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Albino L, Guo Y, Bacani J, Mather C, Nilsson JE, Dieleman LA. Case report: Desmoid fibromatosis diagnosed in a 27-year-old male after being mistaken for a gastrointestinal stromal tumour. Front Med (Lausanne) 2022; 9:998473. [PMID: 36438058 PMCID: PMC9684322 DOI: 10.3389/fmed.2022.998473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/25/2022] [Indexed: 11/04/2023] Open
Abstract
Despite being distinct lesions, gastrointestinal stromal tumours (GISTs) and desmoid fibromatosis may appear similar on imaging when they involve the stomach wall or bowel. As a result, they may be confused with one another when initially diagnosed. This report aims to present a case where a desmoid tumour was mistaken for a gastric GIST in a 27-year-old gentleman despite extensive investigation prior to exploratory laparotomy, and why differentiation through pathology, with a focus on the immunohistochemistry profile, is key for proper prognostication and appropriate management, including timely investigation for associated diseases such as Familial Adenomatous Polyposis in patients with desmoid tumours.
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Affiliation(s)
- Larissa Albino
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yimeng Guo
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Julinor Bacani
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Cheryl Mather
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Jan-Erick Nilsson
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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Batstone R, Sharma S, Bickerstaff H, Persad R, Doyle P. Uretric Obstruction in Gardener's Syndrome. J R Soc Med 2018. [DOI: 10.1177/014107689608900316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Desmoid tumours in Gardener's syndrome are a rare cause of ureteric obstruction. We report two cases of ureteric obstruction caused by desmoids, in a mother and daughter.
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Affiliation(s)
- R Batstone
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - S Sharma
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - H Bickerstaff
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - R Persad
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
| | - P Doyle
- Department of Urology, Addenbrooke's Hospital, Cambridge, England
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Walter T, Zhenzhen Wang C, Guillaud O, Cotte E, Pasquer A, Vinet O, Poncet G, Ponchon T, Saurin JC. Management of desmoid tumours: A large national database of familial adenomatous patients shows a link to colectomy modalities and low efficacy of medical treatments. United European Gastroenterol J 2017; 5:735-741. [PMID: 28815038 PMCID: PMC5548349 DOI: 10.1177/2050640616678150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Desmoid tumours represent a major complication of familial adenomatous polyposis. Our aims were to study the factors associated with the development of desmoid tumours in familial adenomatous polyposis patients, and to describe presentation and management of desmoid tumours. METHODS AND PATIENTS We reviewed all patients with familial adenomatous polyposis followed at our institution between 1965-2013, with either identified adenomatous polyposis coli gene mutation, or a personal and family history suggesting adenomatous polyposis coli-related polyposis. Response to treatment of desmoid tumours was assessed by Response Evaluation Criteria In Solid Tumor (RECIST) criteria. RESULTS A total of 180 patients with familial adenomatous polyposis were included with a median follow-up of 19 years since diagnosis. Thirty-one (17%) patients developed 58 desmoid tumours, a median (range) 4.7 (0.8-41.6) years after their diagnosis of familial adenomatous polyposis. The only factor significantly associated with occurrence of desmoid tumours was the type of surgery: 12 (12%) desmoid tumours in 104 patients treated by colectomy, versus 19 (25%) desmoid tumours in 76 patients treated by proctocolectomy, p = 0.027. The localisation of desmoid tumours was: mesenteric (n = 25), abdominal wall (n = 30) or extra-abdominal (n = 3). Nineteen patients underwent 36 surgical procedures for desmoid tumours. Recurrence occurred in 26 (72%) cases and the recurrence-free survival was 2.6 (95% confidence interval (CI), 0.2-5.9) years. Thirteen patients received 27 medical treatments over a median 14 months. Objective response was observed in four (15%) patients and the median progression-free survival was nine (95% CI, 1.1-16.9) months. CONCLUSION If confirmed, colectomy (versus proctocolectomy) should be performed in adenomatous polyposis coli-related familial adenomatous polyposis patients to avoid desmoid tumours. We show that there is a high prevalence of post-surgical recurrence and the low efficacy of available medical treatments for desmoid tumours.
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Affiliation(s)
- T Walter
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - C Zhenzhen Wang
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
- Ruijin Hospital, Shanghai Jiaotong University, China
| | - O Guillaud
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - E Cotte
- Surgery Department, Lyon Sud Hospital, Lyon, France
| | - A Pasquer
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - O Vinet
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - G Poncet
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - T Ponchon
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - J-C Saurin
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
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Xuereb S, Xuereb R, Buhagiar C, Gauci J, Magri C. A case report of desmoid tumour-a forgotten aspect of FAP? Int J Surg Case Rep 2016; 30:122-125. [PMID: 28012326 PMCID: PMC5192036 DOI: 10.1016/j.ijscr.2016.11.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Desmoid tumours are locally aggressive tumours which are common in Familial Adenomatous Polyposis (FAP). PRESENTATION OF CASE A 20-year old Familial Adenomatous Polyposis (FAP) patient presented with abdominal pain and distention. Abdominal imaging showed small bowel obstruction and hydronephrosis due to a pelvic mass. This mass showed significant enlargement on repeat imaging, and a diagnostic biopsy confirmed desmoid tumour. The mass was deemed unresectable and he was initially started on sulindac and raloxifene. Repeat imaging however showed further enlargement of the tumour, and therefore vinblastine+methotrexate chemotherapy was commenced, with a good response. DISCUSSION FAP is an autosomal dominant condition caused by a germline mutation in the adenomatous polyposis coli (APC) gene. Gardner's syndrome is also caused by a mutation in the APC gene, and is now considered a different phenotypic presentation of FAP. Desmoid tumours are initially kept under observation while their size remains stable. Treatment options for enlarging desmoids tumours include surgery (first-line), radiotherapy, and systemic therapy with non-cytotoxic and cytotoxic therapy. CONCLUSION FAP patients should be examined regularly post-panprocotocolectomy, since desmoid tumours may arise. The presence of epidermal cysts in this FAP patient suggests a diagnosis of Gardner's syndrome.
