Infantile Digital Fibromas
An enlarging mass was noted on the dorsum of the right fifth toe of a 2-month-old boy during a well-child examination. The firm, immobile mass measured approximately 1 cm in diameter. A congenital abnormality was suspected; the patient was referred to a plastic surgeon for consultation.
An enlarging mass was noted on the dorsum of the right fifth toe of a 2-month-old boy during a well-child examination. The firm, immobile mass measured approximately 1 cm in diameter. A congenital abnormality was suspected; the patient was referred to a plastic surgeon for consultation.
Shortly after the initial examination, a similar but smaller lesion developed on the child's left fifth toe. Both tumors were successfully excised; histologic examination confirmed infantile digital fibromas. Within a few months, lesions developed on the right third and fourth toes.
Dr Thomas Zuber, assistant professor at Emory University in Atlanta, writes that infantile digital fibromas appear early in life, generally involve the ulnar 3 digits, may be multiple, and can grow rapidly.1 The lesions tend to have a deep dermal origin and display intracytoplasmic inclusion bodies that are not seen in other fibrous proliferative disorders.1 Similar lesions apparently do not arise in adults.1 While the lesions can be locally aggressive, they do not metastasize.2
The cause is unknown. Early reports suggested that the fibromas result from trauma; however, more recent evidence does not substantiate this theory.3 Studies have failed to demonstrate a causative virus, such as human papillomavirus or herpes simplex virus.4
Although complete excision can eradicate the lesions, local recurrence and the development of additional lesions are common.5 Because the lesions can resolve spontaneously, many practitioners prefer to postpone therapy.6-8
One year after eruption, the lesions on this patient's right third and fourth toes have not yet resolved. The boy's condition will continue to be monitored.
REFERENCES:1. Falco NA, Upton J. Infantile digital fibromas. J Hand Surg [Am]. 1995;20:1014-1020.
2. Baerg J, Murphy JJ, Magee JF. Fibromatoses: clinical and pathological features suggestive of recurrence. J Pediatr Surg. 1999;34:1112-1114.
3. Miyamoto T, Mihara M, Hagari Y, et al. Posttraumatic occurrence of infantile digital fibromatosis: a histologic and electron microscopic study. Arch Dermatol. 1986;122:915-918.
4. Zhu WY, Xia MY, Huang YF, et al. Infantile digital fibromatosis: ultrastructural human papillomavirus and herpes simplex virus DNA observation. Pediatr Dermatol. 1991;8:137-139.
5. Rimareix F, Bardot J, Andrac L, et al. Infantile digital fibroma-report of eleven cases. Eur J Pediatr Surg. 1997;7:345-348.
6. Kawaguchi M, Mitsuhashi Y, Hozumi Y, Kondo S. A case of infantile digital fibromatosis with spontaneous regression. J Dermatol. 1998;25:523-526.
7. Azam SH, Nicholas JL. Recurring infantile digital fibromatosis: report of two cases. J Pediatr Surg. 1995;30:89-90.
8. Ishii N, Matsui K, Ichiyama S, et al. A case of infantile digital fibromatosis showing spontaneous regression. Br J Dermatol. 1989;121:129-133.
