Precalcaneal congenital soft-tissue lesions in children: A case report of fibrous hamartoma of infancy and an approach to differential diagnosis

Abstract

Precalcaneal soft-tissue lesions are uncommon in the pediatric population and can present a diagnostic challenge. Fibrous hamartoma of infancy (FHI) is relatively rare in this location. We report an interesting case of FHI in a 3-years-and-10-months-old boy in the precalcaneal location that was present since birth. We describe the imaging findings of FHI on X-ray, ultrasound, and MRI and discuss the differential diagnoses. It is important to consider FHI during differential diagnosis and be aware of the imaging features of other common possible diagnoses in the precalcaneal region for appropriate management.

Cutaneous fibrolipomatous hamartoma: Report of 2 cases with retrocalcaneal location

“…High‐frequency ultrasonography can be of help in diagnosis. Previous descriptions of ultrasound images include hypoechoic lobules, a heterogeneously hypoechoic mass in the hypodermis, and an ill‐defined slightly hyperechoic lesion near the subcutaneous layer . Despite different sonographic descriptions, the 3 images available were similar to those of our cases.…”

Fibrous hamartoma of infancy: radiologic features and literature review

“…In the first case reported by Loyer et al who described the MR findings of FHI in 1992 [12], the lesion presented as a mass with proximate proportion of strands similar to the signal intensities of adipose or fibrous tissue. In some other cases reported in the literature, however, the lesions could also be showed as predominant intensity of fibrous tissue traversed by disperse strands of fatty component or vice versa [8–10, 16–18]. The interspersed strands usually existed in a parallel fashion, or even in a whirling appearance as in our cases [10, 12–15, 18, 24].…”

“…Because of the rarity of FHI, the radiologic findings of FHI have not been sufficiently investigated in the literature. On PubMed search, we found FHI-related 132 papers in which only 14 cases have detailed clinical and radiologic findings to allow an in-depth imaging analysis (Table 1) [8–10, 12–22]. Of the 16 cases of FHI, including our 2 cases, there were 9 cases undergoing X-ray imaging.…”

“…In the balanced type, the proportion of the two components was basically equal [12–15, 19–22]. In the non-balanced type, however, it was not equal at all, with one of them being predominant and the other one subordinate [5, 8–10, 16–18, 23, 26]. In the first case reported by Loyer et al who described the MR findings of FHI in 1992 [12], the lesion presented as a mass with proximate proportion of strands similar to the signal intensities of adipose or fibrous tissue.…”

“…Although 5 cases of FHI were included in a case series reported by Lee et al [7], no detailed radiologic demonstrations were described. On MR imaging, there were reports that the tumours of FHI had signal intensity similar to fibromatosis, and there were also reports that the tumours of FHI had signal intensity similar to lipoma [8–10]. Therefore, the relationship between the different MR imaging appearances and their corresponding histologic components of FHI should be further investigated.…”