Precalcaneal congenital fibrolipomatous hamartoma: Rare or under‐reported?

Abstract

Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a benign under-reported condition of infancy characterized by the presence of soft nodules on precalcaneal plantar surface of the heel. These lesions are usually bilateral solitary and asymptomatic. We present a 2-monthold infant with solitary skin-colored nodules present on precalcaneal plantar aspect of bilateral heels. K E Y W O R D Scongenital piezogenic-like papules, fibrolipomatous hamartoma, pedal papules, precalcaneal congenital fibrolipomatous hamartoma 1 | INTRODUCTION Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a benign condition that has been referred by disparate nomenclature such as congenital piezogenic-like papules, infantile pedal papules, congenital adipose plantar nodules, and plantar nodules. 1-3 There is apparent lack of published reports in English literature that may be because either the entity is under-diagnosed or misdiagnosed. PCFH is characterized by soft asymptomatic nodules on the plantar aspect of foot. The condition generally presents within first few months of life but can be present at birth. 3 The condition is often bilateral, although unilateral involvement has also been reported. 4,5 The nodules may grow proportionately with the child's growth. 4 No systemic association has been identified so far. We present a case of 2-month old girl infant with skin-colored nodules on precalcaneal aspect of bilateral heel. | CASE REPORTA 2 month-old girl apparently healthy infant, born out of a nonconsanguineous marriage and first in birth order, was brought by her parents for consultation regarding nodular lesions on the plantar aspect of bilateral heel. The infant was born at full term by normal vaginal delivery. The lesions were present since birth and have not changed in appearance since then. On examination, a solitary, skin-colored soft, non-tender nodular-lesion was present on the medial aspect of precalcaneal region of both heels. The individual lesion was approximately 2 × 2 cm in size, poorly circumscribed and freely mobile, with normal overlying skin (Figure 1). The rest of the mucocutaneous and systemic examination was normal. Ultrasound examination revealed an ill-defined slightly hyperechoeic lesion with no increase in vascularity. A skin biopsy was sent from the left heel lesion. The hematoxylin and eosin stained section showed presence of mature adipose tissue enveloped with collagenous fibrous sheaths without any evidence of inflammation seen encircling the appendages (Figure 2A,B). Based on the clinical presentation, typical location and histology, a diagnosis of PCFH was made. The parents were counseled regarding the benign nature of the lesion.

Fibrolipomatous hamartomas not only on the soles

“…To our knowledge, this is the first simultaneous palmoplantar involvement of fibrolipomatous hamartomas. Fibrosing or fibrolipomatous tumors in pediatric patients, including PCFHs, are clinically challenging because they are heterogeneous and variously defined . PCFHs were first described in 1977 by Elsahy and Lorimer; then, Larregue et al proposed the current name .…”

“…PCFHs were first described in 1977 by Elsahy and Lorimer; then, Larregue et al proposed the current name . Its true incidence is unknown . While cases of lesions appearing on the feet, nose, and mandibular region are reported, none describe localization on the hands.…”

“…While cases of lesions appearing on the feet, nose, and mandibular region are reported, none describe localization on the hands. PCFH usually occurs sporadically; however, a possible genetic inheritance is described . The pathogenesis is unclear .…”

“…The pathogenesis is unclear . There might be an abnormal involution of the plantar subcutaneous tissue or a herniation of fat due to a defect in the plantar fascia and fibroconnective trabecular system . In most cases, diagnosis is made by clinical assessment and treatment is not required .…”

“…Invasive investigations or wide excisions should be avoided. There are no reports to date of associated abnormalities or malignant transformation of fibrolipomatous hamartomas . It is important for the dermatologist to identify this condition to reassure parents of the affected children and avoid unnecessary workup.…”