Fibro-osseous pseudotumor of the digit: Case report and surgical experience with extensive digital lesion abutting on neurovascular bundles

• Published in: Annals of medicine and surgery 2018-11, Vol.35, p.158-162
• Main Authors: Jawadi, Tariq, AlShomer, Feras, Al-Motairi, Muhammed, Al-Qahtani, Abdullah, Alfowzan, Mohammad, Almeshal, Obaid
• Format: Article
• Language: English
• Subjects: Case Report; Fibro-osseous; Hand; Myositis ossificans; Pseudotumor; Pyogenic granuloma
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2018.09.034

Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue characterized by fibroblastic proliferation and osteoid formation. Herein, we present a case of massive FOPD lesion in the base of ring finger with extensive involvement of the neurovascular bundles with challenging surgical approach. A 27-year old female patient, presented with 7-months history of a progressively enlarging mass on her left hand. Upon assessment, the mass was located over the proximal phalanx of the left ring finger with extensive involvement of the 4th web space. Her neurovascular examination was normal. Radiological investigations showed partial involvement of the radial sided bundle together with complete involvement of the ulnar sided neurovascular bundle. The patient was bothered by the mass being painful with overlying skin ulceration. She was taken afterwards to the operating room where the mass was dissected freely from those bundles while preserving the radial and ulnar structures. The resected margins were however, positive for residual lesions due to the extensive nature of the mass. The patient was informed about the need for close follow-ups for both clinical and radiological signs of lesion recurrence pending early surgical intervention. FOPD although benign, a soft tissue osteosarcoma is one of the differential diagnosis. Meticulous attention to the clinical, pathological and histological features of FOPD is required. Early diagnosis and treatment of FOPD is very crucial in optimizing the overall outcome. Pre-operative planning with various radiological modalities was of great help anticipating the surgical course. •Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue.•The differential diagnosis includes: myositis ossificans, extraskeletal osteosarcoma, parosteal osteosarcoma.•Meticulous pre-operative planning is of great importance to optimize patient outcome.•Fibro-osseous pseudotumor (FOPD) although benign, complete excision assure lack of recurrence.•Meticulous histological assessment for any features of malignancy assure proper patient outcome.