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Affiliation(s)
- Sarah Xuereb
- Mater Dei Hospital, Triq Dun Karm, L-Imsida, Malta.
| | | | | | | | - Claude Magri
- Mater Dei Hospital, Triq Dun Karm, L-Imsida, Malta.
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Akhtar MS, Basari R, Khan AH, Khurram MF. Complex reconstruction after wide excision of juvenile aponeurotic fibromatoses of upper one-third of leg. Strategies Trauma Limb Reconstr 2014; 9:117-20. [PMID: 25064092 PMCID: PMC4122677 DOI: 10.1007/s11751-014-0195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 07/17/2014] [Indexed: 11/26/2022] Open
Abstract
Juvenile musculoaponeurotic fibromatoses are benign tumors which arise from musculoaponeurotic stromal cells. They rarely occur in lower extremity and more rarely in children. They are locally invasive tumors with a high incidence of recurrence after surgery. Hence, wide local excision is the treatment of choice for such tumors. However, complex reconstruction is often required to cover the resulting soft tissue defect. This report presents a 12-year-old boy with a juvenile musculoaponeurotic fibromatosis in the anteromedial aspect of the upper third of a left leg. Following wide local excision, two local flaps, medial gastrocnemius and a distally based peroneal artery perforator flap, were used to reconstruct the soft tissue defect. Reconstruction has provided an acceptable functional and cosmetic result.
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Affiliation(s)
- Md Sohaib Akhtar
- Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, UP, India,
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Desmoid tumor occurrence in female siblings not associated with familial adenomatous polyposis: genetic or sporadic form? EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-012-0777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Noormohamed MS, Neophytou C, Jain Y, Rawat S. A 66-year-old male with lower abdominal lump: an unusual presentation of an uncommon abdominal pathology. BMJ Case Rep 2012; 2012:bcr.08.2011.4628. [PMID: 22605811 DOI: 10.1136/bcr.08.2011.4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old Caucasian male was admitted following symptoms of intermittent umbilical pain aggravated after meals and associated with vomiting of contents. Physical examination revealed a tender, partially reducible swelling suspicious of complicated umbilical hernia. Abdominal x-ray revealed dilated small bowel loops which appeared consistent with clinical diagnosis. He underwent a laparotomy subsequently which revealed a small defect in the linea alba with viable small bowel and two firm mesenteric masses encroaching the lumen approximately two feet from the ileocaecal junction. The histology of the excised bowel and masses revealed that the tumour composed of bland spindle cells with slender to plump nuclei and eosinophilic cytoplasm. Mesenteric fibromatosis are the most common primary tumours of the mesentery and constitute about 3.5% of all fibrous tissue tumours. Intra-abdominal desmoids are very rare and benign tumours but are very aggressive and should be considered in the differential diagnosis of acute abdominal pain.
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Mortality of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis: a single center review of 154 patients. Ann Surg 2012; 255:511-6. [PMID: 22323009 DOI: 10.1097/sla.0b013e31824682d4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Intra-abdominal desmoid tumors are one of the leading causes of death in patients with familial adenomatous polyposis. Their behavior is unpredictable and their biology is poorly understood, accounting for the lack of a standardized medical and surgical approach. The aim of this study was to evaluate the mortality rate of patients with intra-abdominal desmoid tumors and to identify prognostic factors for the evolution of the disease. MATERIALS AND METHODS A total of 154 patients with intra-abdominal desmoid tumors were included in the study. Each tumor was staged and each patient was categorized according to the stage of their most advanced tumor. Mortality was analyzed and the univariate risk factors associated with survival were included in a multivariable Cox regression model. A scoring system was derived from the multivariate analysis to refine outcomes within stages. RESULTS Five-year survival of patients with stage I, II, III, and IV intra-abdominal desmoid tumor were 95%, 100%, 89%, and 76% respectively (P < 0.001). Severe pain/narcotic dependency, tumor size larger than 10 cm, and need for total parenteral nutrition were shown to further define survival within stages. Five-year survival rate of stage IV patient with all of the above-mentioned risk factors was only 53%. CONCLUSIONS Our study confirmed the validity of the staging system to predict mortality in patients with intra-abdominal desmoid tumors and identified additional risk factors able to better define the risk of death within each stage. Risk stratification is crucial in directing patients with advanced disease and poor prognosis to the most appropriate medical and surgical options.
