Skip to main content
NCBI home page
Indian Journal of Surgical Oncology logoLink to Indian Journal of Surgical Oncology
. 2023 Oct 28;15(1):136–144. doi: 10.1007/s13193-023-01842-5

Calcifying Aponeurotic Fibroma of Leg Masquerading as Hemangioma in an Adolescent Male along with Review of Literature

Akriti Jindal 1, Gargi Kapatia 1,✉, Manjit Kaur Rana 1, Rahul Sharma 2
PMCID: PMC10948668  PMID: 38511046

Abstract

Calcifying aponeurotic fibroma (CAF) is a rare soft tissue tumor which falls under the WHO category of benign fibroblastic and myofibroblastic tumors. It typically occurs on the distal extremities (hands and foot) of children and adolescents. Other less common sites include wrists, ankles, trunk and rarely legs and arms. These tumors present as a painless soft tissue mass, arising in the subcutis, and are usually connected to tendons or aponeuroses. Computed tomography (CT) and magnetic resonance imaging (MRI) are the radiological investigations of choice; however, histopathology remains the diagnostic modality of choice for the diagnosis of CAF. We present a rare case of a 17-year-old boy who presented with a gradually progressive mass lesion on the leg which was later diagnosed as calcifying aponeurotic fibroma on histopathology.

Keywords: Juvenile aponeurotic fibroma, Benign neoplasm, Leg, Young adolescent tumor

Introduction

Calcifying aponeurotic fibroma (CAF) is a very rare soft tissue tumor [1]. It was described by Keasbey in 1953 for the very first time [2].The term was coined by Iwasaki and Enjoji in 1973 [3]. More than 150 cases have been reported in the literature till now [5]. It is mostly seen in children and adolescents predominantly in the first and second decade of life, with peak incidence between 8 and 14 years of age, therefore, also known as juvenile aponeurotic fibroma [1, 4]. However, occasionally, it can also be seen in older individuals [1]. Males have a slightly increased tendency for this tumor with male to female ratio of 2:1 [1, 5]. This tumor most commonly occurs in the distal extremities [1]. A total of 80% of the tumors occur in hands (palm) and feet (plantar aspect) while the rest of the 20% tumors occurs in the proximal extremities or trunk [1]. The rare sites are legs, arms and the lumbosacral region [1]. Local recurrences are common in this tumor due to its infiltrative nature; therefore, though benign in nature, it is important to identify and diagnose this tumor and a long-term follow-up is required [4, 5].

We present a rare case of a 17-year-old boy who presented with a slow growing mass on the leg.

Case Report

A 17-year-old male presented with a mass on the right leg present from the last 9–10 months. He gave the history that it was slowly growing in size from the last 3–4 months and has also become tender from the last 1 month. The magnetic resonance imaging (MRI) findings were a well-defined lobulated altered signal intensity lesion in subfascial planes along the medial border of the soleus muscle with minimal extension into overlying subcutaneous soft tissue—likely slow flow vascular malformation. The clinicians made a provisional diagnosis of venous hemangioma based on the clinical and radiological features. However, computed tomography (CT) was not performed for the lesion. The swelling was excised completely and sent for histopathological examination. On gross examination, it was a grey brown circumscribed lobulated soft tissue mass measuring 3.5 × 2.5 × 2 cm. While cutting, there was a gritty sensation. The cut section showed a nodule measuring 2 × 1.7 × 1.2 cm (Fig. 1A). The nodule had few hard calcified areas. The surrounding area was fibrofatty. The sections were taken and processed. On microscopic examination, an infiltrating tumor was identified comprising of spindle cells arranged in fascicular pattern (Fig. 1B, C). The individual cells were exhibiting oval to spindle shape nuclei with bland chromatin, inconspicuous nucleoli and moderate amount of cytoplasm with indistinct cell boundaries (Fig. 1D). The tumor was infiltrating into the adjacent fat focally (Fig. 1F). There were numerous areas showing marked calcification (Fig. 1E). Few congested blood vessels were also noted in the lesion. However, no atypia/chondroid differentiation/increased mitosis was seen in the sections examined.

Fig. 1.

Fig. 1

Open in a new tab

A Gross picture of the excised mass from the leg of the patient showing a greyish white ill-defined mass infiltrating into the adjacent soft tissue. Note the small white flecks indicating calcified areas. B, C Low power view shows spindle cells arranged in fascicular pattern along with areas of calcification (H&E, × 40 and × 100, respectively); D high power view showing cells exhibiting oval to spindle shape nuclei with bland chromatin and moderate amount of cytoplasm (H&E, × 400); E low power view showing areas of calcification within the lesion (H&E, × 40); F low power view showing the infiltration of spindle cells into the adjacent adipose tissue (H&E, × 40)

Review of Literature (Table 1)

Table 1.

