Desmoplastic fibroma of bone

Desmoplastic fibroma in a child: a 9-year follow-up case report

BACKGROUND

Desmoplastic fibroma is an extremely rare primary bone tumor. Its characteristic features include bone destruction accompanied by the formation of soft tissue masses. This condition predominantly affects individuals under the age of 30. Since its histology is similar to desmoid-type fibromatosis, an accurate diagnosis before operation is difficult. Desmoplastic fibroma is resistant to chemotherapy, and the efficacy of radiotherapy is uncertain. Surgical excision is preferred for treatment, but it entails high recurrence. Further, skeletal reconstruction post-surgery is challenging, especially in pediatric cases.

CASE PRESENTATION

Nine years ago, a 14-year-old male patient presented with a 4-year history of progressive pain in his left wrist. Initially diagnosed as fibrous dysplasia by needle biopsy, the patient underwent tumor resection followed by free vascularized fibular proximal epiphyseal transfer for wrist reconstruction. However, a histological examination confirmed a diagnosis of desmoplastic fibroma. The patient achieved bone union and experienced a recurrence in the ipsilateral ulna 5 years later, accompanied by a wrist deformity. He underwent a second tumor resection and wrist arthrodesis in a single stage. The most recent annual follow-up was in September 2023; the patient had no recurrence and was satisfied with the surgery.

CONCLUSIONS

Desmoplastic fibroma is difficult to diagnose and treat, and reconstruction surgery after tumor resection is challenging. Close follow-up by experienced surgeons may be beneficial for prognosis.

Unraveling the challenges in the diagnosis and management of desmoplastic fibroma of the mandible-a case report

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor's tendency for local recurrence and the patient's well-being. Due to the patient's young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well.

Desmoplastic Fibroma of the Mandible: A Case Without Recurrence After Enucleation

Desmoplastic fibroma (DF) is a rare, benign, yet locally aggressive bone tumor. It frequently affects the facial bones, and the mandible is the most commonly affected site. Treatment of choice is the removal of the tumor with resection of surrounding bone due to its aggressive behavior. We report a case of DF where the tumor showed resolution and almost complete bone deposition following enucleation. Although DF has a high recurrence rate, the patient remains disease-free 31 months post-surgery.

Sinonasal Myxoma: A Distinct Entity or a Myxoid Variant of Desmoid Fibromatosis?

Sinonasal myxoma (SNM) is a rare benign mesenchymal tumor that arises in the sinonasal cavity or maxilla and almost exclusively affects young children. Currently, it is considered a specific entity, but its molecular characteristics have not been reported. Lesions diagnosed as SNM and odontogenic myxoma/fibromyxoma (OM/OFM) were identified from the participating institutions, and the clinicopathologic features were recorded. Immunohistochemistry for β-catenin was performed on all cases with available tissue. Next-generation sequencing (NGS) was performed on all SNM cases. Five patients with SNM were identified, including 3 boys and 2 girls with an age range of 20-36 months (mean: 26 months). The tumors were well-defined, centered in the maxillary sinus, surrounded by a rim of woven bone, and composed of a moderately cellular proliferation of spindle cells oriented in intersecting fascicles in a variably myxocollagenous stroma that contained extravasated erythrocytes. Histologically, the tumors resembled myxoid desmoid fibromatosis. Three tested cases showed nuclear expression of β-catenin. In 3 tumors, NGS revealed intragenic deletions of APC exons 5-6, 9 and 15, or 16, respectively, with concurrent loss of the other wild-type copy of APC, predicted to result in biallelic inactivation. The deletions were identical to those that occur in desmoid fibromatosis, and copy-number analysis raised the possibility that they were germline. In addition, one case showed possible deletion of APC exons 12-14, and another case exhibited a CTNNB1 p.S33C mutation. Ten patients with OM/OFM were identified, including 4 women and 6 men (mean age: 42 years). Seven tumors involved the mandible, and 3 the maxilla. Histologically, the tumors differed from SNM, and all cases lacked nuclear expression of β-catenin. These findings suggest that SNM represents a myxoid variant of desmoid fibromatosis that often arises in the maxilla. Because the APC alterations might be germline, genetic testing of the affected patients should be considered.