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Pajares B, Torres E, Jiménez B, Sevilla I, Rodríguez A, Rico JM, Trigo JM, Alba E. Multimodal treatment of desmoid tumours: the significance of local control. Clin Transl Oncol 2011; 13:189-93. [PMID: 21421464 DOI: 10.1007/s12094-011-0639-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Desmoid tumours are a rare group of tumours arising in the deep musculoaponeurotic structures and although they have no metastatic potential they can be locally aggressive with relapse rates of between 23-40%. Three sub-sites are reported: extra-abdominal, abdominal wall and intra-abdominal. The purpose of this study was to analyze patients with these tumours treated and followed at our institution and to determine factors influencing disease free survival. MATERIAL AND METHODS We conducted a retrospective study of 20 patients treated between 1997 and 2009. Data was compiled to include age, gender, surgical history, familial adenomatous polyposis (FAP), contraceptives, tumour site, first-line treatment, positive margins and adjuvant radiotherapy. A descriptive and survival statistical analysis was also performed. RESULTS Most patients were women, with a median age of 36 years, with abdominal wall involvement and treated with complete surgery without adjuvant radiotherapy. With a median follow-up of 35 months (range 0-188), local control at 5 years for any kind of treatment was 80%. Overall survival (OS) and 5-year progression-free survival (PFS) were 100% and 86%, respectively. CONCLUSION Desmoid tumours are group of rare tumours. Although complete surgical resection remains the cornerstone of treatment for resectable lesions, there is still substantial risk of recurrence. Our outcomes are comparable to those reported in the few series published to date.
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Affiliation(s)
- Bella Pajares
- Department of Clinical Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
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Righetti AEM, Jacomini C, Parra RS, de Almeida ALNR, Rocha JJR, Féres O. Familial adenomatous polyposis and desmoid tumors. Clinics (Sao Paulo) 2011; 66:1839-42. [PMID: 22012061 PMCID: PMC3180149 DOI: 10.1590/s1807-59322011001000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ana Elisa Moraes Righetti
- Division of Coloproctology, Department of Surgery and Anatomy, School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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Affiliation(s)
- Y Wallis
- DNA Laboratory, Regional Genetic Services, Birmingham Heartlands Hospital, Birmingham
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13
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Polat C, Aktepe F, Turel S, Yazicioglu B, Ozkececi T, Arıkan Y. A giant mesenteric fibromatosis case presenting with mechanical intestinal obstruction and successfully resected with partial duodeno-jejunectomy and right hemicolectomy. Clinics (Sao Paulo) 2010; 65:110-3. [PMID: 20126354 PMCID: PMC2815273 DOI: 10.1590/s1807-59322010000100017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Coskun Polat
- General Surgery, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
- , Tel: +90 505 266 45 00
| | - Fatma Aktepe
- Department of Pathology, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
| | - Serkan Turel
- General Surgery, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
| | - Burc Yazicioglu
- General Surgery, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
| | - Taner Ozkececi
- General Surgery, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
| | - Yuksel Arıkan
- General Surgery, Afyon Kocatepe University, Medical Faculty - Afyonkarahisar, Turkey
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Greenberg JA, Somme S, Russnes HE, Durbin AD, Malkin D. The estrogen receptor pathway in rhabdomyosarcoma: a role for estrogen receptor-beta in proliferation and response to the antiestrogen 4'OH-tamoxifen. Cancer Res 2008; 68:3476-85. [PMID: 18451176 DOI: 10.1158/0008-5472.can-07-3046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Highly malignant, RMS frequently fails to respond to conventional aggressive multimodal radiation, surgery, and chemotherapy treatment protocols that also cause significant sequelae in the growing child. Other tumors of mesenchymal origin, such as locally aggressive fibromatoses and desmoid tumors, have been successfully treated with a selective estrogen receptor (ER) modulator, tamoxifen. In an effort to identify new targets for RMS therapy, our group investigated the previously uncharacterized ER pathway in RMS cell culture and primary tumors. We detected ER isoform beta (ER beta), but not isoform alpha, RNA, and protein in five RMS cell lines. Immunohistochemical staining of primary RMS tumor sections confirmed high levels of ER beta but not ER alpha protein. RMS cell growth was dramatically inhibited in steroid-free conditions, and this growth inhibition was rescued with 17-beta-estradiol (E2) supplementation. Exposure of RMS cells to 4'OH-tamoxifen (4OHT) decreased cell viability and inhibited colony formation as detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and colony-forming assays. 4OHT also induced apoptotic signaling in RMS cells as detected by cleavage of caspase-3 and poly(ADP)ribose polymerase. This effect increased 3- to 8-fold in steroid-deprived conditions but was rescued by supplementation with E2. Immunofluorescence studies detected a change in the subcellular localization of ER beta in response to 4OHT. Together, these data suggest an active ER beta-mediated signal transduction pathway in RMS. The ability of 4OHT to induce apoptotic signaling and disrupt estradiol-mediated proliferation provides a rationale to explore a role for selective ER modulators in the treatment of RMS.
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Affiliation(s)
- Joshua A Greenberg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Rampone B, Pedrazzani C, Marrelli D, Pinto E, Roviello F. Updates on abdominal desmoid tumors. World J Gastroenterol 2008. [PMID: 18023087 DOI: 10.3748/wjg.13.5985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.
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Affiliation(s)
- Bernardino Rampone
- Department of General Surgery and Surgical Oncology, Unit of Surgical Oncology, University of Siena, Policlinico Le Scotte, viale Bracci, 1, 53100, Siena, Italy.
