Soft tissue

Fibroblastic / myofibroblastic

Calcifying aponeurotic fibroma

Topic Completed: 1 July 2012

Minor changes: 4 January 2022

Copyright: 2002-2022,, Inc.

PubMed Search: Calcifying aponeurotic fibroma

Komal Arora, M.D.
Page views in 2021: 6,166
Page views in 2022 to date: 252
Cite this page: Arora K. Calcifying aponeurotic fibroma. website. Accessed January 19th, 2022.
Definition / general
  • Rare, slow growing, painless tumor with fibroblasts palisading around chondroid or calcified nodules, usually in hands and feet of children or young adults; rarely at other sites (Hum Pathol 1998;29:1504)
  • Also called juvenile aponeurotic fibroma
Clinical features
  • 50% recur, especially in children
  • Does not metastasize
  • May be cartilaginous analog of fibromatosis
Case reports
  • Conservative excision with reexcision as necessary for recurrences
Clinical images

Images hosted on other servers:

46 year old woman

36 year old woman with distal phalangeal bone involvement

Gross description
  • Nodular or infiltrative gray-white, gritty mass in subcutaneous tissue or tendon, may be calcified, usually 3 cm or less in hands or feet, may be larger elsewhere
Microscopic (histologic) description
  • Nodules of plump or epithelioid fibroblasts palisading around cartilage and spotty calcification
  • Cells have indistinct and variable cytoplasm, plump oval nuclei with vesicular chromatin that may be condensed below nuclear membrane
  • Fibrocytes in stroma between nodules have dense, evenly dispersed chromatin
  • May infiltrate fat or striated muscle at periphery
  • Frequent osteoclast-like giant cells
  • Rare mitotic figures, no atypia
  • More cellular in very young
Microscopic (histologic) images

AFIP images

Poorly circumscribed fibroproliferative

surrounded by
palisading cells

Typical zonation
pattern has
cellular, plump
fibroblastic cells

Cells adjacent to hyalinized layer are commonly more rounded

Chondroid area is adjacent to calcification

Contributed by Mark R. Wick, M.D.


Case #47

16 year old girl with foot tumor

Images hosted on other servers:


Cytology description
Negative stains
Electron microscopy description
  • Chondrocytes, fibroblasts and occasional myofibroblasts
Molecular / cytogenetics description
Differential diagnosis
  • Chondroma of soft parts: may involve hands, but usually well circumscribed with more well developed chondroid differentiation, no infiltration of adjacent tissue, no surrounding epithelioid cells
  • Fibrous hamartoma of infancy: immature mesenchyme, fibroblasts are arranged in trabeculae but no palisading, no cartilage or calcification, not hands and feet
  • Infantile fibromatosis: usually involves head, neck and proximal extremities in infants, not hands and feet of children/young adults, background is more myxoid than chondroid, calcification is rare
  • Superficial [palmar and plantar] and desmoid fibromatosis: usually no calcification or chondroid differentiation
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