Unusual Presentation of Infantile Myofibroma in the Deep Palm of a Child: A Case Report and Discussion of the Differential Diagnosis

Infantile myofibroma or myofibromatosis is a myofibroblastic and fibroblastic proliferation that is most commonly reported in children younger than 2 years of age. It is a benign process composed histologically of a biphasic pattern of spindle-shaped cells surrounding a zone of less differentiated cells in a hemangiopericytoma-like pattern. We report this tumor in a unique presentation in the deep palm of a 2-year-old child without skin ulceration and with an intimate association with the median nerve. The well-circumscribed nature of the tumor facilitated complete excision with neural preservation. Final pathology was consistent with an unusual type of myofibroma or myofibromatosis. Conservative management with partial excision has been advocated for these masses because of potential surgical morbidity and its benign nature. This case report highlights the differential diagnosis of uncommon soft tissue tumors in the pediatric hand as well as the importance of a surgeon's surgical assessment in guiding treatment.