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Rampone B, Pedrazzani C, Marrelli D, Pinto E, Roviello F. Updates on abdominal desmoid tumors. World J Gastroenterol 2008; 13:5985-8. [PMID: 18023087 PMCID: PMC4250878 DOI: 10.3748/wjg.v13.45.5985] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.
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Affiliation(s)
- Bernardino Rampone
- Department of General Surgery and Surgical Oncology, Unit of Surgical Oncology, University of Siena, Policlinico Le Scotte, viale Bracci, 1, 53100, Siena, Italy.
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Wcislo G, Szarlej-Wcislo K, Szczylik C. Control of aggressive fibromatosis by treatment with imatinib mesylate. A case report and review of the literature. J Cancer Res Clin Oncol 2007; 133:533-8. [PMID: 17453242 DOI: 10.1007/s00432-007-0198-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There has been only one report available that focuses on the treatment with imatinib mesylate of two individual persons with aggressive fibromatosis. The authors concluded that after long-term treatment, for 9 and 11 months, with imatinib mesylate, both patients demonstrated radiographic and clinical responses. The novel therapy should be considered as salvage in patients with aggressive fibromatosis expressed platelet-derived growth factor receptor-alfa, beta (PDGFR-alfa, PDGFR-beta), and/or c-kit, whose tumors are uncontrollable by the standard management. On the other hand, the number of kinases blocked by imatinib mesylate is notching up, for instance the tyrosine kinase, which is associated with macrophage-colony stimulating factor receptor (M-CSFR). METHODS The patient was suffering from aggressive fibromatosis after prior therapy including surgery (R2), radiotherapy, and systemic treatment with combination of tamoxifen and sulindac. The tumor specimen was immunostained for PDGFR-beta and c-kit (CD117), and PDGFR-alfa and cytokines platelet-derived growth factor-alfa and beta were not assessed. The tests for both assessed molecules revealed negative results. In spite of this, the patient underwent a unique treatment with imatinib mesylate at the dose of 400 mg orally once daily for 3 years and 2 months. RESULTS After three months of the therapy, radiographic (met criteria of SD but small decrease of the tumor was noted) and clinical responses were recorded for the first time. The same was seen after 6 and 13 months of therapy continuation with imatinib mesylate. Currently, the patient is treated with imatinib mesylate (400 mg orally once daily) without any toxicity effects. The last MRI revealed readily a smaller tumor (35 x 20 mm) after such a therapy lasted more than 3 years. CONCLUSIONS Treatment with imatinib mesylate has been a well-accepted therapy for chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). There have been established four kinases (p210(bcr/abl), c-kit, PDGFR-alfa, PDGFR-beta) suggested as the target for imatinib mesylate. Other potential targets will be discovered as it has lately been determined that M-CSFR kinase activity was blocked by imatinib mesylate. The salvage therapy for aggressive fibromatosis with imatinib mesylate seems to be an attractive opportunity for patients with the advanced disease, whose prior therapy failed.
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Affiliation(s)
- Gabriel Wcislo
- Department of Oncology, Military Institute of Medicine, 128 Szaserow Street, 00-909 Warsaw, Poland.
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Ishizuka M, Hatori M, Dohi O, Suzuki T, Miki Y, Tazawa C, Sasano H, Kokubun S. Expression profiles of sex steroid receptors in desmoid tumors. TOHOKU J EXP MED 2007; 210:189-98. [PMID: 17077595 DOI: 10.1620/tjem.210.189] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Desmoid tumors are benign fibrous neoplasms which arise from the fibrous tissue of intra- and extra- abdominal sites, but their clinical management is sometimes difficult because of extensive infiltration into the surrounding tissues. Desmoid tumors commonly occur in women, especially after childbirth. Recently, both clinical and experimental findings indicate the possible roles of sex steroids in the development and progression of desmoid tumors but detailed information is still ambiguous. In this study, we first examined immunoreactivity of sex steroid receptors in desmoid tumors (27 cases) by immunohistochemistry and compared the findings with those in reactive self-limiting lesions associated with fibrosis (8 cases). Estrogen receptor (ER) alpha and ERbeta immunoreactivities were detected in 7.4% (2/27) and 7.4% (2/27) of desmoid tumors, respectively. One desmoid tumor expressed both ERalpha and ERbeta. Progesterone receptor (PR)-A and PR-B were detected in 25.9% (7/27) and 33.3% (9/27), respectively, and androgen receptor (AR) in 52.9% (14/27). In reactive lesions with fibrosis, only AR was detected in 37.5% (3/8). Sex steroid receptor mRNAs was further examined by reverse transcription and polymerase chain reaction (RT-PCR) analysis using fresh frozen tissues, demonstrating the expression of PR (PR-A and/or PR-B) and AR mRNAs in eight desmoid tumors examined and all cases of reactive fibrosis. These results indicate that sex steroid hormones might play an important role in the pathogenesis of desmoid tumors and could lead to the introduction of novel hormone therapeutic approaches in managing patients with recurrent desmoid tumors.
