ATYPICAL DECUBITAL FIBROPLASIA - A SERIES OF 3 CASES

We report three cases of atypical decubital fibroplasia (ADF), a benig n, reactive pathologic process that develops in the skin and subcutane ous tissue of immobilized or debilitated patients. Two patients were i mmobilized, one wheelchair bound, and one bedridden. The third patient frequently lay over the affected area. Two were male, one female, age s 49, 66, and 89 (mean 68 years old). Each patient presented with a su bcutaneous mass, one with focal surface ulceration, present for 5 mont hs, 6 months, and 12 months (mean 7.7 months). The locations included back, lateral thigh (over greater trochanter), and lateral chest wall. No other lesions were present, and none had recurrences. Histological ly, atypical decubital fibroplasia is characterized principally by der mal and subcutaneous tissue involvement with fibrinoid necrosis, react ive fibrosis, and focal myxoid change with surrounding more cellular z ones of prominent reactive neovascularization including granulation ti ssue and ectatic vessels with reactive atypical fibroblasts and fat ne crosis. Other findings include hyalinization of vessel walls, fibrin t hrombi, red blood cell extravasation, hemosiderin deposition, and acut e and chronic inflammation. Although the changes are predominantly dee p, involving the dermis, subcutaneous tissue and skeletal muscle, the overlying epidermis may ulcerate. Recognition of atypical decubital fi broplasia is of paramount importance, for it may be misinterpreted as a sarcoma, both clinically and histologically.