List of cases diagnosed with calcifying aponeurotic fibroma

S. no Author name Year of publish Site Age Gender Additional findings (clinical features and recurrence of lesion)
1 Sanmiguel et al. [3] 2022 Left clavicular region 64 year Female Swelling of left clavicular region from 3 years
2 Chalatsis et al. [7] 2022 Plantar aspect of right foot 5 year Female
3 Won et al. [8] 2021 Posterior tibial tendon 74 year Female Progressive pain in the medial foot from 3 years
4 Lee et al. [9] 2021 Wrist 59 year Female Mild swelling and discomfort in her left wrist
5 Gallagher et al. [10] 2021 Finger 15 year Female Painless progressively enlarging
6 Sadiq et al. [11] 2021 Tendon of Achilles
7–14 Kang et al. [12] 2020 (8 patients) Foot (5), hand, ankle and knee
15 Hamoud et al. [4] 2020 Tendon of Achilles 4 year Female
16 Zhang et al. [13] 2020 Distal right thigh 8 year
17 Navas et al. [14] 2019 Sole of right foot 84 year Male Firm, immobile, non-tender mass
18 Ozcanli et al. [15] 2019
19 Motta et al. [16] 2018 Dorsum of foot 5 year Male
20 Lee et al. [17] 2018 Carpal joints 59 year Female
21 Chaltsev et al. [18] 2018 Generalized over the whole body 52 year Male Taking medication for rheumatoid arthritis and nodules
22 Sheikh et al. [19] 2018 Medial aspect of distal hallux 25 year Female
23 Romano et al. [20] 2017 3rd finger of left hand 71 year Male Two soft tissue swelling on same finger, one was CAF and other was Masson tumor
24.-27 Corominas et al. [21] 2017 (4 cases) all children
28 Sekiguchi et al. [22] 2017 Right ankle 17 months Female
29 Lee et al. [23] 2017 Knee 19 year Male
30 Shim et al. [24] 2016 Left upper arm 23 year Female
31 Khullar et al. [25] 2016 Mid plantar aspect of left foot 22 year Male Firm tender nodule on mid plantar aspect of left foot
32 Cho et al. [26] 2015 Dorsum of left foot 4 year Male
33 Kim et al. [5] 2014 Dorsal wrist 67 year Male
34 Nishio et al. [27] 2014 Right little finger 69 year Female
35 Schonauer et al. [28] 2013 Tip of index finger of right hand 44 year Male Progressive tender swelling from 2 years
36 Thakur et al. [29] 2011 Forehead 24 year Female Swelling forehead from 6 months
37 Takaku et al. [30] 2011 Elbow 10 year Female Slowly growing mass since 5 years
38 Giuffre et al. [31] 2011 Distal and proximal phalanges of right thumb 44 year Male Recurrent swelling with invasion into the distal and proximal phalanges, the skin, the radial and ulnar neurovascular bundles and the tendons, treated with amputation thumb
39 Kramer et al. [32] 2010 Left ascending ramus 62 year Female Slowly progressive
40 Arora et al. [33] 2010 Gluteus maximus 2 year
41 DeComas et al. [34] 2009 elbow Infantile fibrosarcoma 12 years back on the same site
42 Yura et al. [35] 2008 Medial pterygoid muscle 60 year Female Asymptomatic round radio-opaque lesion in the right mandible
43 Choi et al. [36] 2008 Finger of hand 36 year Female Finger with distal phalangeal bone involvement
44 Oruc et al. [37] 2007 scalp 3 year Male
45 Kim et al. [38] 2006 wrist 38 year Female Painful swelling
46 Parker et al. [39] 2006 Left hand 11 year Male Slow growing mass in the palm of left hand
47 Hasegawa et al. [40] 2006 knee 2 months Male Swelling on right knee
48 Kwak et al. [41] 2004 thigh 4 year Male
49 Sethi et al. [42] 2003
50 Choi et al. [1] 2003 Thumb 14 year Male Non painful mass at the ulnar aspect of thumb
51 Amaravati et al. [43] 2002 Hand
52 Sferopoulos et al. [44] 2001 Palmaris longus tendon 8 year Male
53 Sferopoulos et al. [44] 2001 Lateral aspect of the foot at the base of fifth metatarsal 43 year Female
54 Sferopoulos et al. [44] 2001 Fifth digit of the foot 48 year Male
55 Tai et al. [45] 2001 Hand 9 year Male
56 Desimone et al. [46] 2001 Hand
57 Lim et al. [47] 2001 2nd digit of right hand 24 year Female
58–79 Fetsch et al. [48] 1998 (22 cases)

Back, 8

Knee, 5

Thigh, 3

Forearm, 3

Elbow, 2

Arm, 1

 2–43 years

15 male

7 females

 Painless mass
80 Sharma et al. [49] 1998 Neck 5 year Female
81 Murphy et al. [50] 1996 Subcutis of lumbosacral region 26 year Male Recurrent at the age of 3, 10, 18, 26
82–84 Lu et al. [51] 1995 (3 cases) Hand or foot 8–27 years Female
85 Hassel et al. [52] 1992 Left forefinger 20 year Male 3 subcutaneous tumors
86 Kang et al. [53] 1992 Right sole 11 year old
87 Yee et al. [54] 1991 Digits of foot
88 Rangwala et al. [55] 1988
89 Lafferty et al. [56] 1986 Palm 3.5 year Female Metastatic fibrosarcoma to lungs and bones 5 years later of CAF excision
91 Eisenbaum et al. [57] 1985 (2 cases)