Neglected Desmoplastic Fibroma of calcaneum with collapsed hindfoot, restored with allograft transplantation: A rare case report

Desmoplastic fibroma of the calcaneum is a rare, locally aggressive tumour. A 24-year-old female presented with long-standing heel pain, with the collapse of the calcaneum (hindfoot) that was untreated for 7 years. Eradication of this locally aggressive lesion by adjuvant therapy and restoration of calcaneal bony morphology by allograft was an arduous and challenging task. At the final follow-up, the heel was painless, and the patient could walk normally without support.

Conclusion

Restoration of calcaneal height is challenging in young patients, and using structural allograft restores calcaneal and hindfoot morphology. Patient education about the high chances of recurrence despite surgical clearance is essential, and intraoperative adjuvant usage can reduce the recurrence.

Distal Femoral Replacement as a Salvage Treatment After Desmoplastic Fibroma Resection

Desmoplastic fibroma is an extremely rare primary bone tumor that can mimic the presentation of other bone lesions. We describe the case of a middle-aged male with a mass on the left distal femur initially diagnosed as fibrous dysplasia that underwent a wide margin excision followed by a distal femoral replacement to restore anatomy and functionality. Histologic examination of the complete surgical specimen was consistent with a desmoplastic fibroma. This case is the first report of a successful application of endoprosthetic reconstruction after desmoplastic fibroma resection.

Fibrous and Fibro-Osseous Lesions of Bone

Fibrous and fibro-osseous tumors are some of the most common benign lesions involving bones. Although many of the histomorphologic features of these tumors overlap significantly, an interdisciplinary approach helps to consolidate the classification of these tumors. Herein, the clinical, radiologic, and pathologic features of lesions within these categories are described.

Successful Treatment of a Case of Desmoplastic Fibroma: A Case of Unusual Lesion

Desmoplastic fibroma (DF) is a non-metastatic primary bone tumor that is extremely rare with local aggressive behavior. To the best of our knowledge, only few cases were published discussing this type of tumor and its management. This case report aimed to discuss a novel case as well as its management scheme. We present a case of a 36-year-old male with DF lesion involving the proximal tibial who underwent an extended curettage, triple type of adjuvant thereby, and internal fixation.

Nerve preservation during partial sacrectomy by two-stage anterior and posterior approach: illustrative case

BACKGROUND

Preserving the neurological function of sacral nerves during total or partial sacrectomy is challenging.

OBSERVATIONS

The authors describe a case of an osseous desmoplastic fibroma of the sacrum in a 51-year-old woman. The patient attended the authors’ institution with loss of muscle strength and sensitivity impairment in both legs, gait instability, bowel constipation, urinary incontinence, and weight loss. Preoperative magnetic resonance imaging and positron emission tomography/computed tomography showed intrapelvic and posterior extension of the tumor but sparing of S1 and the sacroiliac and lumbosacral joints. After a multidisciplinary discussion of the case, a staged anterior–posterior approach to the sacrum was chosen. The abdominal approach allowed full mobilization of the uterus, ovaries, bladder, and colon and protection of iliac vessels. After tumor resection, a synthetic surgical mesh was placed over the sacrum to minimize soft tissue defects. Then, the posterior stage allowed the authors to perform a bicortical osteotomy, achieving wide tumor excision with minimal nerve root injury. Spinopelvic fixation was not necessary, because both sacroiliac and lumbosacral joints remained intact. A few days after the surgery, the patient restarted ambulation and recovered sphincter control.

LESSONS

Multidisciplinary planning and a staged abdominal and posterior approach for partial sacrectomy were fundamental to preserve neurological function in this case.

Desmoplastic fibroma of the Mandible with unusual histopathological features

Desmoplastic fibroma (DF) is a rare myofibroblastic primary tumor of bone that histologically and biologically mimics the extra-abdominal desmoid tumor of soft tissue. The surgical management of this tumor has been a matter of controversy and its recurrence has been a matter of clinical relevance. In this case report, we describe an unusual case of DF in a 15-year-old male patient who presented with a slow-growing mass in the right posterior mandibular region of 2 years duration. The presence of areas mimicking Giant cell angiofibroma (GCA) is the highlight of the case. The possibility of misdiagnoses is more in early lesions since the available literature shows that immunohistochemistry (IHC) is not of much benefit while differentiating DFs from other spindle cell lesions.

