Painful and rare tumor of the pediatric hand – calcifying aponeurotic fibroma

Abstract

Pediatric hand tumors are rare and the commonest include ganglion cysts and giant cell tumors. Calcifying aponeurotic fibroma (CAF) is a rare, locally aggressive, benign fibroblastic tumor occurring usually in the palms of the hands and soles of the feet in young and adolescents under 20 years of age. Clinically, it presents as a painless palpable mass. Pathologically, it is characterized by fibroblast proliferation with an indistinct border and calcification. This soft tissue tumor typically infiltrates into the surrounding fascia or muscle and has a predilection for local recurrence after surgical excision of around 50%. Only 4 cases of pediatric CAF have been reported from India till date and all of them were painless swellings, at a site other than the hand. We present the first case of painful pediatric CAF of the hand in an 8 year old male patient. Clinical findings and imaging features (X-ray, USG, MRI) are presented. Patient underwent excision biopsy with complete removal of tumor and histopathological features were consistent with CAF. Patient was followed up for a period of 1 year post-resection and showed good function and no recurrence.