Difference between revisions of "Palmar fibromatosis"

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Palmar fibromatosis (view source)

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#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]]
Michael
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