Desmoplastic fibroma of the jaw bones: A series of twenty-two cases

•

In desmoid-type soft tissue fibromatosis we could see the beta-catenin in the nuclei of neoplastic cells as a diagnostic feature.

•

Beta-catenin in the nuclei of neoplastic cells could not be detected in the present DF series.

•

Most of the DF cases expressed only cytoplasmic beta-catenin immunostainings.

•

Immunohistochemical staining difference of jaw bone desmoplastic fibromas from other soft tissue and bone lesions may be related to the origination of jaw bone from the neural crest.

Desmoplastic fibroma (DF) is an intraosseous counterpart of desmoid-type soft tissue fibromatosis. It is most frequently seen in the jawbones. The clinical and radiological features of the present cases were nonspecific. The accumulation of beta-catenin in the nuclei of neoplastic cells which is a diagnostic feature of desmoid-type soft tissue fibromatosis could not be detectED in the present DF series. The aim of this study is to report a series of 22 cases of DF involving either mandible or maxilla. A retrospective evaluation of desmoplastic fibroma and beta-catenin, smooth muscle actin, nestin, cyclin D1 immunostaining’s patterns.

Most of the DF cases expressed only cytoplasmic beta-catenin immunostainings. We suggest that nuclear beta-catenin staining may not be used as a corroborating the diagnosis of DF. Immunohistochemical staining difference of jaw bone desmoplastic fibromas from other soft tissue and bone lesions may be related to the origination of jaw bone from The neural crest. Strong nestin and cyclin D1 positivity in our series supported this. A combined clinical, radiological, and histopathological analysis of the DF cases is essential in the diagnosis and management.

Desmoplastic fibroma of the mandible: a rare gnathic bone tumor with a review of the literature

Desmoplastic fibroma (DF) is a rare bone tumor, which is known to involve mostly the gnathic bones. In this setting, the clinical presentation is usually represented by a bulging tumor of the face. Radiologically, the tumor is usually characterized by an expansile lytic bone lesion. The histopathology of the tumor shows a poorly circumscribed hypocellular lesion rich in collagen fibers with interspersed spindle cells having bland nuclear chromatin. Despite the lack of mitoses and nuclear pleomorphism, DF has an aggressive nature, presenting as a destructive growth causing entrapment of neuro-vascular bundles, sinusitis, or trismus. Some cases of DF show mutations in the adenomatous polyposis coli pathway shown by nuclear localization of the β-catenin protein. Few reports showed an association with tuberous sclerosis, though most of these cases were sporadic. We discuss a rare case of desmoplastic fibroma involving the mandible, and a review of the literature of the DF cases involving the gnathic bones.

Reconstruction of the Proximal Aspect of the Radius After Desmoplastic Fibroma Resection: A Case Report

CASE

Desmoplastic fibromas are tumors of fibrous tissue that rarely are diagnosed. We present the case of a 27-year-old man who presented with pain of the forearm that was initially diagnosed as a muscle strain. A computed tomography-guided core biopsy revealed a desmoplastic fibroma. Consequently, the patient was treated with a resection of the proximal aspect of the radius followed by reconstruction with use of a vascularized fibular autograft.

CONCLUSION

At the 2-year follow-up, radiographs showed integration of the autograft; additionally, good results were noted with the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Physical Function Short Form T-score and the QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand Score [DASH]) questionnaire, along with good range of motion.

Desmoplastic Fibroma of Bone: a Case Series and Review of Literature

Desmoplastic fibroma is an uncommon locally aggressive benign tumor of the bone. Patients usually present with a long-standing history of pain and swelling. Radiologically and histologically, it can mimic a variety of tumors. This article presents a report on three cases of desmoplastic fibroma in the proximal humerus, distal femur, and neck femur region. The varied radiographic features and the management of the three cases are described in detail. All the three patients were treated by extended curettage. Follow-up ranged from 2 to 5 years. There were no local or systemic recurrence until the last follow-up. Tumor resection with adequate margins is the preferred treatment, although extended curettage can be an acceptable alternative treatment modality when resection is not possible or acceptable.

