Clinical and Pathomorphological Analysis of Mechanisms of Progression of Dupuytren’s Contracture

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Abstract

INTRODUCTION: The factors and mechanisms of progression and recurrence of the palmar fascial fibromatosis with formation of severe Dupuytren’s contracture, remain insufficiently studied.

AIM: To identify probable mechanisms of progression of the palmar fascial fibromatosis based on the comparative analysis of clinical and morphological characteristics of patients with Dupuytren’s contracture of different extent of severity.

MATERIALS AND METHODS: Objects: medical histories and histological preparations of surgical material of patients with I–II (group 1, n = 121) and III–IV (group 2, n = 135) degree Dupuytren’s contracture. Methods: clinical, histological, statistical.

RESULTS: Clinical markers of hereditary predisposition to Dupuytren’s disease (the percentage of patients under 50 at the time of onset of the disease and the frequency of involvement of both hands) were comparable in the study groups. The incidence of diseases of the circulatory system was reliably higher in group 2: 57.0% against 41.3% (p < 0.01). A prolonged course of the disease (> 8 years) was identified only in half of the patients of group 2. The median of the content of hyperplastic connective tissue in the palmar aponeurosis in patients of groups 1 and 2 was 22.9% and 11.3%, respectively (p < 0.001), interquartile range 0%–67.8% and 0%–56.7%, respectively. In the capillary network and in the intima of larger vessels, CD34-positive endothelium was identified in patients of both groups. Around the blood vessels supplying fibromatous nodules and cords, cells expressing CD34 were found. Thickness of adventitia and Kernogan index in the arteries perforating the palmar aponeurosis, were higher in group 2.

CONCLUSION: A higher frequency of comorbid diseases of the circulatory system, more evident thickening of adventitia of arteries perforating the palmar aponeurosis, and reduction of their throughput capacity in patients with severe Dupuytren’s contractures indicate the significance of systemic and regional vasogenic mechanisms of progression of the palmar fascial fibromatosis. The content of hyperplastic connective tissue (histological predictor of recurrence) varies individually with each degree of contracture.

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About the authors

Natal’ya A. Shchudlo

Ilizarov’ National Medical Research Centre for Traumatology and Orthopedics

Email: nshchudlo@mail.ru
ORCID iD: 0000-0001-9914-8563
SPIN-code: 3795-4250
ResearcherId: H-5588-2018

MD, Dr. Sci. (Med.)

Russian Federation, Kurgan

Tat’yana A. Stupina

Ilizarov’ National Medical Research Centre for Traumatology and Orthopedics

Email: stupinasta@mail.ru
ORCID iD: 0000-0003-3434-0372
SPIN-code: 7598-4540
ResearcherId: O-4352-2018

Dr. Sci. (Biol.)

Russian Federation, Kurgan

Tat’yana N. Varsegova

Ilizarov’ National Medical Research Centre for Traumatology and Orthopedics

Author for correspondence.
Email: varstn@mail.ru
ORCID iD: 0000-0001-5430-2045
SPIN-code: 1974-8274
ResearcherId: O-6886-2018

Cand. Sci (Biol.)

Russian Federation, Kurgan

Dar’ya A. Ostanina

Ilizarov’ National Medical Research Centre for Traumatology and Orthopedics

Email: ostaninadar@yandex.ru
ORCID iD: 0000-0002-4399-2973
SPIN-code: 9104-7840
ResearcherId: ААЕ-9123-2022

аспирант

Russian Federation, Kurgan

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Supplementary files

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2. Fig. 1. Distribution of patient with I–II and III–IV degree Dupuytren’s contracture by duration of fibromatosis.

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3. Fig. 2. Fragments of longitudinal and cross sections of subtendinous cord of the palmar aponeurosis in the surgical material of a patient with III degree Dupuytren’s contracture: hyperplastic fibrous tissue (A), dense (“tendon-like”) connective tissue in cross (B) and longitudinal (C) sections. Hematoxylin and eosin staining. Magnification x 500.

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4. Fig. 3. Condition of subcutaneous tissue of a patient with II degree Dupuytren’s contracture: area with normal vascularization (A), hypervascularized adipose tissue (B), ingrowth of cellular-fibrous cords between adipocytes (C). Hematoxylin and eosin staining. Magnification x 500.

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5. Fig. 4. Alterations of the vessels of palmar aponeurosis in patients with Dupuytren’s contracture: inflammation of the walls and narrowing of the lumen of arterioles (A, B), constrictive remodeling of the artery perforating the palmar aponeurosis (C), hemorrhages and formation of new microvessels in the arterial wall (D), accumulations of extravascular erythrocytes (E). A, B — semifine epoxide sections, methylene blue and basic fuchsine staining, magnification x 1000; C, D — paraffin sections, hematoxylin and eosin staining, magnification x 500; E, F — scanning electronic microscopy, magnification x 1900 (E), x 2500 (F).

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6. Fig. 5. Distribution of CD34-positive endothelium in vessels of palmar aponeurosis in patients with II (A) and III (B) degree Dupuytren’s contracture. Magnification х 500.

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