Cases and Research Letters
Precalcaneal Congenital Fibrolipomatous Hamartoma
Hamartoma fibrolipomatoso precalcáneo congénito
C. Rubio-Flores
, O. López-Barrantes González, C. Garrido-Gutiérrez, R.M. Díaz-Díaz
Corresponding author
Sección de Dermatología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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Rubio-Flores, O. López-Barrantes González, C. Garrido-Gutiérrez, R.M. Díaz-Díaz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Rubio-Flores" "email" => array:1 [ 0 => "cristina.rubio.flores@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "López-Barrantes González" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Garrido-Gutiérrez" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Díaz-Díaz" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Sección de Dermatología, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hamartoma fibrolipomatoso precalcáneo congénito" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 710 "Ancho" => 951 "Tamanyo" => 109033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Symmetric nodules on the plantar surface of both feet, just anterior to the heels.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a rare and benign childhood skin disorder, with only a few cases reported in the literature. It has been referred to by a variety of names, including pedal papules in the newborn, congenital piezogenic-like papules, and bilateral congenital adipose plantar nodules.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 9-month-old girl, with no relevant personal or family history, whose family brought her to consultation for the presence of symmetric subcutaneous nodular lesions on the plantar surface of both feet, just anterior to the heels (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions had been present since birth. They had a soft consistency, were poorly circumscribed, and were not adherent to the superficial or deeper layers. The overlying skin was normal. They had a diameter of 1.5 cm at their widest point and appeared to be asymptomatic. There were no other evident abnormalities. Based on these clinical features, a diagnosis of PCFH was made. The lesions remained unchanged over more than 6 months of follow-up. During this time, the patient started to walk and there was no gait disturbance. Treatment was not considered necessary.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PCFH was first reported in 1990 by Larralde et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who described the nodules as <span class="elsevierStyleItalic">pedal papules in the newborn</span>. In 1996, Larregue et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> called the disorder <span class="elsevierStyleItalic">precalcaneal congenital fibrolipomatous hamartoma</span> and this term has been used ever since. The literature contains only isolated case reports and small series. Although PCFH appears to be rare, it is probably underdiagnosed because of low awareness among clinicians and the benign nature of the nodules.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is typically present at birth, but it can develop later. It has been reported to be slightly more common in males than in females.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Its pathogenesis is unknown. Early descriptions suggested that it might be due to incomplete regression of fetal tissue<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> as fibrolipomatous fetal tissue in the area of the heel exhibits physiologic hypodermic hypertrophy. However, the fact that fetal adipose tissue has never been detected on histologic examination and that a higher incidence of PCFH has not been noted in preterm infants would seem to contradict this theory.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Other possible causes that have been suggested include a congenital alteration in the fibroconnective trabecular network of the adipose tissue<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–10</span></a> and a tissue overgrowth disorder.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">PCFH tends to appear sporadically, although there have been reports of a familial association,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,7,9</span></a> with an apparently autosomal dominant pattern of inheritance.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,9</span></a> It has also been suggested that there might be an X-linked or mitochondrial inheritance pattern.