Presentation
Fibromas present as hard swellings or lumps that are typically painless. The tumors are well circumscribed and usually immobile.
Associated symptoms depend upon the type of tumor. For example, a fibroma of the oral cavity may also present with dysphagia, slurring of words and impaired speech, etc.
Entire Body System
- Pain
The pain is relieved by rest or weight bearing restriction. [orthopaedicsone.com]
Over-the-counter pain relief OTC non-steroidal anti-inflammatory drugs (NSAIDs) are another option for people with foot pain. [medicalnewstoday.com]
Painful fibromas may be treated with an off-loading insole or pad. Surgery is done for symptomatic fibromas when conservative treatment fails to give adequate pain relief. [legacy.aofas.org]
People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot. [acfas.org]
Over time his pain increased to the point of requiring opioids for pain control and presenting to our hospital. In the interim, he changed his job and decreased his physical activity, neither of which alleviated his pain. [openorthopaedicsjournal.com]
- Surgical Procedure
During the surgical procedure, we accidentally dissected the surrounding periosteal tissue of the left transport completely in the process of transport disc preparation and made the disc into a free bone graft. [ncbi.nlm.nih.gov]
Often, a minimally invasive biopsy is desirable, prior to commitment to any larger surgical procedure. [my.clevelandclinic.org]
If desired, they can be removed by a simple surgical procedure in which the lump is shaved off. However, many recur after surgery. See smartphone apps to check your skin. [dermnetnz.org]
- Ascites
There was an association between the largest tumor diameter, the presence of ascites and high CA 125 titers (≥35 U/mL): ascites was present in 7% (3/44) of the cases with a largest tumor diameter <9 cm and in 33% (8/24) of the cases with a largest tumor [obgyn.onlinelibrary.wiley.com]
Associations They are associated with ascites in 40% of cases and with pleural effusions in a small percentage of cases. [radiopaedia.org]
They are also sometimes misdiagnosed as malignant ovarian tumors because of accompanying ascites and an increased serum CA-125 level [3]. [bmcsurg.biomedcentral.com]
Ovarian fibroma can be bilateral in 4-8% of patients and multiple in 10% of cases [ 5 ], especially in Gorlin syndrome [ 9, 10 ], or associated with pleural effusion and ascites in Meigs syndrome [ 11 ]. [panafrican-med-journal.com]
- Falling
Once the fibroma gets dry stop using ACV Don’t prick or force the fibroma to fall off, it will fall off on its own when it’s time Source: thehealthawareness.com [organicsolutionsportal.com]
Next, you will see that it will fall off by itself. Depending on the size of the fibroma and how deep it is in the skin, the fibroma may leave a scar after it falls off. To prevent scarring, you can apply marigold ointment or aloe vera gel. [myilifestyle.com]
Leave it to fall out by itself. [womandailytips.com]
(OBQ06.96) A 20-year-old man falls while skiing and complains of knee pain. When he presents to the office 2 weeks later his physical exam is normal and his pain has resolved. Radiographs are shown in Figures A & B. [orthobullets.com]
Our patient had a history of fall, which may have caused damage to the wrist. [journals.lww.com]
- Epilepsy
Pre-Existing Health Conditions – There appears to be a link between diseases including diabetes, epilepsy, and thyroid issues, and an increased likelihood of suffering from plantar fibromas. [houstonfootankle.com]
The disease is more commonly associated with - A family history of the disease[9] Higher incidence in males[7] Palmar fibromatosis 10-65% of the time.[7] Peyronie's disease[8] Epilepsy patients[6] Diabetes mellitus[8] There is also a suspected, although [en.wikipedia.org]
Those with systemic conditions such as epilepsy, alcoholism, liver cirrhosis, hypothyroidism and diabetes mellitus may have an increased incidence of plantar fibromas. Fibromatoses present through different stages of life. [podiatrytoday.com]
Medical Conditions Diabetes, Thyroid problems, Liver disease, Peyronie’s disease and Epilepsy are considered to linked with Ledderhose disease. [paincare.org]
