Calcifying Aponeurotic Fibroma of the Chest Wall in a 5-Month-Old Infant: A Case Report and Review of the Literature

Case Report

Austin J Pediatr. 2014;1(1): 1002.

Calcifying Aponeurotic Fibroma of the Chest Wall in a 5-Month-Old Infant: A Case Report and Review of the Literature

Minoru Kuroiwa1*, Makoto Suzuki2, Shin-itu Hatakeyama3, Junko Hirato4 and Norio Suzuki2

1Department of Pediatric Surgery, Toho University Ohmori Medical Center, Japan

2Department of Surgery, Gunma University School of Medicine, Japan

3Department of Radiology, Gunma Children’s Medical Center, Japan

4Department of Pathology, Gunma University School of Medicine, Japan

*Corresponding author: Minoru Kuroiwa, Department of Pediatric Surgery, Toho University Ohmori Medical Center, 6-11-1 Omori-nishi Ota-ku, Tokyo 143-8541, Japan

Received: March 20, 2014; Accepted: April 06, 2014; Published: April 08, 2014


A 5–month–old female infant was admitted to hospital because of a slowly growing solid mass in the right side of the chest. The mass was located on the right fifth rib and did not involve the skin. Ultrasound (US) revealed that the mass was echogenic with a central high echogenicity, suggesting calcification. Computed tomography (CT) and magnetic resonance imaging (MRI) showed that the calcifying tumor possibly originated from the periosteum of the rib. The tumor was successfully removed and histological diagnosed as a calcifying aponeurotic fibroma (CAF). The patient is free from the tumor 118 months after the surgery. Usually, a CAF develops in the distal extremities and often recurs following excision. To the best of our knowledge, there are no reports in the English literature of a CAF that originated from the chest wall. Herein, we review pediatric cases of CAF that occurred in uncommon sites such as the head, face, neck, and trunk, and discuss the clinical characteristics and treatment of CAF.

Keywords: Calcifying (juvenile) aponeurotic fibroma; Fibrous hamartoma in infancy.


Calcifying aponeurotic fibroma (CAF) was first described by Keasbey in 1953 [1]. CAF is a slow–growing, painless soft tissue tumor usually located in the distal portion of extremities, especially the upper extremities such as the palms, fingers, and wrists [2], while the head, neck, and trunk are less frequently affected. Surgical removal is the treatment of choice, but CAF has a tendency to recur after surgery and may histologically be confused with fibrous soft tissue tumors. Here, we present a case of CAF originating from the chest wall. To our knowledge, only 14 pediatric cases of CAF originating from uncommon sites such as the face, head, neck, and trunk have been previously reported in the English literature.

Case report

A 5–month–old female infant presented with a painless subcutaneous mass on the right lateral chest wall. She was admitted for surgical excision because the mass showed slow growth. Physical examination revealed a 10–mm, firm, round, non–movable mass on the right fifth rib. On X–ray examination, the tumor was detected as a protrusion of soft tissue with obscure cortex of the rib. Ultrasound (US) showed a solid tumor with internal high echogenicity, suggestive of calcification (Figure 1). A computed tomography (CT) scan revealed scattered high densities with possible cortical involvement of the rib; however, the soft tissue density of the marginal area in the tumor was indicative of a non–osseous origin of the tumor. On magnetic resonance imaging (MRI), the tumor had low signal intensity (SI) on T1–weighted images (T1–WI) and high SI on T2–WIcompared with that of muscle on T2–WI (Figure 2). Based on these imaging findings, the preoperative diagnosis was a fibrous soft tissue tumor with calcification.