Precalcaneal congenital fibrolipomatous hamartoma: a case report

¹Department of Dermatology, Faculty of Medicine and Pharmacy, University Ibn Zohr, Agadir, Morocco, ²Department of Radiology, Faculty of Medicine and Pharmacy, University Ibn Zohr, Agadir, Morocco

^&Corresponding author
Radia Chakiri, Department of Dermatology, Faculty of Medicine and Pharmacy, University Ibn Zohr, Agadir, Morocco

Introduction    

Precalcaneal congenital fibrolipomatous hamrtoma (PCFH) is benign congenital affection, for which we find many synonyms in the literature: congenital piezogenic like papules, infantile pedal, papules, congenital adipose plantar nodules and plantar nodules [1,2]. Generally PCFH is presented as symmetric, painless and flesh-colored nodules on the heels of infant [3]. We present a case of 6-month old girl infant with skin colored nodules on precalcaneal region of both heels.

Patient and observation     

A 6 month-old girl was born with symmetric asymptomatic lesions in the plantar region. Within the family no other members were affected by the same lesions. The dermatological examination revealed one lesion in each of two feet, they were skin colored, soft, completely painless, symmetrical nodular lesions and covered with normal epidermis. The individual lesion was 2 x 2cm in diameter freely mobile with normal overlying skin (Figure 1). Ultrasound examination revealed a well-defined echogenic lesions with no increase in vascularity (Figure 2). Based on the clinical presentation with typical location and the ultrasound characteristics, a diagnosis of PCFH was made. Parents were reassured regarding the benign nature of the condition.

Discussion     

Precalcaneal congenital fibrolipomatous hamartoma was initially described as “pedal papules of newborn” in 1990 by Larralde et al. [1]. In 1996 the term of precalacneal congenital fibromatous hamartoma was given by Larregue et al. [4]. In the literature other names have been given to this condition, including bilateral adipose plantar nodules, congenital fatty heels pads, podalic papules, benign anteromedial plantar nodules and congenital piezogenic like papules [5,6]. Recently Rodriguez Bandera et al. had proposed the term “fibrolipomatous hamartoma of the skin”, for this condition, as it is more inclusive and less confusing [7]. Other location has been described, mandibular, nasal and retrocalcaneal [7]. We have chose the term “PCFH”, because it described well our case. Clinically, there is only one lesion on each of the two feet. It is a bilateral precalcaneal nodule with 0.5 to 1cm in diameter on average, soft and mobile. These lesions are completely painless, symmetrical, covered with a normal colored epidermis [8]. Their growth is proportional to that of the child, and their presence has no impact on the learning of walking [8]. Ultrasound examination of a PCFH reveals a homogeneous mass that shows similar echogenicity as subcutaneous tissue [9]. Biopsies are rarely indicated as the diagnosis is made clinically. If, however the biopsy was done, the histology shows mature adipose tissue surrounded by collagen fibers of different thickness [9,10]. The pathogenesis of PCFH still unclear. Several hypothesis have been proposed. The first hypothesis suggests that PCFH is associated with a development alteration [1]. Another hypothesis is that PCFH is caused by fat herniation through defects in the plantar fascia, but these defects have not been observed consistently and the nodules are not reducible [6]. A third hypothesis proposes that PCFH is due to an underlying genetic mechanism caused by autosomal dominant or X-linked inheritance [11]. Thus, more studies are needed to determine the pathogenesis of this condition. The reassurance is the treatment of choice, given that the nodules in most cases are asymptomatic and don´t cause discomfort [10].

Conclusion     

Precalcaneaal congenital fibrolipomatus Hamartoma is benign condition under reported in the literature due to lack of familiarity among clinicians. it is important to know it to reassure anxious parents and avoid unnecessary surgical treatment. Further studies are needed to better understand the PCFH mechanism.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All the authors have read and agreed to the final manuscript.

Figures     

Figure 1: soft skin-colored nodules on the two heels

Figure 2: ultrasound image showing a well-defined echogenic lesion

References