First web space of right hand

Between index and long finger of right hand

11 year

28 year

Male

Female
92 Aprin et al. [58] 1984 Knee joint 14 year Male
93 Allen et al. [59] 1970 Left wrist 11 year Male Two local excision within 12 years
94 Allen et al. [59] 1970 Middle finger right hand 8 year Male Two local excision within 11 years
95 Allen et al. [59] 1970 Plantar surface, right foot 13 year Male Local excision. Asymptomatic post operation
96 Allen et al. [59] 1970 Palmar aspect, base of right index finger 17 year Male Local excision. Asymptomatic post operation
97 Allen et al. [59] 1970 Palm left hand 3 year Male Two local excision within 7 years
98 Allen et al. [59] 1970 Right hypothenar eminence 15 year Male Local excision. Asymptomatic post operation
99 Allen et al. [59] 1970 Palm of hand 1 year Male Two local excision within 6 years
100 Allen et al. [59] 1970 Palm left hand, 11 year Male Local excision. Asymptomatic post operation
101 Allen [59] 1970 Palmar aspect right hand 8 year Male Two local excision within 4 years
102 Allen et al. [59] 1970 Anatomical snuff box, around extensor tendons 10 year Male Two local excision within 4 years
103 Allen et al. [59] 1970 Left palm 19 year Male Local excision. Asymptomatic post operation
104 Allen et al. [59] 1970 Left index finger 5 year Male Two local excision within 3 years
105 Allen et al. [59] 1970 Right index finger 18 year Male Two local excision within 2 years
106 Allen et al. [59] 1970 Posterior thigh 5 year Male Local excision. Asymptomatic post operation
107 Allen et al. [59] 1970 Right forearm 2 year Male Recurred twice within 2 years of first local excision
108 Allen et al. [59] 1970 Popliteal fossa 12 year Male Recurred within 2 years of first local excision
109 Allen et al. [59] 1970 Left hand 9 year Male Local excision. Asymptomatic post operation
110 Allen et al. [59] 1970 Right wrist 8 year Male Local excision. Asymptomatic post operation
111 Allen et al. [59] 1970 Hand 2 year Female Local excision. Asymptomatic post operation
112 Allen et al. [59] 1970 Left palm 10 year Female
113 Allen et al. [59] 1970 Right middle finger 12 year Male
114 Allen et al. [59] 1970 Left knee 15 year Male
115 Allen et al. [59] 1970 Palm of right hand 6 months Female
116 Allen et al. [59] 1970 Left finger 19 year Male
117 Allen et al. [59] 1970 Right foot 21 year Female
118 Goldman et al. [60] 1970 Wrist 14 year Female Two local excision were done within 5 years
119 Goldman et al. [60] 1970 Palm 5 year Male Local excision. Asymptomatic post operation
120 Goldman et al. [60] 1970 Hypothenar 4 year Female Two local excision were done within 6 months
121 Goldman et al. [60] 1970 Ankle 34 year Male Local excision. Asymptomatic post operation
122 Goldman et al. [60] 1970 Abdominal wall 27 year Male Local excision. Asymptomatic post operation
123 Goldman et al. [60] 1970 Neck 6 year Male Local excision. Asymptomatic post operation
124 Goldman et al. [60] 1970 Wrist 64 year Male Local excision. Asymptomatic post operation
125 Brown et al. [60] 1969 Wrist 1.5 year Male Local excision. Asymptomatic post operation
126 Shapiro et al. [60] 1969 Shoulder 11 year Female Local excision. Asymptomatic post operation
127 Kermarec et al. [60] 1968 Popliteal space 1.5 year Male Two local excision were done within 2 years
128 Bartok et al. [60] 1967 Palm 15 year Male Local excision. Asymptomatic post operation
129 Rios Dalenz et al. [60] 1965 Lumbar paravertebral 15 year Male Local excision. lost to follow up
130 Lichtenstein et al. [60] 1964 Metacarpal 10 year Male Two local excision within 7.5 years
131 Lichtenstein et al. [60] 1964 Forearm 35–40 years Male Local excision. Lost to follow up
132 Lichtenstein et al. [60] 1964 Finger 35 year Female Local excision. Asymptomatic post operation
133 Lichtenstein et al. [60] 1964 Finger 32 year Male Recurrent nodule 11 months after first local excision
134 Lichtenstein et al. [60] 1964 Lower leg 52 year Male Local excision. Lost to follow up
135 Keasbey et al. [60] 1961 Plantar fascia 8 year Male Local excision. Asymptomatic 2 years post operation
136 Keasbey et al. [60] 1961 Hypothenar space 6 year Male Local excision. Asymptomatic 4 years post operation
137 Keasbey et al. [60] 1961 Metacarpal 3 year Female Local excision. Asymptomatic 9 years post operation
138 Keasbey et al. [60] 1961 Lumbar paravertebral 6 year Male Local excision. Asymptomatic 7 years post operation
139 Keasbey et al. [60] 1961 Lower leg 12 year Female Local excision. Lost to follow up
140 Keasbey et al. [60] 1961 Upper arm 2 year Male Local excision
141 Keasbey et al. [60] 1961 Forearm 3 year Female Two local excision in 2.5 years
142 Keasbey et al. [60] 1961 Ankle and dorsal foot 18 year Female Local excision. Asymptomatic 2.5 years post operation
143 Booher et al. [60] 1959 Wrist 2 months Female Five local excision in 5 years
144 Booher et al. [60] 1959 Palm 6 months Male Two excision in 14 months
145 Stout et al. [60] 1954 Palm 10 year Male Local excision. Asymptomatic post operation
146 Stout et al. [60] 1954 Thenar space 8 year Male Local excision. Asymptomatic post operation
147 Keasbey et al. [2] 1953 Mid line on the sole of foot 9 year Female Four local excision in 3 years
148 Keasbey et al. [2] 1953 Thenar area 7 year Female Three local excision in 2 years
149 Keasbey et al. [2] 1953 Hypothenar area 6 year Female Three local excision in 16 months
150 Keasbey et al. [2] 1953 Thenar space 2.5 year Male Two local excision in 1 year
Open in a new tab

