The following is a summary of “Management of Fibrous Hamartoma of Infancy: A Contemporary Series,” published in the March 2024 issue of Pediatrics by Smith et al.

Fibrous hamartoma of infancy (FHI) presents a unique challenge due to its rarity and infiltrative nature. It often complicates margin negativity post-primary excision, the gold standard of treatment. This study delves into managing residual disease in cases where positive margins persist after initial excision.

In this retrospective cohort study from 2012 to 2022, researchers analyzed data from nine patients who underwent FHI excision. The median age at excision was 9 months, with a predominance of male patients (78%) and the majority of Caucasian descent (78%). Preoperative imaging, including ultrasound or MRI, was conducted in 78% of cases, and 44% underwent preoperative biopsy for diagnostic confirmation. Common sites of occurrence included the upper extremity (44%) and the lower extremity/inguinal region (44%). Margin positivity was noted in 67% of cases, with 33% in the upper extremity, 22% in the lower extremity/inguinal region, and 11% in the flank. Only one patient (11%) experienced local recurrence, which did not undergo re-excision.

The study underscores the rarity of FHI and the challenge of achieving negative margins upon excision. Despite a high margin positivity rate, clinically significant mass recurrence remains uncommon. Given the benign nature of the disease and low rates of significant mass development, a “watch and wait” approach may be considered for patients with positive histologic margins post-complete gross excision, thereby averting the need for reoperation and complex reconstructions. This insight into FHI management provides valuable guidance for clinicians navigating the complexities of this rare condition.

Source: sciencedirect.com/science/article/abs/pii/S0022346824002045