Calcifying aponeurotic fibroma at the sole of the foot in a 5 year old girl. A case report with 5 years follow up

Abstract

Calcifying aponeurotic fibroma (CAF) is a rare, benign fibroblast tumor with a high recurrence rate. It is most frequently diagnosed in children and adolescents. The most prevalent places of appearance are distal parts of the upper and lower extremities. We present a case of a 5 year old girl, with a palpable mass on the plantar aspect of her left foot. No skin defect was detected but discomfort during gait was reported. Plain radiographs didn't show any evidence of bony involvement. Ultrasound of the soft tissue showed a subcutaneous tumor sizing 1.4 × 1.3 × 1.2 cm. Magnetic Resonance Imaging (MRI) scan featured on both T1 and T2 weighted sequences a benign fibrotic tissue with well defined margins. An excision procedure was performed under general anaesthesia. The excised tissue was sent for biopsy and calcifying aponeurotic fibroma was diagnosed. 1 year post op a new MRI scan was performed with no evidence of recurrence. 5 years post op there was no clinical evidence of recurrence. However a subcutaneous painless scar tissue was palpated with no impact on child's everyday living and activities. Nonmalignant fibrosing tumours are clinically challenging because of their rarity. Differential diagnosis includes fibrosarcoma, dermatofibroma and other fibromatosis. Early surgical treatment should be performed to avoid the need for such a wide excision that could result in a vast dead space and scar tissue formation. In our case, excision of the tumor provided definitive treatment with no later impact on the patients quality of life.