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
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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" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 9 | 31 |
| 2024 Octubre | 245 | 60 | 305 |
| 2024 Septiembre | 184 | 36 | 220 |
| 2024 Agosto | 235 | 63 | 298 |
| 2024 Julio | 233 | 49 | 282 |
| 2024 Junio | 219 | 63 | 282 |
| 2024 Mayo | 160 | 61 | 221 |
| 2024 Abril | 157 | 29 | 186 |
| 2024 Marzo | 150 | 27 | 177 |
| 2024 Febrero | 151 | 43 | 194 |
| 2024 Enero | 159 | 35 | 194 |
| 2023 Diciembre | 130 | 23 | 153 |
| 2023 Noviembre | 118 | 49 | 167 |
| 2023 Octubre | 156 | 57 | 213 |
| 2023 Septiembre | 121 | 37 | 158 |
| 2023 Agosto | 111 | 24 | 135 |
| 2023 Julio | 150 | 38 | 188 |
| 2023 Junio | 150 | 22 | 172 |
| 2023 Mayo | 187 | 30 | 217 |
| 2023 Abril | 114 | 22 | 136 |
| 2023 Marzo | 119 | 29 | 148 |
| 2023 Febrero | 101 | 26 | 127 |
| 2023 Enero | 105 | 25 | 130 |
| 2022 Diciembre | 108 | 29 | 137 |
| 2022 Noviembre | 58 | 27 | 85 |
| 2022 Octubre | 62 | 24 | 86 |
| 2022 Septiembre | 51 | 41 | 92 |
| 2022 Agosto | 34 | 30 | 64 |
| 2022 Julio | 24 | 36 | 60 |
| 2022 Junio | 33 | 28 | 61 |
| 2022 Mayo | 131 | 31 | 162 |
| 2022 Abril | 124 | 41 | 165 |
| 2022 Marzo | 105 | 56 | 161 |
| 2022 Febrero | 91 | 30 | 121 |
| 2022 Enero | 100 | 41 | 141 |
| 2021 Diciembre | 89 | 39 | 128 |
| 2021 Noviembre | 87 | 51 | 138 |
| 2021 Octubre | 244 | 47 | 291 |
| 2021 Septiembre | 70 | 51 | 121 |
| 2021 Agosto | 469 | 34 | 503 |
| 2021 Julio | 61 | 21 | 82 |
| 2021 Junio | 66 | 30 | 96 |
| 2021 Mayo | 39 | 57 | 96 |
| 2021 Abril | 99 | 73 | 172 |
| 2021 Marzo | 73 | 60 | 133 |
| 2021 Febrero | 35 | 34 | 69 |
| 2021 Enero | 80 | 31 | 111 |
| 2020 Diciembre | 46 | 23 | 69 |
| 2020 Noviembre | 25 | 34 | 59 |
| 2020 Octubre | 42 | 47 | 89 |
| 2020 Septiembre | 36 | 36 | 72 |
| 2020 Agosto | 29 | 36 | 65 |
| 2020 Julio | 36 | 31 | 67 |
| 2020 Junio | 54 | 33 | 87 |
| 2020 Mayo | 39 | 32 | 71 |
| 2020 Abril | 39 | 23 | 62 |
| 2020 Marzo | 41 | 19 | 60 |
| 2020 Febrero | 4 | 6 | 10 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 2 | 6 |
| 2019 Julio | 0 | 2 | 2 |
| 2019 Junio | 2 | 6 | 8 |
| 2019 Mayo | 1 | 19 | 20 |
| 2019 Abril | 1 | 1 | 2 |
| 2019 Marzo | 2 | 10 | 12 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 1 | 1 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 11 | 11 |
| 2018 Marzo | 4 | 4 | 8 |
| 2018 Febrero | 94 | 5 | 99 |
| 2018 Enero | 113 | 10 | 123 |
| 2017 Diciembre | 85 | 12 | 97 |
| 2017 Noviembre | 70 | 11 | 81 |
| 2017 Octubre | 102 | 12 | 114 |
| 2017 Septiembre | 105 | 10 | 115 |
| 2017 Agosto | 94 | 13 | 107 |
| 2017 Julio | 85 | 17 | 102 |
| 2017 Junio | 94 | 20 | 114 |
| 2017 Mayo | 82 | 14 | 96 |
| 2017 Abril | 78 | 21 | 99 |
| 2017 Marzo | 72 | 14 | 86 |
| 2017 Febrero | 47 | 9 | 56 |
| 2017 Enero | 52 | 25 | 77 |
| 2016 Diciembre | 48 | 10 | 58 |
| 2016 Noviembre | 76 | 10 | 86 |
| 2016 Octubre | 94 | 13 | 107 |
| 2016 Septiembre | 155 | 11 | 166 |
| 2016 Agosto | 101 | 23 | 124 |
| 2016 Julio | 51 | 15 | 66 |
| 2016 Junio | 7 | 15 | 22 |
| 2016 Mayo | 6 | 18 | 24 |
| 2016 Abril | 4 | 8 | 12 |
| 2016 Marzo | 11 | 13 | 24 |
| 2016 Febrero | 9 | 1 | 10 |
| 2016 Enero | 4 | 4 | 8 |
| 2015 Diciembre | 8 | 1 | 9 |
| 2015 Noviembre | 20 | 4 | 24 |
| 2015 Octubre | 21 | 4 | 25 |
| 2015 Septiembre | 10 | 6 | 16 |
| 2015 Agosto | 12 | 7 | 19 |
| 2015 Julio | 73 | 14 | 87 |
| 2015 Junio | 62 | 4 | 66 |
| 2015 Mayo | 119 | 10 | 129 |
| 2015 Abril | 84 | 13 | 97 |
| 2015 Marzo | 70 | 12 | 82 |
| 2015 Febrero | 49 | 8 | 57 |
| 2015 Enero | 64 | 22 | 86 |
| 2014 Diciembre | 48 | 7 | 55 |
| 2014 Noviembre | 54 | 12 | 66 |
| 2014 Octubre | 89 | 19 | 108 |
| 2014 Septiembre | 67 | 14 | 81 |
| 2014 Agosto | 29 | 4 | 33 |
| 2014 Julio | 21 | 10 | 31 |
| 2014 Junio | 29 | 6 | 35 |
| 2014 Mayo | 33 | 7 | 40 |
| 2014 Abril | 31 | 4 | 35 |
| 2014 Marzo | 32 | 13 | 45 |
| 2014 Febrero | 30 | 6 | 36 |
| 2014 Enero | 24 | 9 | 33 |
| 2013 Diciembre | 28 | 6 | 34 |
| 2013 Noviembre | 19 | 6 | 25 |
| 2013 Octubre | 11 | 7 | 18 |
| 2013 Septiembre | 17 | 4 | 21 |
| 2013 Agosto | 14 | 6 | 20 |
| 2013 Julio | 11 | 3 | 14 |
| 2013 Junio | 10 | 11 | 21 |
| 2013 Mayo | 16 | 3 | 19 |
| 2013 Abril | 16 | 12 | 28 |
| 2013 Marzo | 14 | 7 | 21 |
| 2013 Febrero | 24 | 3 | 27 |
| 2013 Enero | 25 | 10 | 35 |
| 2012 Diciembre | 15 | 5 | 20 |
| 2012 Octubre | 1 | 6 | 7 |
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