Difference between revisions of "Palmar fibromatosis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Palmar fibromatosis -- high mag.jpg | |||
| Width = | |||
| Caption = Palmar fibromatosis. [[H&E stain]]. | |||
| Micro = poorly demarcated, usu. multiple lesions/multiple nodules, composed of bland spindle cells in dense collagen; spindle cells have pale grey cytoplasm and a pale ovoid nuclei with small round nucleolus, +/-giant cells (rare) | |||
| Subtypes = | |||
| LMDDx = [[calcifying aponeurotic fibroma]], extra-abdominal desmoid [[fibromatosis]], inclusion body [[fibromatosis]], [[fibrosarcoma]], [[synovial sarcoma]], [[epithelioid sarcoma]], [[metastasis|Metastatic]] metaplastic carcinoma | |||
| Stains = | |||
| IHC = beta-catenin +ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = hand - palmar fascia, classically ring finger | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = male > female, +/-family history | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Palmar fibromatosis''', also '''Dupuytren's contracture''' and '''Dupuytren disease''', is a common pathology of the hand. | '''Palmar fibromatosis''', also '''Dupuytren's contracture''' and '''Dupuytren disease''', is a common pathology of the hand. | ||
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===Image=== | ===Image=== | ||
<gallery> | |||
Image:Morbus_dupuytren_fcm.jpg Palmar fibromatosis. (WC) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref>URL: [http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html]. Accessed on: 6 January 2011.</ref><ref name=standford_pf_ddx>URL: [http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html]. Accessed on: 9 November 2012.</ref> | Features:<ref>URL: [http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html]. Accessed on: 6 January 2011.</ref><ref name=standford_pf_ddx>URL: [http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html]. Accessed on: 9 November 2012.</ref> | ||
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*[[metastasis|Metastatic]] metaplastic carcinoma, e.g. [[metaplastic breast carcinoma]] - extremely uncommon. | *[[metastasis|Metastatic]] metaplastic carcinoma, e.g. [[metaplastic breast carcinoma]] - extremely uncommon. | ||
Images: | ===Images=== | ||
<gallery> | |||
Image: Palmar fibromatosis -- intermed mag.jpg | PF - intermed. mag. | |||
Image: Palmar fibromatosis -- high mag.jpg | PF - high mag. | |||
Image: Palmar fibromatosis - alt -- high mag.jpg | PF - high mag. | |||
Image: Palmar fibromatosis -- very high mag.jpg | PF - very high mag. | |||
</gallery> | |||
www: | |||
*[http://www.biomedsearch.com/attachments/display/00/16/69/68/16696857/1479-5876-4-21-2.jpg Palmer fibromatosis (biomedsearch.com)].<ref name=pmid16696857>{{cite journal |author=Wang L, Zhu H |title=Clonal analysis of palmar fibromatosis: a study whether palmar fibromatosis is a real tumor |journal=J Transl Med |volume=4 |issue= |pages=21 |year=2006 |pmid=16696857 |pmc=1488873 |doi=10.1186/1479-5876-4-21 |url=http://www.biomedsearch.com/nih/Clonal-analysis-palmar-fibromatosis-study/16696857.html}}</ref> | *[http://www.biomedsearch.com/attachments/display/00/16/69/68/16696857/1479-5876-4-21-2.jpg Palmer fibromatosis (biomedsearch.com)].<ref name=pmid16696857>{{cite journal |author=Wang L, Zhu H |title=Clonal analysis of palmar fibromatosis: a study whether palmar fibromatosis is a real tumor |journal=J Transl Med |volume=4 |issue= |pages=21 |year=2006 |pmid=16696857 |pmc=1488873 |doi=10.1186/1479-5876-4-21 |url=http://www.biomedsearch.com/nih/Clonal-analysis-palmar-fibromatosis-study/16696857.html}}</ref> | ||
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=8235 Palmar fibromatosis (unibas.ch)]. | *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=8235 Palmar fibromatosis (unibas.ch)]. | ||
Revision as of 19:29, 14 December 2013
| Palmar fibromatosis | |
|---|---|
| Diagnosis in short | |
 Palmar fibromatosis. H&E stain. | |
|
| |
| LM | poorly demarcated, usu. multiple lesions/multiple nodules, composed of bland spindle cells in dense collagen; spindle cells have pale grey cytoplasm and a pale ovoid nuclei with small round nucleolus, +/-giant cells (rare) |
| LM DDx | calcifying aponeurotic fibroma, extra-abdominal desmoid fibromatosis, inclusion body fibromatosis, fibrosarcoma, synovial sarcoma, epithelioid sarcoma, Metastatic metaplastic carcinoma |
| IHC | beta-catenin +ve |
| Site | hand - palmar fascia, classically ring finger |
|
| |
| Clinical history | male > female, +/-family history |
| Prognosis | benign |
Palmar fibromatosis, also Dupuytren's contracture and Dupuytren disease, is a common pathology of the hand.
