Pathomorphological characteristics of Dupuytren's contracture in a patient with liver disease (case report)

Abstract

Objective To detect pathomorphological characteristics of the palmar aponeurosis in Dupuytren’s contracture in patients with liver disease. Material and methods The review included a medical record and histological findings of surgical specimen of a 60-year-old patient who underwent surgeries for Dupuytren’s contracture in 2016 and 2019 first on the right and then on the left side. Micropreparations of palmar aponeurosis stained with hematoxylin and eosin, Masson’s trichrome, using van Gieson and Hart methods were examined with light microscopy. Results Typical lamellar pattern in thickened pretendinous cord of the palmar aponeurosis was observed in surgical specimen of 2016 with flexion contracture at the metacarpophalangeal joints in IV–V digits of the right hand that developed 4 years after the first clinical signs of the palmar fascial fibromatosis. In 2019 the patient developed grade III–IV Dupuytren’s contracture at the metacarpophalangeal joints and the proximal interphalangeal joints in IV–V digits of the left hand. Active proliferative areas were observed in central parts of tendon resembling bands of digital fasciae with signs of fibrocartilaginous metaplasia and lipomatosis seen in the surgical specimen. Collagen fiber bundles were shown to intensively develop de novo at the periphery of the cords. Discussion Fibrocartilaginous metaplasia of dense Dupuytren’s connective tissue was described in single publications, and this is the first report on lipomatosis and collagen fiber bundles developed de novo. Conclusion Specific features of pathomorphology of fascial fibromatosis were likely to be associated with chronic hepatitis of unknown etiology.

Keywords

• dupuytren’s contracture
• histological examination
• fibrocartilaginous metaplasia
• lipomatosis
• chronic hepatitis