Conditions include: chronic liver disease diabetes epilepsy long-term alcohol abuse There is also an association between plantar fibroma and some medications and supplements including: anti-seizure medications, such as phenytoin beta-blockers for high [medicalnewstoday.com]
Respiratoric
- Pleural Effusion
Associations They are associated with ascites in 40% of cases and with pleural effusions in a small percentage of cases. [radiopaedia.org]
Meigs syndrome is the constellation of ascites, ovarian fibroma and right pleural effusion. [1] Mnemonic FAR : Fibroma. Ascites. Right pleural effusion. References ↑ Novoa Vargas, A.; Tenorio González, F.; Gómez Pedroso, J.; Torres Martínez, A. [librepathology.org]
Differential Diagnosis List Pleural fibroma Intercostal schwannoma Loculated pleural effusion Pleural metastases Pleural lipoma Final Diagnosis Pleural fibroma References [1] Dynes MC, White EM, Fry WA, Ghahremani GG (1992) Imaging manifestations of pleural [eurorad.org]
Ovarian fibroma can be bilateral in 4-8% of patients and multiple in 10% of cases [ 5 ], especially in Gorlin syndrome [ 9, 10 ], or associated with pleural effusion and ascites in Meigs syndrome [ 11 ]. [panafrican-med-journal.com]
- Pleuritic Pain
Pleuritic pain may be due to small hemothorax secondary to spontaneous rupture of the distended veins on the surface of the tumor. Pressure of the tumor and erosion of the ribs may also cause pain. [journal.chestnet.org]
Gastrointestinal
- Abdominal Pain
We hereby present a case of a 30 year old young woman who presented with abdominal pain and secondary infertility. Ultrasound evaluation misdiagnosed it as uterine fibroid. [casereports.in]
The tumors can be asymptomatic but, depending on the size and location of occurrences, can cause various symptoms, including abdominal pain, vaginal bleeding, dyspareunia, or dysuria. [liebertpub.com]
Sometimes, they manifest with abdominal enlargement, urinary symptoms, abdominal pain [ 5 ], and occasionally withtorsion [ 1 ] which is rare in the postmenopausal patient such us our case [ 14, 15 ]. [panafrican-med-journal.com]
Homepage Rare diseases Search Search for a rare disease Ovarian fibroma Disease definition A rare benign ovarian tumor of sex cord / stromal origin characterized by an abdominal mass which may present with abdominal pain, distension, or menorrhagia, among [orpha.net]
If symptoms are present, the most common one is abdominal pain.[1] On gross pathology, they are firm and white or tan. On microscopic examination, there are intersecting bundles of spindle cells producing collagen. [en.wikipedia.org]
Cardiovascular
- Heart Disease
Disease Cuts Both Ways AHA News: Woman's Frozen Face, Garbled Speech During Zoom Call Were Signs of a Stroke View All News > View All News > ABOUT Overview History Editors and the Editorial Process Publishing and Production Staff Editorial Board Contributors [msdmanuals.com]
Skin
- Skin Disease
See smartphone apps to check your skin. [Sponsored content] On DermNet NZ Birthmarks Skin lesions Fibromatosis Other websites Infantile Digital Fibromatosis – Medscape Reference Books about skin diseases See the DermNet NZ bookstore. [dermnetnz.org]
Neurologic
- Seizure
TSC1 and TSC2 are the causative genes, and mental retardation, epileptic seizures, and facial angiofibroma develop in many patients with the disease. [ncbi.nlm.nih.gov]
Other Conditions : Beta-blockers, anti-seizure medications, and certain supplements may contribute to the development of plantar fibromas following trauma to the plantar fascia. [gifootclinic.com]
Case report A 41-year-old woman with no known history of seizures presented to the emergency department after a witnessed fall from standing. The patient had transient loss of consciousness, suffered a seizure and experienced post-ictal amnesia. [academic.oup.com]
Medication Beta-blockers, anti-seizure agents, excess vitamin C supplements, and glucosamine/chondroitin medications can all trigger the formation of plantar fibroma. [upstep.com]
Also, anti-seizure drugs like phenytoin and large doses of supplemental vitamin C can cause the production of excess collagen. Excessive alcohol consumption – Heavy drinking may be a factor in the development of plantar fibromas. [houstonfootankle.com]
Workup
Workup consists of a detailed history and physical examination.
