is more common in women. The current case is a 30-year-old man who presented with pain and swelling on the dorsum of middle phalanx of the left index finger without history of trauma. Diagnosis of this lesion requires a high index of suspicion and should be differentiated from myositis ossificans, turret exostosis, and extra-skeletal osteosarcoma, which are discussed. This lesion is considered benign and has an excellent prognosis following complete removal and local recurrence is unusual. No cases of malignant change are on record.
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Affiliation(s)
- Mohammad Javdan
- Department of Orthopedics, Medical University of Isfahan, Kashani Hospital, Iran
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38
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Tan CW, Tan PL, Teoh LC. An unusual case of subungal ossification in the finger. ACTA ACUST UNITED AC 2012; 17:275-8. [PMID: 22745100 DOI: 10.1142/s0218810412720331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/24/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022]
Abstract
We report the case of a painless deforming subungual mass at the nail tip, progressively enlarging over three months. Radiographs showed an extra-osseous ossification. Intraoperatively this was found to be a bony mass arising from the sterile matrix. Unusual extra-osseous ossification in the finger is rare and this case highlights the need of this benign lesion to be considered when a patient presents with finger swellings.
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Affiliation(s)
- Colin Weixuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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39
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Hodges TR, Karikari IO, Nimjee SM, Tibaleka J, Friedman AH, Cummings TJ, Fukushima T, Friedman AH. Calcifying pseudoneoplasm of the cerebellopontine angle: case report. Neurosurgery 2011; 69:onsE117-20. [PMID: 21415795 DOI: 10.1227/neu.0b013e3182155511] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Calcifying pseudoneoplasms are rare tumors of the neuraxis. To our knowledge, this is only the second reported case in the literature of calcifying pseudoneoplasm of the cerebellopontine angle. The etiology and natural history of these neoplasms are not well understood. This case report provides a thorough review of the histology and potential origins of calcifying pseudoneoplasm. CLINICAL PRESENTATION A 34-year-old previously healthy man presented with a 6-month history of progressive worsening headaches, fatigue, tinnitus, dizziness, and blurry vision. Neurological examination was notable for tongue deviation, tongue atrophy, and left uvula deviation. Computed tomography (CT) scanning showed a 3.3 × 3.5 cm densely calcified posterior fossa mass appearing to arise from the occipital bone. Magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 × 2.9 cm left posterior fossa enhancing mass with the margin tip from the left occipital condyle. A transcondylar approach was used to resect the lesion. The mass was found to have eroded through the bone into the foramen magnum. Histopathological examination confirmed the diagnosis of calcifying pseudoneoplasm of the cerebellopontine angle. CONCLUSION Calcifying pseudoneoplasms should be considered in the differential diagnosis of calcified cerebellopontine angle tumors. Histopathologic diagnosis is extremely important in the characterization of these lesions in order to direct the course of appropriate management. An inaccurate diagnosis of a malignant tumor can result in potentially harmful and unnecessary therapies, as prognosis for these lesions is generally favorable.
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Affiliation(s)
- Tiffany R Hodges
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Chaudhry IH, Kazakov DV, Michal M, Mentzel T, Luzar B, Calonje E. Fibro-osseous pseudotumor of the digit: a clinicopathological study of 17 cases. J Cutan Pathol 2010; 37:323-9. [PMID: 19678826 DOI: 10.1111/j.1600-0560.2009.01385.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fibro-osseous pseudotumor (FP) of the digit is a rare, non-neoplastic heterotopic ossifying lesion involving the subcutaneous tissues of the digits. To date, there are only a few published series in the literature. Our study of 17 cases, retrieved from the authors' referral archives, shows that the condition chiefly affects young to middle-aged adults (median = 34 years), with a slight female predominance and involves the fingers (n = 8) and toes (n = 8). One identical lesion was identified on the forehead (n = 1). Lesional size ranges from 0.8 to 5.6 cm. Treatment was by surgical excision. Histologically, 14 cases show a fairly well-circumscribed dermal (n = 10) or dermal and subcutaneous (n = 7) lesion with surface ulceration (n = 7). The lesion is composed of fascicles of variably cellular, spindle-shaped cells [calponin (n = 14) and smooth muscle actin (SMA) (n = 11) positivity], with minimal to mild atypia (n = 5), dispersed in a myxoid stroma, focally reminiscent of nodular fasciitis. At least focal irregular trabeculae with osteoid formation and osteoblastic rimming are seen in all cases. The main differential diagnosis is an extraskeletal osteosarcoma; however, this afflicts an older age group, with prominent cytological atypia and atypical mitoses. Clinical follow-up (range: 18 months - 14 years, n = 12) reveals evidence of local recurrence in some cases (n = 2), but no evidence of metastases. In conclusion, we report an additional 17 cases of this rare lesion to increase awareness amongst dermatopathologists.
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Bettex S, Guillou L, Jovanovic B, Favarger N. [Fibro-osseous pseudotumor of the thumb. Report of a case]. CHIRURGIE DE LA MAIN 2009; 28:107-112. [PMID: 19233702 DOI: 10.1016/j.main.2008.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/19/2008] [Accepted: 12/26/2008] [Indexed: 05/27/2023]
Abstract
Fibro-osseous tumor of the digits is an uncommon, benign condition with an excellent prognosis after local excision. Like myositis ossificans, clinical and histological features may mimic a malignant tumour, especially an extraskeletal osteosarcoma. A correct interpretation of clinical, radiological and histological data is a prerequisite to avoid misdiagnosis and unnecessary radical surgery (for example, amputation). We report the case of a 15-year-old boy who presented with a slow-growing mass of the left thumb, which turned out to be a fibro-osseous tumor on microscopic examination. A complete excision was performed without loss of function. Fifteen months postoperatively, there was no local recurrence.
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Affiliation(s)
- S Bettex
- Service universitaire de chirurgie de la main, clinique et permanence Longeraie, 1003 Lausanne, Suisse.
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Cutaneous myositis ossificans: an appropriate descriptor for fibro-osseous lesion of the external auditory canal. Am J Dermatopathol 2009; 31:170-2. [PMID: 19318804 DOI: 10.1097/dad.0b013e318192947c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myositis ossificans is a benign pseudosarcomatous bone-forming lesion, histologically characterized by 2 components: a spindle (myo)fibroblastic cell population and a bony component that is arranged in a "zonal" pattern. It mainly affects the deep soft tissues of limbs, but its occurrence in other unusual locations, such as abdomen, inside nerves, and the subcutaneous fat, has been reported. The existence of myositis ossificans restricted to the skin has rarely been published under the term "fibro-osseous lesion of the external auditory canal." Here, we describe an additional case in the external auditory canal, emphasizing its differential diagnosis and alerting dermatopathologists and pathologists to the possibility of encountering such lesion in this anatomic location. For purposes of unifying terms, we propose that cases similar to ours be called "cutaneous myositis ossificans" instead of fibro-osseous lesion of the external auditory canal.
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