Recurrent Fibro-Osseous Pseudotumour of the Digit Mimicking Infection: A Narrative Review and Case Report.

Abstract

Background: Fibro-osseous pseudotumour of the digit (FOPD) is a rare, benign soft-tissue lesion that mimics infection and malignancy due to its rapid growth, pain, and radiological features. Misdiagnosis can result in inappropriate treatment, including unnecessary ablative surgery.

Methods: A narrative literature review was conducted using PubMed and Embase, supplemented by reference screening. Case reports and case series of FOPD involving the digits of the hands or feet were included. Data were synthesised to identify clinical, histopathological, radiological, and management patterns. In addition, we report a recurrent case of FOPD misdiagnosed as tenosynovitis.

Results: Twenty-two case reports published between 2015 and 2025 and four large case series prior to 2015 yielded a total of 134 patients. Fibro-osseous pseudotumor of the digit typically affects young to middle-aged adults (mean age, 36 years) with a slight female predominance. Lesions presented as rapidly enlarging painful nodules, occasionally associated with prior trauma, and were frequently mistaken for infection or extraskeletal osteosarcoma. Complete surgical excision was the definitive treatment, with recurrence reported rarely and almost exclusively following incomplete excision. Our case demonstrated recurrence after initial debridement, with subsequent definitive excision leading to functional recovery, although residual stiffness and sensory disturbance persisted.

Conclusions: Fibro-osseous pseudotumor of the digit should be considered in the differential diagnosis of rapidly enlarging digital lesions. Complete surgical excision is curative in most cases, while molecular markers such as ubiquitin-specific peptidase 6 may refine the diagnosis in morphologically ambiguous presentations. Future research should prioritise the development of standardised diagnostic criteria, prognostic markers, and long-term outcome reporting.