Desmoplastic Fibroma of the Mandible in a Pediatric Patient: A Case Report of Resection and Reconstruction With A Six-Year Follow-Up

Desmoplastic fibroma (DF) of bone is considered a benign but locally aggressive tumor of fibroblastic origin. DF is rare, representing less than 1% of all bone tumors. Approximately 84% of patients are younger than 30 years. DF has a slow but aggressive growth potential and can recur locally when it has not been completely excised. Complete resection is the treatment of choice to decrease recurrence and morbidity. Mandibular reconstruction is mandatory in pediatric patients to ensure correct craniofacial development. The present report describes the case of a pediatric patient with mandibular DF in whom complete resection and immediate reconstruction with a fibula flap proved a satisfactory treatment option, with low morbidity and excellent esthetic and functional results at 6-year follow-up.

[Protocol for the study of bone tumours and standardization of pathology reports]

Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology.

[Ewing's sarcoma, fibrogenic tumors, giant cell tumor, hemangioma of bone : Radiology and pathology]

Radiological imaging only reflects the anatomy and its pathological abnormalities. Therefore, the radiologist should be able to recognize the basic features of the pathological anatomy of bone tumors. This can only be learned working closely with a pathologist who is experienced in this field. On the other hand, the pathologist needs from the radiologist their diagnostic assessment with information on size, location, aggressiveness and the existence of a bone tumor's matrix, of the whole lesion, because he usually only receives a small part for examination in the form of a biopsy. In this article, the features and fundamentals (standards) of radiological-pathological cooperation as the mainstay for a precise diagnosis in bone tumors are outlined. The radiological appearance and the histopathological features behind it are presented for Ewing's sarcoma, fibrogenic tumors, giant cell tumor, and hemangioma of the bone.

Desmoplastic Fibroma of the Pediatric Cranium: An Aggressive Skull Tumor with Local Recurrence

Cranial desmoplastic fibroma (DF) is extremely rare and only 20 cases, including only 7 pediatric cases, have been reported previously. We describe the first case of a child with cranial DF that increased in size over a short-term and recurred after resection. The aim of this case report was to discuss the clinical, radiological, and histological characteristics and optimal treatment for this rare and aggressive skull tumor.

Desmoplastic Fibroma-A Rare Case Report

Desmoplastic fibroma (DF) is a benign intra-osseous neoplasm, that is, recognized as the intra-osseous counterpart of soft tissue fibromatosis in both gnathic and extra-gnathic sites. It has a propensity for locally aggressive behavior and local recurrence. An occurrence of intra-osseous lesion other than that of odontogenic origin is rare in the jaws. In this case report, we define the clinico-pathological and radiographic features of DF of the mandible in a 35-year-old female, who presented to the Outpatient Department with a 3-year history of a slowly expanding painless mass in the left mandibular posterior region. Thus, we present a classic case of DF exhibiting characteristic features along with a review of the literature.

Periosteal desmoplastic fibroma of the tibia in a 3-year-old child

Desmoplastic fibroma is a rare benign fibrogenic, locally aggressive, primary bone tumor. It is the intraosseous counterpart of soft tissue aggressive fibromatosis. The lesion may very rarely appear as a superficial bone lesion arising from the periosteum; in such cases, a soft tissue mass with changes in the adjacent bone is evident. Periosteal lesions are very rare in the literature; diagnosis is usually based on the radiographic findings, and histological proof of the tumor origin is missing. A periosteal desmoplastic fibroma of the distal tibial metaphysis in a 3-year-old boy is presented. Radiographic investigation included plain radiographs and computed tomography imaging. Both demonstrated a soft tissue lesion involving the superficial bone tissues with non-aggressive looking borders and a pressure effect with a sclerotic rim in the bone. The lesion was excised, and the surgical as well as the histological findings indicated the diagnosis of a desmoplastic fibroma of bone arising from the periosteum. No recurrence was detected 5 years after surgery.

