Fibrous hamartoma of infancy
Fibrous hamartoma of infancy | |
---|---|
Other names | Subdermal fibromatous tumor of infancy |
Surgical resection | |
Prognosis | Excellent |
Frequency | rare |
Fibrous hamartoma of infancy (FHI) is a rare, typically painless, benign tumor that develops in the
The cells involved in FHI include bland
Fibrous hamartoma of infancy is generally a benign tumor but may be locally aggressive,[7] locally infiltration,[8] and in uncommon cases produce symptoms such as tenderness.[9] Surgical excision is the treatment of choice for FHI tumors.[7]
Presentation
The largest study to date examined 197 cases of FHI. In this study, most individuals presented with a slowly growing, symptomless, subcutaneous mass although rarely these masses were rapidly growing, and/or were tender, painful, warm, and/or were accompanied by skin changes, pigmentation, sweat gland enlargement, and/or increased hair overlaying the tumor. Sixty-eight percent of these cases were diagnosed in the first year of life, 23% were diagnoses at birth, and 9% were diagnosed in children 2–5 years old. The male-to female ratio was 2.4. The tumors were most common in the axilla (23% of cases), upper arm (12.5%), lower arm (10.5%), external
Pathology
On
Earlier
Chromosome and gene abnormalities
The EGFR gene which codes for the production of the
Genomic microarray analyses performed on the two FHI cases with tumors that had areas of sarcoma-like morphology found sarcoma-like cells hyperdiploid (i.e. cell with at least 2 more chromosomes than the normal 48), near tetraploid (i.e. four instead of the normal two chromosomes for some but not all chromosomes), single chromosome gains for several chromosomes, and loss of heterozygosity in the p arms of chromosomes 1 and 11 in the first case and in the second case a loss of the p arm in chromosome 10, lose of chromosome 14, and lose of a portion of the q arm of chromosome 22q. These two cases along with recurrent EGFR gene abnormalities strongly support the notation that FHI is as neoplastic tumor.[5]
Diagnosis
The diagnosis of FHI is dependent on its presentation as a subcutaneous tumor that often occurs in individuals at birth or ages <1–2 years old; its highly characteristic histopathology consisting of fibroblast/myofibroblast, adipose tissue, and myxoid zones; and its content of tumor cells which have one of the EGFR gene mutations described in the previous section.[2][5] The combination of these factors clearly distinguishes FHI from three recently defined tumors (i.e. fibroblastic connective tissue nevus, medallion-like dermal dendrocyte hamartoma, and plaque-like CD34-positive dermal fibroma[11]) as well as various pediatric spindle-shaped cell neoplasms.[5] Tumor imaging methods such as magnetic resonance imaging may also be helpful in suggesting that a tumor is an FHI.[7][15][16]
Treatment and prognosis
FHI tumors, if left untreated, have been documented to grow for as long as ~5 years following their diagnosis.[17] The treatment of choice for these tumors is complete surgical excision with clear margins (i.e. with removal of all tumor tissue). Recurrence rates at the site of excision in several studies have been ~15% although rates as low as 1% have been reported by specialized centers.[8] These tumors do not metastasize (i.e. spread to distant tissues) and have an excellent long-term prognosis.[1][7]
See also
- List of cutaneous conditions
- Skin lesion
- Hamartoma
References
- ^ PMID 31950474.
- ^ S2CID 3477224.
- PMID 13367990.
- S2CID 42199990.
- ^ S2CID 207941071.
- PMID 33179614.
- ^ S2CID 19576285.
- ^ PMID 34088477.
- ^ S2CID 3022223.
- ^ S2CID 40041944.
- ^ PMID 34449590.
- ^ "EGFR epidermal growth factor receptor [Homo sapiens (Human)] - Gene - NCBI".
- S2CID 4572547.
- S2CID 24148406.
- S2CID 219763567.
- PMID 31376836.
- S2CID 3638558.