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Dr. P here.

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Pain on and off for a month in this woman.

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4 00:00:06,529 --> 00:00:07,840 You'd think she would have noticed this

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mass a little bit sooner than that.

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The short axis T2, the short axis fat-weighted

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T1, and then the contrast-enhanced T1.

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I think if you are imaginative,

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you might look at this and say, Well, those

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are the gyri and sulci of a brain.

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So I refer to this as the brain

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sign of a collagenous lesion.

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Now, the brain sign has also been described in the

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spine where you have an expansile plasmacytoma.

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And those two look alike, by the way.

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If you look at the architecture,

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that too looks like gyri and sulci.

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But this brain-like characteristic is very

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typical of collagenous lesions with this very

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complex pattern of hypointensity without.

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So, this is a pathognomonic diagnosis to

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most musculoskeletal radiologists,

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and this is known as plantar fibromatosis,

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so-called Ledderhose's disease.

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Now, it is closely related to other

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fibromatoses. In fact, the incidence of

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having fibromatosis in the other foot

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is somewhere between 25% and 33%

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The incidence of having Dupuytren's contracture of

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one hand or the other is about 33%. So you

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can see there is some systemic predilection,

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most likely a genetic predilection, to this condition.

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Some other fibrosing syndromes, to just talk about

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briefly, Peyronie's disease occurs in the pelvic

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area, juvenile aponeurotic fibroma of children

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would be another very important differential

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diagnosis had this patient been a bit younger.

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Now, plantar fibromatosis,

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or Ledderhose's disease, occurs in adults,

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middle-aged and maybe a little bit older in JAF.

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42 00:01:54,900 --> 00:01:58,440

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This is an aggressive lesion of the hands,

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but also of the feet, hands more than feet.

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Usually males, usually calcifies.

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And this lesion does not calcify.

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The high recurrence of JAF suggests

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the possibility of malignancy.

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Another fibrous lesion, fibromatosis coli.

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We now know that's related to an

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infarct, to a lack of blood supply of

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the heads of the sternocleidomastoid

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and may be a cause of torticollis.

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Then you have the rare

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juvenile hyaline fibromatosis,

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which is heredofamilial.

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Occurs in the first few years of life.

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Multiple subcutaneous lesions.

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It may involve the lower extremities.

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It's also associated with short stature.

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So that wouldn't really apply here.

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You're all familiar with retroperitoneal

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fibrosis that may occur with increased

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frequency in these types of patients,

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but that is essentially a very loose connection.

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Radiation fibromatosis, progressive myositis

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fibrosa, also known as hereditary

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poly-fibromyomatous, or poly-fibromatosis, would be

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another one not to be considered here, but that

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is closely associated with myositis ossificans,

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which we don't have here.

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A very important fibrous tumor for you

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musculoskeletal radiologists that does not

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occur in the foot is elastofibroma dorsi.

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It can occur unilaterally

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but frequently bilaterally.

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It likes the scapula and shoulder.

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They're usually middle-aged

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laborers, weightlifters, athletes.

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It's a friction-induced event.

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And it's more common, in my experience,

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in women than men, by quite a bit.

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Then you've also got the nodular

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fibrotic fasciitis syndromes.

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Nodular fasciitis, something called

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paraosteal fasciitis, when you have

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that nodular fasciitis next to the bone.

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Pseudosarcomatous fasciitis is another name.

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Proliferative fasciitis or myositis.

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And any of these can have rapid growth.

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They're very scary.

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They simulate tumors.

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And in my experience, they really

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like the volar aspect of the forearm.

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So not near the foot.

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Then we get into infantile

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myofibromatosis of infants.

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These are superficial, but involve the viscera

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and bones, not too often in the lower extremity.

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And then the fibrous hematoma of infancy likes the

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axilla less than two years of age, not too big.

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A third are congenital.

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So, this is a pathognomonic diagnosis, plantar

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fibromatosis, Ledderhose's disease, check

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the other foot, check the hands for

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Dupuytren's contracture, and the only other

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really foot-loving fibromatosis

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lesion is gonna be juvenile aponeurotic

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fibroma, which has a propensity to calcify.

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That's a lot.

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Dr. P out.