Three databases, namely PubMed/MEDLINE, Embase and Scopus, were systematically searched for case reports and case series published in English from the year 1953 to 2021. A total of 150 case reports have been published till now to the best of our knowledge and are included in the review in this study [1–60].

Of the 150 cases, there were 79 males and 48 females (Table 1). Gender was unknown in 23 cases. Male to female ratio was 1.4:1 representing a male predominance.

The age ranged widely ranging from 2 months to 84 years. The age group wise distribution of cases is as follows: 1–10 years—48 cases, 11–20 years—25 cases, 21–30 years—9 cases, 31–40 years—6 cases, 41–50 years—4 cases, 51–60 years—5 cases, 61–70 years—5 cases, 71–80 years—2 cases, 81–90 years—1 case and unknown age group—45 cases. Majority of the patients (73 cases) were < 20 years of age.

On the basis of site, most commonly involved were hands and foot (51 and 20 cases respectively) followed by arm (14 cases), trunk (13 cases), wrist and knee (10 cases each), thigh (9 cases), head and neck (7 cases), ankle (5 cases) and leg (3 cases). Site was not mentioned in 7 cases. Of the data available, few of the patients (n 24) showed recurrence of swelling at the same site multiple times. Only one case is reported till now in which metastatic spread of malignant fibrosarcoma to lungs and bone was seen, 5 years after the excision of CAF. Our case in the current study represents a rare case of CAF present on leg which was misdiagnosed as hemangioma.

Discussion

Calcified aponeurotic fibroma is a rare, benign fibroblastic soft tissue neoplasm which commonly arises from deep volar fascia, aponeurosis of hands or tendons [4, 6]. The etiopathogenesis of calcified aponeurotic fibroma is still unclear. It presents as a solitary, slow-progressing, non-tender mass. Rarely, it can present as multiple discrete masses. Radiological findings include soft tissue mass with foci of fine or coarse calcifications. Computed tomography (CT) is the modality of choice for visualization of calcification while magnetic resonance imaging (MRI) is useful to know the extent of the lesion pre-operatively [4]. MRI features of CAF are poorly defined subcutaneous mass and low to intermediate intensity on T1 weighed images due to fibrous component and calcification. The intensity varies on T2 weighed images [3]. However, the radiological findings can sometimes be non-specific. A definite diagnosis of the lesion can be made on histopathology [4]. Macroscopically, the tumor may range from 1 to 5 cm in diameter [6]. Histopathologically, calcified aponeurotic fibroma is characterized by proliferation of fibroblastic cells in a diffuse or nodular pattern along with foci of calcification and chondroid areas and absence of mitosis [1, 6]. Osteoclast-like giant cells may also be seen in varying proportion [6]. The lesion may also infiltrate the surrounding adipose tissue. Some lesions may also show fibromatosis-like areas. The tumor has a biphasic development comprising of initial and late phase. In the initial phase, the tumor lacks calcification and has more infiltrative growth while in the late phase, it is nodular and calcified and chondroid lesions are more common, therefore, indicating that cartilaginous component increases with the evolution of disease [1, 5]. The current entity should be differentiated with other soft tissue neoplasms like infantile fibromatosis, plantar fibromatosis, fibrous hamartoma of infancy, fibroma and monophasic synovial sarcoma [1, 4] (Table 2). On immunohistochemistry, calcified aponeurotic fibroma shows positivity for CD99, CD68, vimentin and S100 protein [6]. The fibroblasts show positivity for SMA and are negative for beta catenin [6]. The FN1-EGF fusion appears to be the main driver of mutation in CAF [3]. It has not been observed in any other neoplasm, so appears to be a characteristic of CAF [3]. The treatment is complete surgical excision and close follow-up as it has a high tendency to recur [1, 4]. The recurrence rate has been found to be approximately 50% [5]. The local recurrence is more common in children < 5 years old [7]. Rarely, malignant transformation of the lesion has also been reported [7, 56].

