Histological Features of Fascial Fibromatosis in Patients with Rapidly Progressive Dupuytren’s Contracture

Abstract

Background. Research into the etiology and pathogenesis of palmar fascial fibromatosis remains relevant to this day. However, the data on the histogenetic nature of its rapid progression and histological predictors of its recurrence are absent in the literature. The aim of the study — to perform a comparative analysis of the tissue composition and perforating arteries of the palmar aponeurosis in patients with rapid and typical progression of Dupuytren’s contracture. Methods. A total of 222 medical records of patients operated on in the period from 2014 to 2019 were analyzed. The development period of Dupuytren’s contracture (DC) in the largest group (n = 88) — from 3 to 8 years — was defined as typical; the development of DC in two years or less (n = 41) was interpreted as rapid. Histomorphometry of the surgical material was performed in cases of rapid (n = 20, Group 1) and typical (n = 25, Group 2) progression of DC. We used the fragments of palmar aponeurosis from conditionally healthy people (n = 5) as control samples. These were excised during surgical treatment of the hand wounds. Results. The median content of hyperplastic connective tissue was statistically significantly higher in Group 1 (p 0.05), though the indicator varied widely in both groups. Group 1 showed a statistically significantly higher proportion of microvasculature vessels, including pathologically altered and newly formed ones (CD34+). Histomorphometry of the perforating arteries of the palmar aponeurosis showed that, compared with the control samples, the outer diameter in medium-sized arteries in patients of Groups 1 and 2 is larger by 4% (p 0.05) and 12.5% (p 0.01), respectively. The lumen diameter is 30% smaller in Group 1 (p 0.01) and 31% larger in Group 2 (p 0.05). In large-caliber arteries in Groups 1 and 2, the outer diameter is smaller by 18% (p 0.01) and 17% (p 0.05) compared to the control, and the lumen diameter is smaller by 52% (p = 0.00) and 18% (p 0.05), respectively. Conclusion. Despite the shorter duration of the disease, patients with rapidly progressive Dupuytren’s contracture showed an increase in the number of pathologically altered microcirculatory vessels, as well as more pronounced stenotic remodeling of the perforating arteries of the palmar aponeurosis, which verifies early vascular aging. Histologic predictors of postoperative recurrence should be assessed individually