Hilal SUSAM-ŞEN, Berna OĞUZ, Bilgehan YALÇIN, Zuhal AKÇÖREN, Canan AKYÜZ, Duygu DEMİRTAŞ-GÜNER

Fibrous hamartoma of infancy: A case report with typical ultrasonographic findings

Demirtaş-Güner D, Susam-Şen H, Akçören Z, Yalçın B, Oğuz B, Akyüz C. Fibrous hamartoma of infancy: A rare cause of axillary masses in children. Turk J Pediatr 2016; 58: 683-686.Fibrous hamartoma of infancy (FHI) is a rare, benign lesion which is commonly seen under two years of age. Clinical and radiological features of FHI can mimic malignant soft tissue sarcomas, it is important to make differential diagnosis. Ultrasound (US) examination reveals heterogeneous echogenicity that can be also suggestive for other soft tissue tumors but newly defined “serpentine pattern” of intervening hypoechoic portions in the hyperechoic mass with poorly defined margins and with poor vascularity is special for FHI. Here we report a 15-month-old-boy with FHI with serpentine pattern on US. He initially presented with a painless mass in his left axilla existing for approximately seven months. The mass was successfully excised and he has been followed for three years without any evidence of recurrence. Fibrous hamartoma of infancy should always be considered in differential diagnosis in children under two years of age with a firm and solitary mass in the axilla especially when US reveals serpentine pattern with poorly defined margins and with poor vascularity. If these clinical and ultrasonographic findings are seen in a child under two years old, surgery can be performed without any additional imaging modalities. Awareness and careful assessment are important in order not to misdiagnose this benign mass for which surgical excision is curative

PDF

___

1. Coffin CM, Dehner LP. Fibroblastic and myofibroblastic tumors in children and adolescents: a clinicopathologic study of 108 examples in 103 patients. Pediatr Pathol 1991; 11: 569-588.
2. Enzinger FM. Fibrous hamartoma of infancy. Cancer 1965; 18: 241-248.
3. Lee S, Choi YH, Cheon JE, Kim MJ, Lee MJ, Koh MJ. Ultrasonographic features of fibrous hamartoma of infancy. Skeletal Radiol 2014; 43: 649-653.
4. Goraya JS, Virdi VS. Bacille Calmette-Guerin lymphadenitis. Postgrad Med J 2002; 78: 327-329.
5. Riordan A, Cole T, Broomfield C. Fifteen-minute consultation: Bacillus Calmette-Guerin abscess and lymphadenitis. Arch Dis Child Educ Pract Ed 2014; 99: 87-89.
6. Venkataraman A, Yusuff M, Liebeschuetz S, Riddell A, Prendergast AJ. Management and outcome of Bacille Calmette-Guerin vaccine adverse reactions. Vaccine 2015; 33: 5470-5474.
7. Turnbull FM, McIntyre PB, Achat HM, et al. National study of adverse reactions after vaccination with Bacille Calmette-Guerin. Clin Infect Dis 2002; 34: 447-453.
8. Wolinsky E. Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up. Clin Infect Dis 1995; 20: 954-963.
9. Tebruegge M, Pantazidou A, MacGregor D, et al. Nontuberculous mycobacterial disease in childrenepidemiology, diagnosis&management at a tertiary center. PLoS One 2016; 11: e0147513.
10. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 367-416.
11. Hashimoto H. Fibrous hamartoma of infancy. In: Fletcher CDM, Unni KK, Mertens F (eds). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Soft Tissue and Bone. Lyon: IARC Press, 2002: 58-59.
12. Reye RD. A consideration of certain subdermal fibromatous tumours of infancy. J Pathol Bacteriol 1956; 72: 149-154.
13. Agrawal L, Bansal R, Singh J, Sharma S. Fibrous hamartoma of infancy in an unusual location- a case report. Gulf J Oncolog 2010; 8: 52-54.
14. Seguier-Lipszyc E, Hermann G, Kaplinski C, Lotan G. Fibrous hamartoma of infancy. J Pediatr Surg 2011; 46: 753-755.
15. Sengar M, Mohta A, Manchanda V, Khurana N. Paratesticular fibrous hamartoma in an infant. Singapore Med J 2012; 53: 63-65.
16. Dickey GE, Sotelo-Avila C. Fibrous hamartoma of infancy: current review. Pediatr Dev Pathol 1999; 2: 236-243.
17. Eich GF, Hoeffel JC, Tschappeler H, Gassner I, Willi UV. Fibrous tumours in children: imaging features of a heterogeneous group of disorders. Pediatr Radiol 1998; 28: 500-509.
18. Miyamoto M, Tsunoda R, Gembun Y, et al. Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery. J Neurosurg Pediatr 2010; 5: 136-139.
19. Carretto E, Dall’Igna P, Alaggio R, et al. Fibrous hamartoma of infancy: an Italian multi-institutional experience. J Am Acad Dermatol 2006; 54: 800-803.
20. Kang G, Suh YL, Han J, Kwon GY, Lee SK, Seo JM. Fibrous hamartoma of infancy: an experience of a single institute. J Korean Surg Soc 2011; 81: 61-65.