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A 46 year old Indian woman presented with a 15 year history of painless, nodular swellings over the fingers and wrist of her right hand, which were making daily activities increasingly difficult. An excision biopsy three years before had revealed a calcifying aponeurotic fibroma, but the lesion had recurred. She was otherwise well with no other rheumatological or metabolic disease. Plain radiographs showed well defined, calcified lesions that appeared to erode the adjacent bone (fig 1).
Calcifying aponeurotic fibromata are rare soft tissue tumours, usually present in childhood and typically affect the fingers and palms.1 They are slow growing and painless, and almost never undergo malignant transformation. Histologically, they are characterised by lines of plump fibroblasts, surrounding areas of dense collagenous stroma with focal calcification. Treatment should be conservative, as local recurrence after excision is seen in 50% of cases.
Contributors: ian mccurdie, sli s jawad. Rheumatology Department, The Royal Hospitals NHS Trust, Mile End Hosptial, Bancroft Road, London E1 4DG.