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Affiliation(s)
- Masato Ishizuka
- Department of Orthopedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
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Koh PK, Loi C, Cao X, Cheah PY, Ho KS, Ooi BS, Tang CL, Eu KW. Mesenteric desmoid tumors in Singapore familial adenomatous polyposis patients: clinical course and genetic profile in a predominantly Chinese population. Dis Colon Rectum 2007; 50:75-82. [PMID: 17082890 DOI: 10.1007/s10350-006-0759-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study examined the mutational profile of the adenomatous polyposis coli gene in relation to the development of desmoid tumors in familial adenomatous polyposis patients from a predominantly Chinese population. METHODS This is a retrospective review of all patients with familial adenomatous polyposis coli from the Singapore Polyposis Registry. Identification of specific adenomatous polyposis coli gene mutation was performed and clinical course of associated desmoid disease obtained from case records and a computerized database. RESULTS Two hundred five patients from 75 families afflicted with familial adenomatous polyposis coli were reviewed, with gene mutations identified in 107 patients. Of these, 23 (11.2 percent) developed desmoids. The male-to-female ratio was 1:1.3 and the ethnic distribution was Chinese (n=17) and Malay (n=6). Of the 92 patients with mutations 5' to codon 1444, 11 patients (12 percent) developed desmoids compared with 6 of 15 (40 percent) patients with adenomatous polyposis coli gene mutations 3' to codon 1444 (P<0.01). The clinical course of desmoid tumors can be divided into stable (n=11), variable (n=3), progressive (n=6), and aggressive growth (n=3). Only 3 (13 percent) patients with aggressive tumor growth required chemotherapy. There was no correlation between the site of mutation and the clinical progression of the desmoids. Seventy-four percent of these desmoids (17/23) developed at a mean interval of 2.98 years after restorative proctocolectomy, while only 30 percent (7/23) were diagnosed preoperatively or discovered during the initial surgery. The most common complications related to the mesenteric desmoids were intestinal obstruction (21.7 percent), ureteric obstruction (17.4 percent), and encasement of superior mesenteric vessels (13 percent). CONCLUSION The clinical course of desmoids in an individual familial adenomatous polyposis patient remains unpredictable and no reliable genetic marker is available for prognostication in desmoid disease.
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Affiliation(s)
- Poh-Koon Koh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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20
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Abstract
Desmoid tumours are rare neoplasms of fibroblastic origin which arise with disproportionate frequency in patients with familial adenomatous polyposis (FAP). They are thought to develop in about 10-25% of FAP patients and may be the leading cause of death amongst those who have undergone colectomy. Risk factors include trauma, having a distal germline APC mutation, having a family history of desmoids, and probably oestrogens. In very high-risk individuals there may be a case for delay of colectomy or chemoprophylaxis at the time of surgery. Desmoids are now known to be true neoplasms but with normal telomere length and telomerase activity. FAP-associated tumours seem to carry biallelic APC mutations, one of which lies in the distal part of the gene. Such loss of wild-type APC seems to occur relatively late in tumour development. It is likely that beta-catenin plays an important role in tumourigenesis. FAP-associated desmoids tend to arise in the abdomen or abdominal wall. CT scanning gives the best information on tumour anatomy whilst T2-weighted MRI indicates likely behaviour. Treatment may simply consist of observation. Otherwise, usual first-line therapy is with sulindac with or without an anti-oestrogen. Cytotoxic chemotherapy is an option in unresectable tumours. Surgery is a reasonable first-line treatment in abdominal wall tumours but is risky for intra-abdominal tumours and may necessitate massive small bowel resection. Desmoids are the greatest remaining challenge in the management of FAP and further research into their aetiology needs to be combined with multicentre clinical trials of new treatments in order to improve management of the disease.
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Affiliation(s)
- N Julian H Sturt
- Polyposis Registry, Cancer Research UK Colorectal Cancer Unit, St Mark's Hospital, HA1 3UJ, Harrow, UK
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21
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Moreno J, Burgos J, López-Duque J, Rodríguez L, Díeza J, Herruzo A. Fibromatosis mamaria en paciente con tumorectomía previa. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2006. [DOI: 10.1016/s0210-573x(06)74113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Holubar S, Dwivedi AJ, O'Connor J. Giant Mesenteric Fibromatosis Presenting as Small Bowel Obstruction. Am Surg 2006. [DOI: 10.1177/000313480607200512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mesenteric fibromatosis is a proliferative fibroblastic neoplasia of the small intestine mesentery that may occur as a unique or multiple formation. Mesenteric fibromatosis is a rare, locally aggressive neoplasm and may present with abdominal discomfort, abdominal pain, weight loss, or symptoms of ureteral obstruction, mesenteric ischemia, or intestinal obstruction. It is of the utmost importance to distinguish mesenteric fibromatosis from gastrointestinal stromal tumors. Histopathology accurately differentiates between these two distinct entities. The preferred treatment is local surgical excision with a margin of uninvolved tissue. The involvement of important structures like the superior mesenteric artery and the superior mesenteric vein may pose a challenge during resection, but these tumors can be excised and the vessels repaired primarily.