Table 2.

Differential diagnosis of calcifying aponeurotic fibroma on histopathology

Entity– >  Calcifying aponeurotic fibroma Fibrous hamartoma of infancy Infantile fibromatosis/lipofibromatosis Palmar and plantar fibromatoses Monophasic fibrous type synovial sarcoma
Age 2 years–adults Birth–2 years Birth–8 years Adults (60 years) 6–82 years
Sex M > F M > F M > F M > F M > F
Site Distal extremities (hands and feet), trunk, ankles, arms, legs Axillary folds, upper arm, thigh, inguinal and pubic region, etc Extremities, trunk, head and neck Palms and plantar aspect of foot Extremities–knee region being the most common
Regression May be present in early stages Not identified Not identified Not identified Not identified
Recurrence Present (50% cases) Present (16% cases) Present Present (rates vary significantly) Present
Clinical features Solitary, poorly circumscribed firm slowly progressing mass Small rapidly growing mobile mass in subcutis or reticular dermis Solitary, poorly circumscribed firm rapidly growing mass Solitary slow growing firm nodule Palpable deep-seated tender swelling
Microscopic findings Proliferation of fibroblastic cells in a diffuse or nodular pattern and absence of mitosis Organoid pattern comprised of interlacing fibrous tissue, islands of loosely arranged spindle shaped cells and mature adipose tissue Proliferation of primitive mesenchymal cells and fibroblasts in a myxoid background and residual muscle fibres and fat Fascicles of slender fibroblasts separated by variable amount of collagen. Multinucleated giant cells are present. Mitotic figures may be identified Proliferation of spindle cells (sarcomatous component) or rarely epithelial glandular component
Calcification and chondroid differentiation Present Absent Absent Absent Present
Open in a new tab

Author Contribution

Dr. AJ took part in evaluation of the case and manuscript drafting. Dr. GK was involved in final evaluation of the case, manuscript drafting and editing and revision. Dr. RS was involved in the management of the patient. Dr. MKR was involved in the final evaluation of the case.

Funding

None.

Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declarations

Conflict of Interest

The authors declare no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Choi JH, Seo JS, Cho KH. Calcifying aponeurotic fibroma: a case report. Yeungnam Univ J Med. 2003;20(2):223–228. doi: 10.12701/yujm.2003.20.2.223. [DOI] [Google Scholar]
  • 2.Keasbey LE. Juvenile aponeurotic fibroma (calcifying fibroma); a distinctive tumor arising in the palms and soles of young children. Cancer. 1953;6(2):338–46. doi: 10.1002/1097-0142(195303)6:2&#x0003c;338::AID-CNCR2820060218&#x0003e;3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]
  • 3.Sanmiguel J, Diaz PS, Marsico S, Trull JL, López AS. Calcifying aponeurotic fibroma: a multimodal imaging description of an unusual case involving soft tissues adjacent to the clavicle. Radiol Case Rep. 2022;17(5):1424–1430. doi: 10.1016/j.radcr.2022.02.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.MusabHamoud A, Yasser Nasser A, Najd AA. Calcifying aponeurotic fibroma around Achilles tendon: a case report. Radiol Case Rep. 2020;15(6):753–756. doi: 10.1016/j.radcr.2020.03.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Kim OH, Kim YM. Calcifying aponeurotic fibroma: case report with radiographic and MR features. Korean J Radiol. 2014;15(1):134–9. doi: 10.3348/kjr.2014.15.1.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Bajaj A. The concrete paltriness-calcifying fibrous tumour. Clin Surg. 2020;3(5):1–4. [Google Scholar]
  • 7.Chalatsis GP, Mitrousias V, Siouras A, Aggelis F, Rigopoulos N, Papachristou DJ, Malizos KN. Calcifying aponeurotic fibroma at the sole of the foot in a 5 year old girl. A case report with 5 years follow up. Foot Ankle Surg: Tech Rep Cases. 2022;2(2):100180. [Google Scholar]
  • 8.Won SH, Kim J, Cho J, Chun DI, Kim K, Yi Y. Calcifying aponeurotic fibroma around posterior tibialis tendon in an elderly patient with flatfoot: a case report. Medicine. 2021;100(30):e26803. doi: 10.1097/MD.0000000000026803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Lee JK, Kwon YW, Shim JC, Kang YK, Cho WM, Park JW, Han SH. Similar appearance of different multifocal carpal bone destructing disease entities in 3 patients: a case report. Medicine. 2021;100(28):e26445. doi: 10.1097/MD.0000000000026445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Gallagher M, Cooper L, Ibanez MJ. Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape. BMJ Case Rep. 2021;14(1):e238418. doi: 10.1136/bcr-2020-238418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Sadiq M, Nayeemuddin M, Hussain MW. A case of large calcifying fibroma of tendo-achilles managed by en-block resection and tendon reconstruction. J Foot Ankle Surg. 2021;60(1):167–171. doi: 10.1053/j.jfas.2020.05.018. [DOI] [PubMed] [Google Scholar]
  • 12.Kang JH, Lee K, Yoo HJ, Chae HD, Hong SH, Choi JY. Ultrasound and magnetic resonance imaging features of calcifying aponeurotic fibromas. J Ultrasound Med. 2020;39(7):1299–1306. doi: 10.1002/jum.15222. [DOI] [PubMed] [Google Scholar]
  • 13.Zhang L, Kobayashi H, Ikegami M, Ohki T, Shinoda Y, Tanaka S, Kawano H. Calcifying aponeurotic fibroma of the thigh: a differential diagnosis for infant knee contracture and leg length inequality (a case report) Int J Surg Case Rep. 2020;69:96–100. doi: 10.1016/j.ijscr.2020.03.039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Garcia Navas FM, Fernandez N, Lopez A, Montero P. Calcifying aponeurotic fibroma of the sole of the foot in an elderly patient. Foot (Edinb) 2019;40:64–67. doi: 10.1016/j.foot.2019.04.006. [DOI] [PubMed] [Google Scholar]
  • 15.Ozcanli H, Ozaksar K, Cavit A, Gurer EI, Cevikol C, Ada S. Deep palmar tumorous conditions of the hand. J Orthop Surg. 2019;27(2):2309499019840736. doi: 10.1177/2309499019840736. [DOI] [PubMed] [Google Scholar]
  • 16.Motta F, Scavo S, Vecchio GM, Fuccio-Sanzà G, Nicolosi F, Magro G. Calcifying aponeurotic fibroma: a core biopsy-based diagnosis. Pathologica. 2018;110(4):307–312. [PubMed] [Google Scholar]
  • 17.Lee SM, Ha DH, Kang H, Rho JY. Intraarticular calcifying aponeurotic fibroma of the wrist: mimicking gout or calcium pyrophosphate dihydrate deposition disease. Skeletal Radiol. 2018;47(5):729–734. doi: 10.1007/s00256-017-2847-7. [DOI] [PubMed] [Google Scholar]
  • 18.Chaltsev BD, Vasilyev VI, Pavlovskaya AI, Palshina SG, Nikonorova NO. Multiple calcifying aponeurotic fibroma: case report and review of the literature. Ter Arkh. 2018;90(4):91–95. doi: 10.26442/terarkh201890491-95. [DOI] [PubMed] [Google Scholar]
  • 19.Sheikh RN, Karlic K. Calcifying aponeurotic fibroma of the hallux a case report. J Am Podiatr Med Assoc. 2018;108(1):68–73. doi: 10.7547/16-138. [DOI] [PubMed] [Google Scholar]