Fibro-osseous lesion of the cranium in an adolescent patient

Background:

Fibrous dysplasia, ossifying fibroma, and desmoplastic fibroma are rare benign calvarial lesions, which can have local aggressive behavior. These tumors can present with similar clinical and radiologic characteristics making diagnosis difficult at times.

Case Description:

A 16-year-old male presents after noting an indentation of his skull. Comparison with current and previous imaging revealed progressive erosion of the skull underlying the indentation.

Conclusion:

Fibrous dysplasia, ossifying fibroma, and desmoplastic fibroma are rare fibro-osseous tumors with similar characteristics radiographically. Accurate diagnosis of these tumors can be difficult even with the combination of clinical presentation, imaging, and pathology. The treatment of choice is resection and cranial reconstruction, if necessary, with close follow-up as recurrence can occur.

Desmoplastic fibroma of bone: A rare bone tumour

We identified thirteen patients with desmoplastic fibroma of bone treated at our institute over a 30 year period. The patients had a mean age of 25.9 years; eight were female. The incidence of desmoplastic fibroma of bone in all patients with benign bone tumours in our population is 0.003%. Surgical treatment ranged from primary amputation to intra-lesional curettage. The incidence of local recurrence was 15.4%. All cases of local recurrence after curettage or marginal excision demonstrated soft-tissue extension of their tumours on initial presentation suggesting that extra-osseous extension requires more radical surgery to control the disease.

This study presents the largest single centre series of desmoplastic fibroma of bone with a mean follow-up time of 8 years. We recommend wide surgical excision, particularly if the lesion can be resected without significant loss of function, as the treatment modality of choice with the lowest rate of recurrence. Patients undergoing intra-lesional or marginal resection need to be advised of the possibility of local recurrence and the need for long-term surveillance.

Desmoplastic fibroma of the rib with cystic change: a case report and literature review

Desmoplastic fibroma (DF) is a rare, locally aggressive, solitary tumor microscopically composed of well-differentiated myofibroblasts with abundant dense collagen deposition. The most common sites are the long tubular bones and mandible. To our knowledge, only five cases of DF in the ribs have been reported. Here, we report a case of DF in this rare location with unusual radiological findings. A 40-year-old man presented with a 4-year history of swelling of the right chest wall. Radiographs revealed a mass at the right 9th rib, and computed tomography demonstrated a mass of 14 × 12 × 8 cm at the right 9th rib with expanded cystic change and marked calcification that appeared to have arisen from the bone. Open biopsy suggested DF. Total excision was performed, and the chest wall was reconstructed. The surgical specimen was a yellowish tumor with multilocular cystic change containing a viscous liquid. The tumor was composed of a proliferation of less-atypical spindle-shaped cells in a collagenous background. The cystic change was observed in the extra-osseous lesion. No β-catenin cytoplasmic/nuclear accumulation was detected, and no β-catenin or GNAS genetic mutations were detected. A final diagnosis of DF was made on the basis of the pathological and radiological findings. The patient was successfully treated with total excision of the tumor with no evidence of recurrence 6 months after surgery.

Imaging findings of desmoplastic fibroma rarely involving the clavicle: case report

Desmoplastic fibroma of bone is a rare locally aggressive, but non-metastatic tumor. In this case report, we present a desmoplastic fibroma in an unusual location, the clavicle. Desmoplastic fibroma involving the clavicle is extremely rare, with only 2 reported cases before 1985. We report the imaging findings of a desmoplastic fibroma of the clavicle with a review of the relevant literature.

Desmoplastic fibroma of the pediatric cranium: case report and review of the literature

PURPOSE

Desmoplastic fibromas are primary bone tumors that seldom occur in the cranial bones. Furthermore, reports of desmoplastic fibromas of the skull in children are exceedingly rare. Although desmoplastic fibromas are histologically benign, they are locally aggressive and have a propensity to reoccur. Their radiographic appearance may mimic other more common central nervous system and bone neoplasms. There are only 19 reported cases of desmoplastic fibroma of the cranium in the literature, and only seven occurred in the pediatric age group. We present a case report of an 11-year-old female patient with a desmoplastic fibroma of the parieto-occipital region and review the literature.