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Affiliation(s)
- Stefan Holubar
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
| | - Amit J. Dwivedi
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
| | - James O'Connor
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
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23
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Cholongitas E, Koulenti D, Panetsos G, Kafiri G, Tzirakis E, Thalasinou P, Papatheodoridis GV. Desmoid tumor presenting as intra-abdominal abscess. Dig Dis Sci 2006; 51:68-9. [PMID: 16416214 DOI: 10.1007/s10620-006-3086-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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24
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Soon JL, Lau WKO, Seow-Choen F, Cheng CWS. Unresectable desmoid tumours causing obstructive uropathy in familial adenomatous polyposis. Asian J Surg 2005; 28:233-7. [PMID: 16024324 DOI: 10.1016/s1015-9584(09)60351-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Desmoid tumour-related ureteral obstruction in familial adenomatous polyposis presents difficult management problems. Its role in altering prognosis for the worse in young patients has been neglected. Two patients are reported and 14 cases in the literature reviewed. Both our patients developed intra-abdominal desmoid tumours following proctocolectomies with pouch reconstruction (performed 0.7 and 2.5 years earlier). Despite therapy with sulindac and tamoxifen, both suffered progressive ureteral obstruction that required initial percutaneous drainage. Ureteral stenting was effective and safe in both patients (10 and 18 months' follow-up, respectively), but the long-term outcome awaits assessment. The optimal regimen of adjuvant medical therapy is uncertain. Successful renal autotransplantation and combination chemotherapy have been tried after failure of conventional therapy.
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Affiliation(s)
- Jia Lin Soon
- Department of Urology, Singapore General Hospital, Singapore
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Affiliation(s)
- Anders Merg
- Roswell Park Cancer Center, Buffalo, New York, USA
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26
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Abstract
Mesenteric fibromatosis (MF) is a rare, benign tumor commonly associated with Gardner's syndrome. The signs and symptoms in patients with MF are insidious. Patients may present with abdominal pain or discomfort when the tumors reach large sizes, which is typical at the time of diagnosis. Differentiating MF from other neoplasms such as gastrointestinal stromal tumors may present a diagnostic dilemma, especially in patients without any history of familial adenomatous polyposis. In the present report, we discuss a young girl who presented with MF. A pertinent review of the literature is also presented. This case is peculiar in that MF presented at a young age in a patient without history of familial adenomatous polyposis and occurred in the omentum with local invasion to the stomach.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of California, Irvine, Orange, CA 92868, USA.
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27
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Picariello L, Tonelli F, Brandi ML. Selective oestrogen receptor modulators in desmoid tumours. Expert Opin Investig Drugs 2005; 13:1457-68. [PMID: 15500393 DOI: 10.1517/13543784.13.11.1457] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Selective oestrogen receptor modulators (SERMs) are compounds with a mixed agonist/antagonist activity on oestrogen receptors. An ideal SERM is a compound with an oestrogen antagonist effect on the breast and uterus but oestrogen agonist effect on bone. Beside tamoxifen, a group of well-investigated SERMs is represented by raloxifene, LY-353381 (SERM3), EM-800 and CP-336156. On an empirical basis, tamoxifen has been used to pharmacologically treat desmoid tumours. Recently, raloxifene, a second-generation SERM, has been used in the treatment of familial adenomatous polyposis patients affected by desmoid tumour. The mechanisms through which these molecules affect desmoid tumour growth appear to be due, in part, to the fact that SERMs may act independently of oestrogen receptors. The knowledge of the molecular basis of SERM action will make the development of novel synthetic compounds with engineered tissue selectivity possible.
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Affiliation(s)
- Lucia Picariello
- Department of Clinical Physiopathology, University of Florence, Italy
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28
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Cotte E, Glehen O, Monneuse O, Cotton F, Vignal J. Tumeurs desmoïdes associées à la polypose adénomateuse familiale. ACTA ACUST UNITED AC 2004; 28:574-81. [PMID: 15243391 DOI: 10.1016/s0399-8320(04)95014-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eddy Cotte
- Service de chirurgie viscérale et thoracique, Centre Hospitalier Universitaire Lyon Sud, 69495 Pierre Bénite
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29
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Campos FG, Habr-Gama A, Kiss DR, Atuí FC, Katayama F, Gama-Rodrigues J. [Extracolonic manifestations of familial adenomatous polyposis: incidence and impact on the disease outcome]. ARQUIVOS DE GASTROENTEROLOGIA 2004; 40:92-8. [PMID: 14762478 DOI: 10.1590/s0004-28032003000200006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Familial adenomatous polyposis is a hereditary disease with autossomic and dominant features, frequently associated to many extracolonic manifestations. AIM To report extracolonic manifestations incidence and to analyze its impact on the disease's outcome. PATIENTS AND METHODS Revision of patient charts treated from 1977 to 2001, relating associated extracolonic manifestations and its complications. RESULTS Among 59 familial adenomatous polyposis patients, 23 (38,9%) presented some extracolonic manifestations at diagnosis or during follow-up. There were registered 37 different extracolonic manifestations (1.6 per patient). The most common manifestations were osteomas and congenital hypertrophy of the retinal pigment epithelium, diagnosed in 25% and 20% of the investigated patients, respectively. Other extracolonic manifestations were represented by upper digestive adenomas, epidermoid cysts, desmoid tumor (seven each), gastric cancer (three) and tireoid cancer (two). Desmoid-associated complications were reported in six patients, being intestinal obstruction in four and hidronephrosis in two; two deaths (28,5%) were registered. CONCLUSIONS Extracolonic manifestations incidence is high (40%) and may affect disease's outcome and patient's quality of life. For these reasons, the research, prevention and adequate treatment of extracolonic manifestations turn into vital importance in familial adenomatous polyposis patients.
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Affiliation(s)
- Fábio Guilherme Campos
- Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São paulo, Brasil.