Laboratory Tests
- Complete blood count
- Tumor growth factors
Imaging Studies
- CT scan to see the extent of growth
- Fine needle aspiration
- Biopsy
Test Results
A detailed physical examination along with imaging studies is sufficient to come to a diagnosis.
Pleura
- Pleural Effusion
Associations They are associated with ascites in 40% of cases and with pleural effusions in a small percentage of cases. [radiopaedia.org]
Meigs syndrome is the constellation of ascites, ovarian fibroma and right pleural effusion. [1] Mnemonic FAR : Fibroma. Ascites. Right pleural effusion. References ↑ Novoa Vargas, A.; Tenorio González, F.; Gómez Pedroso, J.; Torres Martínez, A. [librepathology.org]
Differential Diagnosis List Pleural fibroma Intercostal schwannoma Loculated pleural effusion Pleural metastases Pleural lipoma Final Diagnosis Pleural fibroma References [1] Dynes MC, White EM, Fry WA, Ghahremani GG (1992) Imaging manifestations of pleural [eurorad.org]
Ovarian fibroma can be bilateral in 4-8% of patients and multiple in 10% of cases [ 5 ], especially in Gorlin syndrome [ 9, 10 ], or associated with pleural effusion and ascites in Meigs syndrome [ 11 ]. [panafrican-med-journal.com]
Treatment
Treatment depends upon thy subtype of the fibroma. Intralesional curettage and cementation is an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate [9].
Gingival fibromas and plantar fibromas are recommended to be surgically excised. Angiosarcomas are also treated by surgical removal, etc. Aggressive treatment of ameloblastic fibrosarcoma (AFS) including resection with negative margins is the treatment of choice [10].
Prognosis
Fibromas are benign tumors so they have an excellent prognosis. With appropriate treatment, all symptoms can be successfully relieved.
Complications
Complications of fibromas depend on the location and type of tumor. For instance, a gingival fibroma such as POF or giant cell fibroma may obstruct the oral and nasal cavity. Surface ulceration is common [8]. A plantar fibroma may cause chronic heel pain. And like any other benign tumor, there is a chance, no matter how slight, that it may become premalignant or in some extremely rare cases, malignant.
Etiology
Fibromas are majorly idiopathic. Some, however, are drug induced. For example, some fibromas arising in the gingiva can be the result of chronic use of some drugs. Drug induced gingival overgrowth has been associated with systemic use of phenytoin, cyclosporin and calcium channel blockers [2]. Other causes include familial inheritance and benign overgrowth due to irritants.
Epidemiology
Incidence
The exact incidence of fibromas is unknown.
Age
Fibromas can occur at any age. However, they are more common in adults.
Pathophysiology
Fibromas are connective tissue tumors so they can occur anywhere in the body. They arise from the mesenchyme either due to mutation in the cells or due to irritants, such as plaque in the case of oral cavity fibromas. Histologically, they are unencapsulated, hard, nodular masses of hyalinized connective tissue fibres arranged haphazardly.
Types
The following are the most common type of fibromas:
- Oral cavity fibromas
- Angiofibromas
Oral cavity fibromas
Some subtypes of oral cavity fibromas include:
- Peripheral ossifying fibroma
Peripheral ossifying fibroma (POF) is a reactive lesion of the gingival tissues that predominantly affects women and is usually located in the maxilla anterior to the molars [3]. Surgical excision is the treatment of choice.