CASE REPORT

An 11-year-old female presented to the craniofacial clinic complaining of intermittent pain and a soft mass in the occipital region. There was a distant history of trauma to the region that did not require medical intervention. Computed tomography imaging revealed a lytic bone lesion overlying the sagittal sinus in the parieto-occipital region. Surgical resection with wide margins and immediate autologous reconstruction was performed. Pathological analysis revealed a desmoplastic fibroma. At 4 months of follow-up, no recurrence has been noted.

CONCLUSION

Desmoplastic fibroma of the cranium is rare. Complete surgical resection with careful follow-up is the treatment of choice.

Desmoplastic fibroma of bone in a toe: radiographic and MRI findings

Desmoplastic fibroma is a rare benign primary bone tumor that is histologically similar to the soft tissue desmoid tumor. It most often involves the mandible, large long bone or iliac bone. Desmoplastic fibroma in a toe has been extremely rarely reported. Authors report a rare case of desmoplastic fibroma of bone occurring in the distal phalanx of a foot, with descriptions of the radiographic and MRI findings, correlation of the radiologic and pathologic findings, and discussion on the differential diagnosis of the tumor.

Desmoplastic fibroma of the ilium

INTRODUCTION

The desmoplastic fibroma is a rare locally invasive bone tumour. Surgical resection with minimal margins is recommended.

PRESENTATION OF CASE

A 15 year-old boy was referred with chronic left thigh pain. MRI revealed a bone lesion within the cavity of the inner table of the left iliac wing without invasion of the underlying bone marrow. A surgical biopsy revealed a desmoplastic bone fibroma. A partial resection of the inner table of the iliac wing sparing the outer table was performed. At the latest follow-up the initially spared iliac wing had needed further resection. The reason proposed for this is devascularisation by substantial periosteal stripping causing partial resorption initially, then necrosis and ultimately ulceration through the skin necessitating further surgical resection.

DISCUSSION

The technique of resection of a pelvic desmoplastic fibroma sparing the outer table of the iliac wing has not previously been reported. The objective of a limited resection was to minimize the risk of a postsurgical limp caused by weakness of the gluteus medius muscle. However we report that this technique did not work in this case. A wider resection of the iliac wing as it is recommended for a malignant tumour would have yielded a similar final outcome.

CONCLUSION

A partial resection of the iliac wing seemed an appealing technique for a benign tumour of the inner table of the iliac wing. However, considering the complications encountered, the authors advise a simple “en bloc” resection of the iliac wing for this type of tumour in this location.

Desmoplastic fibroma of the spine causing severe mediastinal compression and brachial plexus encasement: report of 2 cases

Desmoplastic fibroma (DF) is a rare bone tumor that accounts for about 0.1%-0.3% of all bone tumors. It is typically characterized as slow growing, but in rare cases it can proliferate extensively and exhibit locally aggressive characteristics. It is found most commonly in the appendicular skeleton and rarely in the axial skeleton. The authors present the cases of 2 women in their 20s with DF originating from the cervicothoracic spine. Both tumors intimately involved the brachial plexus and caused significant impingement of the mediastinum resulting in cardiopulmonary compromise. Both patients underwent hemiclamshell thoracotomies for tumor resection, and in both cases subtotal resection was performed given the encasement of the brachial plexus. Although DF is a benign process, it can be locally aggressive and proliferate at extensive rates. The authors describe these 2 cases, review the literature, and discuss management.

Maxillary desmoplastic fibroma with initial symptoms suggestive of sinusitis

Desmoplastic fibroma (DF) is a benign intra-osseous neoplasm characterized by the formation of abundant collagen fibers. It arises most commonly in the jaws and exhibits local aggressiveness and high recurrence rates after local resection. An uncommon case of expansive DF involving the right maxilla, maxillary sinus, and inferior orbital wall of a 49-year-old man whose initial symptoms were similar to acute sinusitis is presented, and the criteria for diagnosis and clinical management are discussed.

Desmoplastic fibroma: a case report with three years of clinical and radiographic observation and review of the literature

Background:

Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue.

Case Presentation and Literature Review:

A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented.