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PCFH is characterized by the presence of soft, symmetric, mobile, subcutaneous nodular lesions that are generally located on the mid region of the soles of both feet, just anterior to the heel, although they can also extend onto the heel. On occasions, the nodules can be more prominent on one foot than on the other.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The color of the overlying skin is normal. The nodules are asymptomatic and have not been reported to cause gait disturbance. Accordingly, they do not generally require treatment, but surgical excision is an option if they cause discomfort.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The natural history of PCFH is not well established. The nodules tend to increase in size as the child grows, and there have been reports of lesions persisting well into adulthood.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> However, because so few reports have been published on this relatively recently described disorder, little is known about clinical course or potential for spontaneous regression. There have been no reports to date of associated abnormalities or potential for malignant transformation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Histology is generally not necessary to diagnose PCFH.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a> Histologic findings include mature adipose tissue surrounded by collagen fibers of different thicknesses and normal elastic fibers. In addition, there may be mucin deposits at the periphery and within the fat lobules<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> and an increased number of blood vessels without associated perivascular alterations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The above findings have been confirmed in ultrastructural studies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should include piezogenic papules, which are generally found in adults and are caused by herniation of fat through the dermis following injury. Unlike PCHF nodules, piezogenic papules are typically multiple and are often painful, particularly on walking. Other types of neonatal nodular lesions should also be considered in the differential diagnosis. Examples are juvenile fibromatosis, lipomas, nevus lipomatosus, dermal hypoplasia, infantile hemangioma, congenital hemangioma, lymphatic malformation, or plexiform neurofibroma, all of which are typically unilateral. In most cases, these conditions can be distinguished by their clinical features. In equivocal cases, however, histologic examination, or even less invasive procedures such as transillumination or echo Doppler, can be helpful.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is important to be familiar with this probably underdiagnosed disease and to inform parents that it is a harmless, asymptomatic condition that is not associated with other abnormalities and generally does not require further tests or aggressive treatments. Parents should also be informed that it might be hereditary, although the pattern of transmission has not yet been well established.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Rubio-Flores C, López-Barrantes González O, Garrido-Gutiérrez C, Díaz-Díaz RM. Hamartoma fibrolipomatoso precalcáneo congénito. Actas Dermosifiliogr.2012;103:651-653.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 710 "Ancho" => 951 "Tamanyo" => 109033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Symmetric nodules on the plantar surface of both feet, just anterior to the heels.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pápulas podálicas en el recién nacido" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Larralde de Luna" 1 => "J. 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Munn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2008" "paginaInicial" => "495" "paginaFinal" => "496" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precalcaneal congenital fibrolipomatous hamartoma: report of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Chiaradia" 1 => "R.C. Fiss" 2 => "C.M. Silva" 3 => "A.E. Kiszewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpedsurg.2011.09.048" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "2011" "volumen" => "46" "paginaInicial" => "E11" "paginaFinal" => "E12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22152899" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000007/v1_201304241318/S1578219012002302/v1_201304241318/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000007/v1_201304241318/S1578219012002302/v1_201304241318/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002302?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 9 | 32 |