- Other gingival fibromas
Localised overgrowths of the gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG) [4]. They occur in response to chronic low-grade irritation of the oral mucosa.
Angiofibroma
Soft tissue angiofibroma is a recently described neoplasm that typically presents as a slowly growing, painless mass in the soft tissues of the lower extremities [5]. A t(5;8) translocation has been found associated with it.
Others
- Elastofibroma
Histologically, the elastofibroma consists of collagen fibres and coarse elastic fibres that can be demonstrated by elastin stain [6]. This subtype is fairly uncommon.
- Sclerotic fibroma
This type is an uncommon benign growth occurring most commonly in the skin either singly or it can be multifocal. The tumor cells are CD34 and vimentin positive [7].
Prevention
Summary
Fibromas are benign overgrowths of the connective tissue that occur in response to a mutation in the cells. As they are non cancerous, they do not pose serious health risks and can be surgically removed when needed. Recurrence is possible, however, if the offending irritant persists [1].
Patient Information
Definition
Fibromas are non cancerous overgrowths of connective tissues like bone, soft tissues, skin, blood, etc.
Cause
Fibromas are generally idiopathic. Some, like oral cavity fibromas however, may be due to irritants such as chewing beetle nuts, a common practise in many South Asian countries. Others may be due to drug associated growth, familial inheritance predisposing to the condition and genetic mutations.
Symptoms
Patients generally complain of single or multiple painless swelling, associated with regional (area-wise) symptoms.
Treatment
Treatment is surgical excision of the tumor.
Prevention
Fibromas have no definite preventive measures. However, they can be avoided by safe guarding against external irritants and harmful drugs.
References
- Esmeili T, Lozada-Nur F, Epstein J. Common benign oral soft tissue masses. Dent Clin North Am. Jan 2005;49(1):223-40, x [Medline]
- Dongari-Bagtzoglou A. Drug-associated gingival enlargement. J Periodontol. Oct 2004;75(10):1424-31. [Medline]
- Kale L, Khambete N, Sodhi S, Sonawane S. Peripheral Ossifying Fibroma: series of 5 cases. J Indian Soc Periodontol. 2014 July;18(4):527-30 doi: 10.4103/0972-124X.138762.
- Parwani S, Parwani RN. Diagnosis and management of focal reactive overgrowths of gingival-a case series. H Mich Dent Assoc. 2014 July;96(7):36-47. PMID 25163184 [PubMed]
- Lee JJ, Bredella MA, Springfield DS, Neilson GP. Soft tissue angiofibroma: a case report. Skeletal Radiol 2014 March;43(3):403-7. doi: 10.1007/s00256-013-1742-0 PMID 24113908 [PubMed]
- Lee JH, An JS, Lee ES, Kwon SY, Kim YS. Comparison of sporadic sclerotic fibroma and solitary fibrous tumor in the oral cavity. Yonsei Med J. June 30 2007;48(3):535-9 [Medline].
- Manchandu R, Foote J, Alawi F. Elastofibroma presenting as an oral soft tissue mass. J Oral Pathol Med. Feb 2008;37(2):125-6. [Medline]
- Buchner A, Hansen LS. The histomorphologic spectrum of peripheral ossifying fibroma. Oral Surg Oral Med Oral Pathol. Apr 1987;63(4):452-61
- Bhamra JS, Al-Khateeb H, Dhinsa BS, Gikas PD, Tirabosco T, Pollock RC, Skinner JA, Aston WJ, Saifuddin A, Briggs TW. Chondromyxoid fibroma Management: a single institution experience of 22 cases. World J Surg Oncol. 2014 Sep 12;12(1):283.
- Wang BY. Head and Neck Pathology:SS13-1 Ameloblastic Fibrosarcoma of Mandible. Pathology. 2014 Oct;46 Suppl 2:S18. doi 10.1097/01.PAT.0000454111.11437.36. PMID 25188081.