Conclusion:

In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.

Desmoplastic fibroma of the cranium in a young man

Desmoplastic fibroma, which develops predominantly in long bones and the mandible, is a rare and benign but locally aggressive tumor. Desmoplastic fibroma of the cranium is extremely rare. We report a case of desmoplastic fibroma of the frontal bone in a young man. Because of its locally aggressive behavior, complete surgical excision with a safety margin is essential.

Huge desmoplastic fibroma of the paediatric mandible: surgical considerations and follow-up in three cases

The desmoplastic fibroma is a rare locally aggressive spindle-cell proliferation made up of fibroblasts/myofibroblasts immersed in a dense collagenic stroma. Head and neck localisation of desmoplastic fibromas is even more rare and the literature is limited to small case series and reviews. A comprehensive review of the English literature from 1968 to 2011 revealed only 79 cases of mandibular desmoplastic fibromas and only 18 (22%) in patients under 4 years of age. Complete resection with clear margins is the surgical first option, but it can be difficult to achieve in the paediatric mandible, especially for giant tumours as the three reported here. Mandibular reconstruction in these cases is mandatory to ensure correct craniofacial development. The authors present three cases of huge mandibular desmoplastic fibromas in paediatric patients treated with mandibulectomy and immediate reconstruction using rib grafts. Indications, reconstructive options and results are discussed.

Desmoplastic fibroma of the scapula: a case report and review of the literature

Desmoplastic fibroma of the scapula is a rare benign tumor in a rare site. We describe the management of a 61-year-old man with desmoplastic fibroma of the scapula. We think that a wide excision is one good treatment for this tumor. If there is a major functional deficit, the reconstructional operation may be designed for saving the function.

A rare tumour in a rare location: desmoplastic fibroma in a toe

We report a case of desmoplastic fibroma occurring in the 2nd toe. This lesion most frequently occurs in the long bones or the mandible. This is only the second reported case of desmoplastic fibroma in a toe in the English language. The importance and process of establishing a differential diagnosis in such lesions is highlighted. The similarity between the clinical and histological findings of this tumour and other tumours, both benign and malignant, makes familiarity with the character of desmoplastic fibroma essential for proper treatment.

Desmoplastic fibroma of the cervical spine: case report and review of the literature

STUDY DESIGN

A case report and literature review are presented.

OBJECTIVE

To present a rare case of desmoplastic fibroma (DF) in the cervical spine and discuss the diagnosis and treatment of this disorder.

SUMMARY OF BACKGROUND DATA

DF is an extremely rare primary tumor of bone, especially in cervical spine. It is a benign but locally aggressive tumor of the connective tissue. It has a predilection for the mandible and the metadiaphyses of long bones. It has a propensity for local recurrence, especially after intralesional resection.

METHODS

We report on a 70-year-old woman with a DF of the fourth and fifth cervical vertebrae. The patient complained of progressive neck pain and limitation of activity. After radiologic evaluation, a mass lesion was found on the fourth and fifth cervical vertebral bodies. A 2-level corpectomy with wide marginal resection of the tumor was performed through the anterior approach, and the histopathologic examination yielded the diagnosis of DF. Reconstruction was achieved with a long titanium mesh and locking plate with autologous iliac crest bone graft.

RESULTS

After surgery, pain was completely relieved, and neurologic function was normal. The postoperative course was uneventful, and the patient has been well without recurrence for 35 months of follow-up evaluation.

CONCLUSION

Patients with DF of the cervical spine may present with the arm and neck pain mimicking cervical disc disease. High index of suspicion by the clinicians must be practiced to make the appropriate diagnosis, and histologic confirmation of the diagnosis is essential. Surgical resection with wide margins is the preferred treatment.

Desmoplastic fibroma of the mandible--review of the literature and presentation of a rare case

Desmoplastic fibroma (DF) is a rare, benign but locally aggressive, intraosseous lesion with a high tendency of local recurrence. In this report the actual literature is reviewed regarding epidemiological data, pathology, clinical diagnostic criterias, therapy and prognosis. Moreover, a report of an interesting case is included localized in the mandibular corpus.

