Stanford School of Medicine
Surgical Pathology Criteria
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Plantar Fibromatosis

Definition

  • A nodular, cytologically bland fibroproliferative process that involves the plantar aponeuroses

Alternate / Historical Names

  • Ledderhose disease

Diagnostic Criteria

  • Involves plantar aponeurosis
    • May extend to dermis
    • Deeper tissues not involved except post surgery
  • Forms nodule or nodules
    • Infrequently over 3 cm
  • Cellularity ranges from low to high
    • Older lesions are densely collagenous
    • Bland spindle cells
    • Nuclei small and dark to moderate sized and vesicular
    • Scant cytoplasm
    • Variable numbers of multinucleated giant cells seen in most cases
    • Mitotic figures may be frequent but not atypical
  • Small foci of perivascular hemorrhage and hemosiderin may be present
  • Metaplastic cartilage and bone are seen rarely

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting: November 29, 2007

Supplemental studies

Immunohistology

Actin Variable positivity
Beta-catenin Variable positivity

Differential diagnosis

Palmar or Plantar Fibromatosis Calcifying Aponeurotic Fibroma
Rare under 20 Predominantly <20
Not calcified Calcified
Rarely chondroid Chondroid
No muscle or nerve infiltration May infiltrate muscle and nerve

 

Extra-abdominal Desmoid Fibromatosis Palmar and Plantar Fibromatosis
Rare on hands and feet Occurs on hands and feet
Primarily one large mass Multiple small nodules
Infiltrates muscle No muscle infiltration

 

Palmar or Plantar Fibromatosis Adult Fibrosarcoma
Occurs in hands Rare in hands
Multiple small nodules Single large mass
Involves fascia Deep to fascia
Haphazard pattern Herringbone pattern
Cytologically bland Cytologically atypical
No atypical mitotic figures Atypical mitotic figures may be seen
Rarely necrotic Frequent necrosis

 

Palmar or Plantar Fibromatosis Synovial Sarcoma
Rare under age 20 Frequently under age 20
Multiple small nodules Single large mass
Not biphasic May be biphasic
Variable cellularity Uniformly hypercellular
Lacks ropy collagen, calcification and stag horn vessels May have ropy collagen, calcification and stag horn vessels
No SYT-SSX fusion SYT-SSX fusion present

 

Palmar or Plantar Fibromatosis Epithelioid Sarcoma
Necrosis absent Necrosis common
No epithelioid cells Epithelioid cells present
Cytologicially bland Cytologically atypical
Keratin negative Keratin positive
CD34 negative CD34 50% positive

 

Palmar or Plantar Fibromatosis Inclusion Body Fibromatosis
Usually in palm or sole Usually on digits
Uncommon in children Vast majority very young
No inclusions Inclusions

Clinical

  • Usual age range 10-66 years
    • One large series documents occurence in children, age 2-12 years
      • Same histology
      • Same associations
    • Variant in children with nodules at anterior medial edge of sole of heel has been described
      • Regresses spontaneously
  • Contracture unusual
  • May be associated with
    • Palmar fibromatosis
    • Penile fibromatosis
    • Knuckle pads
  • May ulcerate with trauma
  • Familial predisposition
    • Generally appears to be autosomal dominant
  • Recurrences do occur but are not destructive
    • Never metastasizes
    • May regress with age

Lists

Fibromatoses

Bibliography

  • Kempson RL, Fletcher CDM, Evans HL, Henrickson MR, Sibley RS. Tumors of the Soft Tissues, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 30, 2001
  • Fletcher CDM, Unni KK, Mertens F. Pathology and Genetics of Tumours of Soft Tissue and Bone, World Health Organization Classification of Tumours 2002
  • Weiss SW, Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors, 4th edition, 2001
  • Montgomery E, Lee JH, Abraham SC, Wu TT.  Superficial fibromatoses are genetically distinct from deep fibromatoses.  Mod Pathol 2001 Jul;14(7):695-701
  • Evans HL.  Multinucleated giant cells in plantar fibromatosis.  Am J Surg Pathol 2002 Feb;26(2):244-8
  • Jacob CI, Kumm RC.  Benign anteromedial plantar nodules of childhood: a distinct form of plantar fibromatosis.  Pediatr Dermatol 2000 Nov-Dec;17(6):472-4
  • Godette GA, O'Sullivan M, Menelaus MB.  Plantar fibromatosis of the heel in children: a report of 14 cases.  J Pediatr Orthop 1997 Jan-Feb;17(1):16-7
  • Alexander IJ, Johnson KA, Shives TC, Reiman HM, Johnson JE.  Aggressive fibromatosis of the plantar aspect of the foot. A case report.  Bull Hosp Jt Dis Orthop Inst 1987 Fall;47(2):103-8 
  • Chen KT, Van Dyne TA.  Familial plantar fibromatosis.  J Surg Oncol 1985 Aug;29(4):240-1
  • Ushijima M, Tsuneyoshi M, Enjoji M.  Dupuytren type fibromatoses. A clinicopathologic study of 62 cases.  Acta Pathol Jpn 1984 Sep;34(5):991-1001
  • Lee TH, Wapner KL, Hecht PJ.  Plantar fibromatosis.  J Bone Joint Surg Am 1993 Jul;75(7):1080-4
  • Fetsch JF, Laskin WB, Miettinen M. Palmar-plantar fibromatosis in children and preadolescents: a clinicopathologic study of 56 cases with newly recognized demographics and extended follow-up information. Am J Surg Pathol. 2005 Aug;29(8):1095-105.
  • de Palma L, Santucci A, Gigante A, Di Giulio A, Carloni S. Plantar fibromatosis: an immunohistochemical and ultrastructural study. Foot Ankle Int. 1999 Apr;20(4):253-7.
 
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