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30
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Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003; 14:181-90. [PMID: 12562642 DOI: 10.1093/annonc/mdg064] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite the use of surgery and radiotherapy, 20-35% of patients with aggressive fibromatosis (AF) will have local recurrence. The purpose of this review was to collect and analyze all available information regarding the role of non-cytotoxic and cytotoxic chemotherapy in AF that has been accumulated over the past few decades. PATIENTS AND METHODS A systematic review of published clinical trials, studies and case series was carried out using the Medline Express Databases and the Cochrane Collaboration Database from 1970 to October 2000. RESULTS Most studies published in the literature are in the form of successful case reports and single-arm series with small patient numbers. Most commonly used agents include hormonal agents, non-steroidal anti-inflammatory drugs (NSAIDs), interferons and cytotoxics. The literature data support the use of hormonal agents. Several questions, however, remain unresolved, such as which is the most suitable endocrine manipulation and what is the optimal dose and duration of treatment. NSAIDs and interferons have demonstrated activity against AF either alone or in combination with hormone therapy or chemotherapy but the precise mechanism of action is still unknown. Finally, there is growing evidence in the literature that chemotherapy is effective against AF with almost one in two patients being likely to respond. CONCLUSIONS The evidence in the literature supports the opinion that both non-cytotoxic and cytotoxic chemotherapies are effective against AF. However, the lack of sufficient patient numbers and randomized trials compromises the validity of the reported results and mandates further investigation with properly designed prospective studies including larger patient numbers, with main end points to include not only tumor response rate and survival but also quality-of-life issues.
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Affiliation(s)
- J Janinis
- Social Security Organization Oncology Center, Kifissia, Greece.
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31
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Lilli C, Marinucci L, Bellocchio S, Ribatti D, Balducci C, Baroni T, Cagini L, Giustozzi G, Locci P. Effects of transforming growth factor-beta1 and tumour necrosis factor-alpha on cultured fibroblasts from skin fibroma as modulated by toremifene. Int J Cancer 2002; 98:824-32. [PMID: 11948458 DOI: 10.1002/ijc.10306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To determine how toremifene, an anti-oestrogen triphenylethylene derivate, reduces tumour mass, we investigated its modulation of TGF-beta1 and TNF-alpha in fibroma fibroblasts. Normal and fibroma fibroblasts, isolated from patients affected by Gardner's syndrome without or with fibroma manifestation, were cultured in vitro. Secretion of GAG, collagen and TGF-beta1 was increased in fibroma fibroblasts compared to healthy cells. The increase in TGF-beta1 secretion into the medium was associated with a parallel increase in TGF-beta1 gene expression and receptor number. Receptor cross-linking studies using radiolabelled TGF-beta1 revealed more receptors, particularly types I and II, in fibroma fibroblasts than in normal cells. Normal and fibroma fibroblasts did not synthesise TNF-alpha, but they had TNF-alpha membrane receptors, as shown by TNF-alpha assay. TNF-alpha secreted by human monocytes, which may be present in the peritumoral area, increased cell proliferation and GAG accumulation and was, in turn, enhanced by TGF-beta1 treatment. Both growth factors increased angiogenesis, as shown by the CAM assay. Toremifene reduced TGF-beta1 secretion by fibroma fibroblasts and TNF-alpha secretion by monocytes, thus downregulating cell proliferation, ECM macromolecule accumulation and angiogenic progression. We hypothesise that increased TGF-beta1 gene expression and TGF-beta1 secretion in fibroma fibroblasts as well as the subsequent rise in TNF-alpha production by monocytes may facilitate fibroma growth and that toremifene inhibits autocrine and paracrine growth factor production.
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Affiliation(s)
- Cinzia Lilli
- Department of Experimental Medicine and Biochemical Science, University of Perugia, Perugia, Italy
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32
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Abstract
Desmoid tumours exhibit fibroblastic proliferation and arise from fascial or musculoaponeurotic structures. Despite their benign microscopic appearance, and their negligible metastatic potential, the propensity of desmoid tumours for local infiltration is potentially significant in terms of deformity, morbidity and mortality due to pressure effects and obstruction of vital structures and organs. The rarity of desmoid tumours, coupled with the variability in their clinical course, renders these lesions a vexing entity, and makes demonstration of the efficacy of any specific intervention difficult. Failure to recognize the potential for malignant behaviour in this tumour renders desmoids susceptible to inadequate treatment. This distinct pathological entity is reviewed with a specific focus on aetiology and treatment.