Myofibroblastic bone tumor of the toe: case report

Level of Evidence: V, Expert Opinion

Desmoplastic fibroma with malignant transformation

Desmoplastic fibroma (DF) is a rare neoplasm of bone, showing infiltrative and locally aggressive nature. Here, we report a case of DF with an unusual histology arising in a 41-year-old female in the left distal femur, which was detected by plain x-ray as an osteolytic lesion and by magnetic resonance imaging as a well-demarcated mass with endosteal scalloping. Pathologically, the tumor was composed mainly of bland-looking spindle cells in abundant collagenous stroma, accompanied with areas of myxofibrosarcomatous and malignant fibrous histiocytomatous components. These histologically different areas were admixed with each other. The array-based comparative genomic hybridization study on the histologically different areas showed some specific gained or lost loci according to their histologic features. The specific genetic events and the histologic features of this case might represent the malignant transformation of DF.

Desmoplastic fibroma of the mandible

Desmoplastic fibroma (DF) of the bone, also know as desmoid tumour, is a rare non-metastasizing but locally aggressive tumour. In this case report, we present imaging findings of a histopathologically proven desmoplastic fibroma involving the left mandibular region in a 15-year-old Chinese patient. We have also discussed the usefulness of different imaging modalities (plain film radiography, CT and MRI) in DF diagnosis and treatment.

Desmoplastic fibroma of the skull

Desmoplastic fibroma is a primary bone tumour which occurs exceedingly rarely in the cranial bones. We report a histopathologically confirmed example in a 21 year old man with a painless swelling over the sagittal suture. In the light of our experience and reports of previous examples, we review the features of the condition and its management.

Primary Skull Lesions in the Pediatric Population: A 25-Year Experience

Context.—Primary skull lesions are rare in the pediatric population. The differential diagnosis of these lesions is broad and includes both congenital and acquired lesions. Previous studies of skull lesions in the pediatric population suggest that dermoid/epidermoid tumors are the most common childhood skull tumors.

Objective.—To review the clinicopathologic features of primary skull lesions identified within the pediatric population of an academic tertiary medical center.

Design.—A retrospective review of surgical pathology reports during a 25-year period identified 19 primary skull lesions occurring in the pediatric population. Lesions were excluded if they were of known soft tissue or intracranial origin with secondary calvarial involvement, or if they represented a metastasis from a known primary malignancy.

Results.—Nineteen primary skull lesions were identified in 11 male (58%) and 8 female (42%) patients, with a median age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 8). The lesions were located in the occipital bone (n = 7), frontal bone (n = 5), parietal bone (n = 2), and temporal bone (n = 1). Diagnoses included epidermoid/ dermoid cyst (n = 8), Langerhans cell histiocytosis (n = 6), intraosseous hemangioma (n = 2), osteoblastoma (n = 1), infantile myofibroma (n = 1), and fibroma (n = 1). Intracranial extension was identified in 1 case, and recurrence was found in only 2 cases.

Conclusions.—Epidermoid/dermoid cysts and Langerhans cell histiocytosis are the most commonly encountered skull lesions in the pediatric population at our institution. Intracranial extension of these lesions is rare, and recurrence is uncommon following complete surgical resection.

[Desmoplastic fibroma of the rib: two case reports]

Desmoplastic fibroma is a very rare primary tumor of bone, closely related to aggressive fibromatosis of soft tissue. Although considered a benign lesion, it can be very aggressive locally and has a high rate of local recurrence after incomplete surgical excision. Radiologically, the lesion shows no distinctive features, often simulating osteosarcoma, fibrous dysplasia, or fibrosarcoma. Rib involvement by desmoplastic fibroma is extremely rare. We present two cases of desmoplastic fibroma involving this unusual location with lytic costal lesion and chest wall extension. Histological examination after surgical resection revealed that the tumor consisted of spindle cells with small, elongated nuclei in a background of numerous collagen fibers and infiltrating lamellar bone. There was no evidence of nuclear atypia, mitotic activity, or necrosis. We also discuss histological differential diagnosis as well as clinical features and the radiological and pathologic findings of this rare disease. Recognition of this entity is important to ensure proper surgical treatment.