Difference between revisions of "Palmar fibromatosis"

Revision as of 19:14, 14 December 2013

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:
- Alcohol abuse.
May be familial.

Gross

Ring finger - classic location.^{[citation needed]}
Nodular.
Poorly demarcated.

Image

Palmar fibromatosis (WC).

Microscopic

Features:^[2]^[3]

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:

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.

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.

[1] URL: http://www.humpath.com/palmar-fibromatosis. Accessed on: 6 January 2011.

[2] URL: http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html. Accessed on: 6 January 2011.

[standford_pf_ddx-3] 3.0 ^3.1 URL: http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html. Accessed on: 9 November 2012.

[pmid16696857-4] 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.

[pmid18958538-5] 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.

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[2]

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[5]

@@ Line 1: / Line 1: @@
-#redirect [[Non-malignant_skin_disease#Palmar_fibromatosis]]
+'''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:<ref>URL: [http://www.humpath.com/palmar-fibromatosis http://www.humpath.com/palmar-fibromatosis]. Accessed on: 6 January 2011.</ref>
+*Usually older - 60s or 70s (years old).
+*Male > female.
+*Associated with:
+**[[Alcohol abuse]].
+*May be familial.
+==Gross==
+*Ring finger - classic location.{{fact}}
+*Nodular.
+*Poorly demarcated.
+===Image===
+*[http://commons.wikimedia.org/wiki/File:Morbus_dupuytren_fcm.jpg Palmar fibromatosis (WC)].
+==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>
+*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:<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>
+*[[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.
+*[[metastasis|Metastatic]] metaplastic carcinoma, e.g. [[metaplastic breast carcinoma]] - extremely uncommon.
+Images:
+*[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://commons.wikimedia.org/wiki/File:WVSOM_Pacinian_Corpuscle.JPG Pacinian corpuscle (WC)].
+*[http://commons.wikimedia.org/wiki/File:Tendon_-_intermed_mag.jpg Tendon without fibromatosis - intermed. mag. (WC)].
+==IHC==
+*Beta-catenin +ve (cytoplasmic & nuclear).<ref name=pmid18958538>{{Cite journal  | last1 = Degreef | first1 = I. | last2 = De Smet | first2 = L. | last3 = Sciot | first3 = R. | last4 = Cassiman | first4 = JJ. | last5 = Tejpar | first5 = S. | title = Beta-catenin overexpression in Dupuytren's disease is unrelated to disease recurrence. | journal = Clin Orthop Relat Res | volume = 467 | issue = 3 | pages = 838-45 | month = Mar | year = 2009 | doi = 10.1007/s11999-008-0590-z | PMID = 18958538 }}</ref>
+==Sign out==
+===Left===
+<pre>
+PALMAR FASCIA, LEFT, FASCIECTOMY:
+- PALMAR FIBROMATOSIS.
+</pre>
+===Right===
+<pre>
+PALMAR FASCIA, RIGHT, FASCIECTOMY:
+- PALMAR FIBROMATOSIS.
+</pre>
+====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===
+<pre>
+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.
+</pre>
+=====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====
+<pre>
+PALMAR FASCIA, RIGHT, FASCIECTOMY:
+- PALMAR FASCIA WITHIN NORMAL LIMITS.
+- NEGATIVE FOR FIBROMATOSIS.
+COMMENT:
+The tissue was submitted in toto and levels were cut.
+</pre>
+=====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==
+*[[Non-malignant skin disease]].
+*[[Fibromatosis]].
+==References==
+{{Reflist|2}}
+[[Category:Diagnosis]]
+[[Category:Non-malignant skin disease]]

Difference between revisions of "Palmar fibromatosis"

Revision as of 19:14, 14 December 2013

Contents

General

Gross

Image

Microscopic

IHC

Sign out

Left

Right

Micro

Missed fibromatosis

Micro

Straight

Micro

See also

References

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