Overview
Palmar/plantar type fibromatosis, also known as plantar or palmar fibromatosis, refers to benign fibroblastic proliferations typically affecting the palms and soles, often characterized by nodules that can be locally aggressive but do not metastasize. 123Diagnosis
Histological Examination: Essential for definitive diagnosis, showing characteristic fibroblastic proliferation. 3
Immunohistochemistry: Use of non-phospho β-catenin staining may aid in assessing aggressiveness and could be a prognostic marker. 1
Genetic Testing: CTNNB1 mutation analysis can be considered, especially in familial cases, to identify underlying genetic alterations. 1Management
COX-2 Inhibitors: Meloxicam or celecoxib as first-line pharmacological treatment, with efficacy evaluated using RECIST criteria. 1
Surgical Intervention: Indicated for symptomatic relief or when lesions are causing significant functional impairment, though recurrence rates can be high. 3
Observation: May be appropriate for asymptomatic or minimally symptomatic cases, especially in pediatric populations where growth and development are considerations. 2Special Populations
Familial Cases: Recognize hereditary predisposition, as evidenced by familial clustering, which may influence management strategies. 2
Pediatrics: Specific considerations for growth and development; observation might be preferred unless symptoms are severe. 2Key Recommendations
Utilize non-phospho β-catenin immunohistochemical staining to assess the aggressiveness of palmar/plantar fibromatosis lesions for both diagnostic and prognostic purposes. (Evidence: Moderate) 1
Consider COX-2 inhibitors (meloxicam or celecoxib) as first-line pharmacological therapy, evaluating response with RECIST criteria. (Evidence: Moderate) 1
Acknowledge hereditary factors in familial cases, potentially guiding more aggressive monitoring or intervention strategies. (Evidence: Weak) 2References
1 Sakai T, Nishida Y, Hamada S, Koike H, Ikuta K, Ota T et al.. Immunohistochemical staining with non-phospho β-catenin as a diagnostic and prognostic tool of COX-2 inhibitor therapy for patients with extra-peritoneal desmoid-type fibromatosis. Diagnostic pathology 2017. link
2 Chen KT, Van Dyne TA. Familial plantar fibromatosis. Journal of surgical oncology 1985. link
3 Jaworek TE. A histologic analysis of plantar fibromatosis. The Journal of foot surgery 1976. link