The bigger topic of fibromatoses is covered in the article fibromatosis.
General
Clinical:[1]
- Usually older - 60s or 70s (years old).
- Male > female.
- Associated with:
- May be familial.
Gross
- Ring finger - classic location.[citation needed]
- Nodular.
- Poorly demarcated.
Image
- Morbus dupuytren fcm.jpg Palmar fibromatosis. (WC)
Microscopic
- Poorly demarcated, usu. multiple lesions/multiple nodules.
- Composed of bland spindle cells in dense collagen.
- Pale grey cytoplasm (moderate quantity).
- Pale ovoid nuclei with small round nucleoli.
- Giant cells - rare.
Note:
- No nuclear atypia.
- Mitotic figures - rarely present, none atypical.
- May see Pacinian corpuscle (AKA lamellar corpuscle) as an incidental finding.
DDx:[3]
- Calcifying aponeurotic fibroma - calcification, chondroid differentiation, usu. < 20 years old.
- Extra-abdominal desmoid fibromatosis - extremely rare on hands and feet, muscle infiltrative.
- Inclusion body fibromatosis.
- Fibrosarcoma - atypia, necrosis, herring-bone pattern.
- Synovial sarcoma - one mass.
- Epithelioid sarcoma - necrosis, atypia.
- Metastatic metaplastic carcinoma, e.g. metaplastic breast carcinoma - extremely uncommon.
Images
PF - intermed. mag.
PF - high mag.
PF - high mag.
PF - very high mag.
www:
- Palmer fibromatosis (biomedsearch.com).[4]
- Palmar fibromatosis (unibas.ch).
- Pacinian corpuscle (WC).
- Tendon without fibromatosis - intermed. mag. (WC).
IHC
- Beta-catenin +ve (cytoplasmic & nuclear).[5]
Sign out
Left
PALMAR FASCIA, LEFT, FASCIECTOMY: - PALMAR FIBROMATOSIS.
Right
PALMAR FASCIA, RIGHT, FASCIECTOMY: - PALMAR FIBROMATOSIS.
Micro
The sections show multiple poorly-demarcated nodules composed of bland spindle cells with moderate pale grey cytoplasm and pale ellipsoid nuclei with small round nucleoli. The poorly-demarcated nodules are completely surrounded by dense collagen. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present.
Missed fibromatosis
PALMAR FASCIA, LEFT, FASCIECTOMY: - PALMAR FASCIA WITHIN NORMAL LIMITS AND BENIGN FIBROADIPOSE TISSUE -- IN AN INDIVIDUAL WITH A CLINICAL HISTORY OF PALMAR FIBROMATOSIS. - NEGATIVE FOR MALIGNANCY.
Micro
The sections show dense collagen (tendon) without an apparent pathology. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present. Lamellar corpuscles are present. The tissue was submitted in toto and levels were cut.
Straight
PALMAR FASCIA, RIGHT, FASCIECTOMY: - PALMAR FASCIA WITHIN NORMAL LIMITS. - NEGATIVE FOR FIBROMATOSIS. COMMENT: The tissue was submitted in toto and levels were cut.
Micro
The sections show dense collagen (tendon) without an apparent pathology. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present. Lamellar corpuscles are present.
See also
References
- ↑ URL: http://www.humpath.com/palmar-fibromatosis. Accessed on: 6 January 2011.
- ↑ URL: http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html. Accessed on: 6 January 2011.
- ↑ 3.0 3.1 URL: http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html. Accessed on: 9 November 2012.
- ↑ Wang L, Zhu H (2006). "Clonal analysis of palmar fibromatosis: a study whether palmar fibromatosis is a real tumor". J Transl Med 4: 21. doi:10.1186/1479-5876-4-21. PMC 1488873. PMID 16696857. http://www.biomedsearch.com/nih/Clonal-analysis-palmar-fibromatosis-study/16696857.html.
- ↑ Degreef, I.; De Smet, L.; Sciot, R.; Cassiman, JJ.; Tejpar, S. (Mar 2009). "Beta-catenin overexpression in Dupuytren's disease is unrelated to disease recurrence.". Clin Orthop Relat Res 467 (3): 838-45. doi:10.1007/s11999-008-0590-z. PMID 18958538.