  • 20.Romano N, Fischetti A, Mussetto I, Bianchi R, Muda A. Masson’s tumor and calcifying aponeurotic fibroma: two rare softtissue lesions in the same finger. High-resolution ultrasound features with histopathological correlations. Med Ultrason. 2017;19(4):457–461. doi: 10.11152/mu-1251. [DOI] [PubMed] [Google Scholar]
  • 21.Corominas L, Sanpera I, Jr, Sanpera-Iglesias J, Ramos-Ansesio RF. Calcifying aponeurotic fibroma in children: our experience and a literature review. J Pediatr Orthop B. 2017;26(6):560–564. doi: 10.1097/BPB.0000000000000335. [DOI] [PubMed] [Google Scholar]
  • 22.Sekiguchi T, Nakagawa M, Miwa S, Shiba A, Ozawa Y, Shimohira M, Sakurai K, Shibamoto Y. Calcifying aponeurotic fibroma in a girl: MRI findings and their chronological changes. Radiol Case Rep. 2017;12(3):620–623. doi: 10.1016/j.radcr.2017.04.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Lee SH, Lee IS, Song YS, Choi KU, Kim JI, Song JW. Calcifying aponeurotic fibroma of the knee: a case report with radiographic and MRI finding. Invest Magn Resonance Imaging. 2017;21(4):259–263. doi: 10.13104/imri.2017.21.4.259. [DOI] [Google Scholar]
  • 24.Shim SW, Kang BS, Lee CC, Suh JH, Shim HS. MRI features of calcifying aponeurotic fibroma in the upper arm: a case report and review of the literature. Skeletal Radiol. 2016;45(8):1139–1143. doi: 10.1007/s00256-016-2412-9. [DOI] [PubMed] [Google Scholar]
  • 25.Khullar G, De D, Tripathy S, Prakash M, Saikia UN, Handa S. Painful calcifying aponeurotic fibroma. Indian J Dermatol Venereol Leprol. 2016;82(4):449–52. doi: 10.4103/0378-6323.181503. [DOI] [PubMed] [Google Scholar]
  • 26.Cho YH, Ahn KS, Kang CH, Kim CH. Calcifying aponeurotic fibroma of the dorsum of the foot: radiographic and magnetic resonance imaging findings in a four-year-old boy. Iran J Radiol. 2015;12(2):e23911. doi: 10.5812/iranjradiol.23911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Nishio J, Inamitsu H, Iwasaki H, Hayashi H, Naito M. Calcifying aponeurotic fibroma of the finger in an elderly patient: CT and MRI findings with pathologic correlation. Exp Ther Med. 2014;8(3):841–843. doi: 10.3892/etm.2014.1838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Schonauer F, Avvedimento S, Molea G. Calcifying aponeurotic fibroma of the distal phalanx. J Plast Reconstr Aesthet Surg. 2013;66(2):e47–e49. doi: 10.1016/j.bjps.2012.11.004. [DOI] [PubMed] [Google Scholar]
  • 29.Thakur JS, Diwana VK, Sharma S, Thakur A. Calcifying (juvenile) aponeurotic fibroma of the scalp. Ear Nose Throat J. 2011;90(10):E14–E16. doi: 10.1177/014556131109001019. [DOI] [PubMed] [Google Scholar]
  • 30.Takaku M, Hashimoto I, Nakanishi H, Kurashiki T. Calcifying aponeurotic fibroma of the elbow: a case report. J Med Invest. 2011;58(1–2):159–162. doi: 10.2152/jmi.58.159. [DOI] [PubMed] [Google Scholar]
  • 31.Giuffre JL, Kovachevich R, Bishop AT, Shin AY. Recurrent calcifying aponeurotic fibroma of the thumb: case report. J Hand Surg Am. 2011;36(1):110–115. doi: 10.1016/j.jhsa.2010.09.004. [DOI] [PubMed] [Google Scholar]
  • 32.Kramer JM, Doscher JC, Ruvinsky M, Fantasia JE. Calcifying aponeurotic fibroma with bone islands exhibiting hematopoiesis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(6):878–882. doi: 10.1016/j.tripleo.2010.01.020. [DOI] [PubMed] [Google Scholar]
  • 33.Arora S, Sabat D, Arora SK, Kumar V, Saran RK. Giant intramuscular calcifying aponeurotic fibroma of gluteus maximus: case report. Ann Trop Paediatr. 2010;30(3):259–263. doi: 10.1179/146532810X12786388978922. [DOI] [PubMed] [Google Scholar]
  • 34.DeComas AM, Heinrich SD, Craver R. Infantile fibrosarcoma successfully treated with chemotherapy, with occurrence of calcifying aponeurotic fibroma and pleomorphic/spindled celled lipoma at the site 12 years later. J Pediatr Hematol Oncol. 2009;31(6):448–452. doi: 10.1097/MPH.0b013e3181a1c0c4. [DOI] [PubMed] [Google Scholar]
  • 35.Yura S, Terahata S, Ohga N, Ooi K. A case of calcifying aponeurotic fibroma arising in the medial pterygoid muscle. J Oral Maxillofac Surg. 2008;66(2):359–361. doi: 10.1016/j.joms.2006.10.032. [DOI] [PubMed] [Google Scholar]
  • 36.Choi SJ, Ahn JH, Kang G, Lee JH, Park MS, Ryu DS, Jung SM. Calcifying aponeurotic fibroma with osseous involvement of the finger: a case report with radiologic and US findings. Korean J Radiol. 2008;9(1):91–3. doi: 10.3348/kjr.2008.9.1.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Oruç M, Uysal A, Kankaya Y, Yildiz K, Aslan G, Sengül D. A case of calcifying aponeurotic fibroma of the scalp: case report and review of the literature. Dermatol Surg. 2007;33(11):1380–1383. doi: 10.1111/j.1524-4725.2007.33296.x. [DOI] [PubMed] [Google Scholar]