| 2024 October | 245 | 60 | 305 |
| 2024 September | 184 | 36 | 220 |
| 2024 August | 235 | 63 | 298 |
| 2024 July | 233 | 49 | 282 |
| 2024 June | 219 | 63 | 282 |
| 2024 May | 160 | 61 | 221 |
| 2024 April | 157 | 29 | 186 |
| 2024 March | 150 | 27 | 177 |
| 2024 February | 151 | 43 | 194 |
| 2024 January | 159 | 35 | 194 |
| 2023 December | 130 | 23 | 153 |
| 2023 November | 118 | 49 | 167 |
| 2023 October | 156 | 57 | 213 |
| 2023 September | 121 | 37 | 158 |
| 2023 August | 111 | 24 | 135 |
| 2023 July | 150 | 38 | 188 |
| 2023 June | 150 | 22 | 172 |
| 2023 May | 187 | 30 | 217 |
| 2023 April | 114 | 22 | 136 |
| 2023 March | 119 | 29 | 148 |
| 2023 February | 101 | 26 | 127 |
| 2023 January | 105 | 25 | 130 |
| 2022 December | 108 | 29 | 137 |
| 2022 November | 58 | 27 | 85 |
| 2022 October | 62 | 24 | 86 |
| 2022 September | 51 | 41 | 92 |
| 2022 August | 34 | 30 | 64 |
| 2022 July | 24 | 36 | 60 |
| 2022 June | 33 | 28 | 61 |
| 2022 May | 131 | 31 | 162 |
| 2022 April | 124 | 41 | 165 |
| 2022 March | 105 | 56 | 161 |
| 2022 February | 91 | 30 | 121 |
| 2022 January | 100 | 41 | 141 |
| 2021 December | 89 | 39 | 128 |
| 2021 November | 87 | 51 | 138 |
| 2021 October | 244 | 47 | 291 |
| 2021 September | 70 | 51 | 121 |
| 2021 August | 469 | 34 | 503 |
| 2021 July | 61 | 21 | 82 |
| 2021 June | 66 | 30 | 96 |
| 2021 May | 39 | 57 | 96 |
| 2021 April | 99 | 73 | 172 |
| 2021 March | 73 | 60 | 133 |
| 2021 February | 35 | 34 | 69 |
| 2021 January | 80 | 31 | 111 |
| 2020 December | 46 | 23 | 69 |
| 2020 November | 25 | 34 | 59 |
| 2020 October | 42 | 47 | 89 |
| 2020 September | 36 | 36 | 72 |
| 2020 August | 29 | 36 | 65 |
| 2020 July | 36 | 31 | 67 |
| 2020 June | 54 | 33 | 87 |
| 2020 May | 39 | 32 | 71 |
| 2020 April | 39 | 23 | 62 |
| 2020 March | 41 | 19 | 60 |
| 2020 February | 4 | 6 | 10 |
| 2020 January | 0 | 4 | 4 |
| 2019 December | 4 | 1 | 5 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 4 | 2 | 6 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 2 | 6 | 8 |
| 2019 May | 1 | 19 | 20 |
| 2019 April | 1 | 1 | 2 |
| 2019 March | 2 | 10 | 12 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 1 | 1 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 4 | 0 | 4 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 11 | 11 |
| 2018 March | 4 | 4 | 8 |
| 2018 February | 94 | 5 | 99 |
| 2018 January | 113 | 10 | 123 |
| 2017 December | 85 | 12 | 97 |
| 2017 November | 70 | 11 | 81 |
| 2017 October | 102 | 12 | 114 |
| 2017 September | 105 | 10 | 115 |
| 2017 August | 94 | 13 | 107 |
| 2017 July | 85 | 17 | 102 |
| 2017 June | 94 | 20 | 114 |
| 2017 May | 82 | 14 | 96 |
| 2017 April | 78 | 21 | 99 |
| 2017 March | 72 | 14 | 86 |
| 2017 February | 47 | 9 | 56 |
| 2017 January | 52 | 25 | 77 |
| 2016 December | 48 | 10 | 58 |
| 2016 November | 76 | 10 | 86 |
| 2016 October | 94 | 13 | 107 |
| 2016 September | 155 | 11 | 166 |
| 2016 August | 101 | 23 | 124 |
| 2016 July | 51 | 15 | 66 |
| 2016 June | 7 | 15 | 22 |
| 2016 May | 6 | 18 | 24 |
| 2016 April | 4 | 8 | 12 |
| 2016 March | 11 | 13 | 24 |
| 2016 February | 9 | 1 | 10 |
| 2016 January | 4 | 4 | 8 |
| 2015 December | 8 | 1 | 9 |
| 2015 November | 20 | 4 | 24 |
| 2015 October | 21 | 4 | 25 |
| 2015 September | 10 | 6 | 16 |
| 2015 August | 12 | 7 | 19 |
| 2015 July | 73 | 14 | 87 |
| 2015 June | 62 | 4 | 66 |
| 2015 May | 119 | 10 | 129 |
| 2015 April | 84 | 13 | 97 |
| 2015 March | 70 | 12 | 82 |
| 2015 February | 49 | 8 | 57 |
| 2015 January | 64 | 22 | 86 |
| 2014 December | 48 | 7 | 55 |
| 2014 November | 54 | 12 | 66 |
| 2014 October | 89 | 19 | 108 |
| 2014 September | 67 | 14 | 81 |
| 2014 August | 29 | 4 | 33 |
| 2014 July | 21 | 10 | 31 |
| 2014 June | 29 | 6 | 35 |
| 2014 May | 33 | 7 | 40 |
| 2014 April | 31 | 4 | 35 |
| 2014 March | 32 | 13 | 45 |
| 2014 February | 30 | 6 | 36 |
| 2014 January | 24 | 9 | 33 |
| 2013 December | 28 | 6 | 34 |
| 2013 November | 19 | 6 | 25 |
| 2013 October | 11 | 7 | 18 |
| 2013 September | 17 | 4 | 21 |
| 2013 August | 14 | 6 | 20 |
| 2013 July | 11 | 3 | 14 |
| 2013 June | 10 | 11 | 21 |
| 2013 May | 16 | 3 | 19 |
| 2013 April | 16 | 12 | 28 |
| 2013 March | 14 | 7 | 21 |
| 2013 February | 24 | 3 | 27 |
| 2013 January | 25 | 10 | 35 |
| 2012 December | 15 | 5 | 20 |
| 2012 October | 1 | 6 | 7 |
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