  • 38.Kim DH, Hwang M, Lee JI, Park JW. Acute median-nerve compression caused by calcifying aponeurotic fibroma. Am J Phys Med Rehabil. 2006;85(12):1017–1018. doi: 10.1097/01.phm.0000247781.86876.3e. [DOI] [PubMed] [Google Scholar]
  • 39.Parker WL, Beckenbaugh RR, Amrami KK. Calcifying aponeurotic fibroma of the hand: radiologic differentiation from giant cell tumors of the tendon sheath. J Hand Surg Am. 2006;31(6):1024–8. doi: 10.1016/j.jhsa.2006.04.011. [DOI] [PubMed] [Google Scholar]
  • 40.Hasegawa HK, Park S, Hamazaki M. Calcifying aponeurotic fibroma of the knee: a case report with radiological findings. J Dermatol. 2006;33(3):169–173. doi: 10.1111/j.1346-8138.2006.00039.x. [DOI] [PubMed] [Google Scholar]
  • 41.Kwak HS, Lee SY, Kim JR, Lee KB. MR imaging of calcifying aponeurotic fibroma of the thigh. Pediatr Radiol. 2004;34(5):438–440. doi: 10.1007/s00247-003-1110-7. [DOI] [PubMed] [Google Scholar]
  • 42.Sethi S, Mishra K, Rajni, Calcifying aponeurotic fibroma: a case report and review of literature. Indian J Pathol Microbiol. 2003;46(2):223–6. [PubMed] [Google Scholar]
  • 43.Amaravati R. Rare malignant transformation of a calcifying aponeurotic fibroma. J Bone Joint Surg Am. 2002;84(10):1889. doi: 10.2106/00004623-200210000-00024. [DOI] [PubMed] [Google Scholar]
  • 44.Sferopoulos NK, Kotakidou R. Calcifying aponeurotic fibroma: a report of three cases. Acta Orthop Belg. 2001;67(4):412–416. [PubMed] [Google Scholar]
  • 45.Tai LH, Johnston JO, Klein HZ, Rowland J, Sudilovsky D. Calcifying aponeurotic fibroma features seen on fine-needle aspiration biopsy: case report and brief review of the literature. Diagn Cytopathol. 2001;24(5):336–339. doi: 10.1002/dc.1072. [DOI] [PubMed] [Google Scholar]
  • 46.DeSimone RS, Zielinski CJ. Calcifying aponeurotic fibroma of the hand. a case report. J Bone Joint Surg Am. 2001;83(4):586–8. doi: 10.2106/00004623-200104000-00016. [DOI] [PubMed] [Google Scholar]
  • 47.Lim TG, Park JH, Kim YK, Choi GS. A case of calcifying aponeurotic fibroma. Korean J Dermatol. 2001;39(8):930–932. [Google Scholar]
  • 48.Fetsch JF, Miettinen M. Calcifying aponeurotic fibroma: a clinicopathologic study of 22 cases arising in uncommon sites. Hum Pathol. 1998;29(12):1504–1510. doi: 10.1016/S0046-8177(98)90022-3. [DOI] [PubMed] [Google Scholar]
  • 49.Sharma R, Punia RS, Sharma A, Marwah N. Juvenile (calcifying) aponeurotic fibroma of the neck. Pediatr Surg Int. 1998;13(4):295–296. doi: 10.1007/s003830050322. [DOI] [PubMed] [Google Scholar]
  • 50.Murphy BA, Kilpatrick SE, Panella MJ, White WL. Extra-acral calcifying aponeurotic fibroma: a distinctive case with 23-year follow-up. J Cutan Pathol. 1996;23(4):369–372. doi: 10.1111/j.1600-0560.1996.tb01312.x. [DOI] [PubMed] [Google Scholar]
  • 51.Lu FH, Tzen CY, Chen BF, Chang PY. Calcifying aponeurotic fibroma: a report of three cases. Zhonghua Yi Xue Za Zhi (Taipei) 1995;56(2):139–142. [PubMed] [Google Scholar]
  • 52.Hassel B. Calcifying aponeurotic fibroma. A case of multiple primary tumours. Case report. Scand J Plast Reconstr Surg Hand Surg. 1992;26(1):115–6. doi: 10.3109/02844319209035195. [DOI] [PubMed] [Google Scholar]
  • 53.Kang JS, Kim TH, Park KB (1992) A case of calcifying aponeurotic fibroma. Korean J Dermatol 30:253–7
  • 54.Yee DY, Mott RC, Nixon BP. Calcifying aponeurotic fibroma. J Foot Surg. 1991;30(3):279–83. [PubMed] [Google Scholar]
  • 55.Rangwala AF, Bateyko R, Sacco M, Arvanitis C. Calcifying aponeurotic fibroma. N J Med. 1988;85(9):729–730. [PubMed] [Google Scholar]
  • 56.Lafferty KA, Nelson EL, Demuth RJ, Miller SH, Harrison MW. Juvenile aponeurotic fibroma with disseminated fibrosarcoma. J Hand Surg Am. 1986;11(5):737–740. doi: 10.1016/S0363-5023(86)80024-7. [DOI] [PubMed] [Google Scholar]
  • 57.Eisenbaum SL, Eversmann WW., Jr Juvenile aponeurotic fibroma of the hand. J Hand Surg Am. 1985;10(5):622–625. doi: 10.1016/S0363-5023(85)80196-9. [DOI] [PubMed] [Google Scholar]
  • 58.Aprin H, Schwartz G, Lipper S. Juvenile nodular aponeurotic fibroma in the area of the knee joint. Clin Orthop Relat Res. 1984;190:257–259. doi: 10.1097/00003086-198411000-00045. [DOI] [PubMed] [Google Scholar]
  • 59.Allen PW, Enzinger FM. Juvenile aponeurotic fibroma. Cancer. 1970;26(4):857–867. doi: 10.1002/1097-0142(197010)26:4&#x0003c;857::AID-CNCR2820260420&#x0003e;3.0.CO;2-S. [DOI] [PubMed] [Google Scholar]
  • 60.Goldman RL. The cartilage analogue of fibromatosis (aponeurotic fibroma). Further observations based on 7 new cases. Cancer. 1970;26(6):1325–31. doi: 10.1002/1097-0142(197012)26:6&#x0003c;1325::AID-CNCR2820260620&#x0003e;3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Articles from Indian Journal of Surgical Oncology are provided here courtesy of Springer

RESOURCES