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Affiliation(s)
- C J Shields
- Department of Academic Surgery, National University of Ireland, Wilton, Cork, Ireland
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Wehrli BM, Weiss SW, Yandow S, Coffin CM. Gardner-associated fibromas (GAF) in young patients: a distinct fibrous lesion that identifies unsuspected Gardner syndrome and risk for fibromatosis. Am J Surg Pathol 2001; 25:645-51. [PMID: 11342777 DOI: 10.1097/00000478-200105000-00012] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gardner syndrome (GS), caused by mutations in the adenomatous polyposis coli (APC) gene, is characterized by polyposis coli, osteomas, and various soft-tissue tumors. If undetected or untreated, virtually all patients develop colonic carcinoma at a young age. Early detection, while essential, can be difficult because of attenuated phenotypes or spontaneous mutations. We present the clinicopathologic features of 11 identical fibromatous lesions that we have termed Gardner-associated fibroma (GAF), which not only appear to be a part of the spectrum of lesions associated with GS but, in some cases, represent the sentinel event leading to its detection. The GAFs occurred in 11 patients (5 boys and 6 girls; age range, 3 months-14 years), were solitary (n = 7) or multiple (n = 4), and occurred in the superficial and deep soft tissues of the paraspinal region (n = 7), back (n = 3), face (n = 2), scalp (n = 2), chest wall (n = 2), thigh (n = 1), neck (n = 1), and flank (n = 1). Histologically, GAFs resemble nuchal-type fibromas (NFs), consisting of thick, haphazardly arranged collagen bundles between which are found occasional bland fibroblasts, and having margins that frequently engulf surrounding structures including adjacent fat, muscle and nerves. After surgical excision, four patients developed recurrences that were classic desmoid fibromatoses (DFs). In one patient with multiple GAFs, one lesion had the features of GAF and DF in the absence of surgical trauma. A family history of GS or polyposis (n = 6) or DF (n = 1) was known at the time of surgery in seven patients. In three patients, the diagnosis of GAF resulted in the diagnosis of unsuspected APC in older family members, with the detection of an occult colonic adenocarcinoma in one parent. In the family of the remaining patient, no stigmata of GS were present. Genetic analysis of this child was performed to investigate the presence of a spontaneous (new) mutation; however, no abnormalities were detected. The significance of GAF is that it serves as a sentinel event for identifying GS kindreds, including those with a high risk for the development of DF, and it may potentially identify children with spontaneous mutations of the APC gene. Because NFs and GAFs resemble one another, we suggest that a subset of NF occurring in multiple sites, unusual locations, or children may be GAF.
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Affiliation(s)
- B M Wehrli
- Department of Pathology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Chatzipetrou MA, Tzakis AG, Pinna AD, Kato T, Misiakos EP, Tsaroucha AK, Weppler D, Ruiz P, Berho M, Fishbein T, Conn HO, Ricordi C. Intestinal transplantation for the treatment of desmoid tumors associated with familial adenomatous polyposis. Surgery 2001; 129:277-81. [PMID: 11231455 DOI: 10.1067/msy.2001.110770] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Desmoid tumors associated with familial adenomatous polyposis (FAP) are locally invasive. Often occurring in the mesentery of the intestine, they sometimes recur after resection. Complications can include intestinal failure and dependence on parenteral nutrition. We describe 9 patients who underwent intestinal transplantation for the treatment of desmoid tumors associated with FAP. METHODS Records of patients undergoing intestinal transplantation for desmoid tumors at 2 transplant centers were reviewed for patient age, sex, type of graft, procedure date, tumor site, desmoid complications, medications, extracolonic manifestations, status at follow-up, and length of survival. RESULTS Nine patients with FAP and intestinal failure caused by desmoid tumors were treated with isolated intestinal (n = 6), multivisceral (n = 2), or combined liver-intestinal transplantation (n = 1). Desmoid tumors recurred in the abdominal walls of 2 patients. Two patients died: one as a result of sepsis, the other because of a rupture of a mycotic aneurysm of the aortic anastomosis. One graft lost to severe rejection was replaced with a second intestinal graft. Eleven to 53 months after transplantation, 7 patients were alive, well, independent of parenteral treatment, and leading apparently normal lifestyles. CONCLUSIONS Transplantation of the intestine alone or as part of a multivisceral transplantation may help rescue otherwise untreatable patients with complicated desmoid tumors.
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Affiliation(s)
- M A Chatzipetrou
- Department of Surgery, Division of Liver and GI Transplant, University of Miami School of Medicine, FL 33136, USA
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Hyodo M, Yumoto E, Wakisaka H, Mori T, Takada K. Gastric scirrhous carcinoma as a rare cause of aggressive fibromatosis in the neck. Am J Otolaryngol 2001; 22:38-42. [PMID: 11172213 DOI: 10.1053/ajot.2001.20697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aggressive fibromatosis is characterized by locally aggressive proliferation of fibroblasts and occasionally occurs in the head and neck. Although the etiology of this disease is still controversial, recent studies have shown that high levels of growth factors are found in these lesions. This article reports a case of 51-year-old woman with aggressive fibromatosis in the neck and inguinal region bilaterally. Gastric fiberscopic examination revealed a complication of advanced gastric scirrhous carcinoma. There were remarkably high levels of basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) in the serum. Postmortem autopsy examination was performed and scattered gastric carcinoma cells were observed in the fibromatosis lesions. Immunohistological staining showed positive expression of bFGF in the fibromatoses and stomach. We concluded that this was a rare case in which bFGF and PDGF released from gastric carcinoma cells caused aggressive fibromatosis by promoting unregulated proliferation of fibroblasts and collagen production locally.
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Affiliation(s)
- M Hyodo
- Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan
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Middleton SB, Fidler K, Hyer W, Phillips RK. Familial adenomatous polyposis complicated by an intrahepatic desmoid tumor: report of a case. Dis Colon Rectum 2000; 43:1012-4. [PMID: 10910252 DOI: 10.1007/bf02237369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Desmoids are uncommon proliferations of fibroblasts that occur with disproportionate frequency in patients with familial adenomatous polyposis. They do not metastasize and are histologically benign. Despite this, the unpredictable and often aggressive nature of familial adenomatous polyposis-associated desmoids and their tendency to occur in intra-abdominal sites means that they present a difficult management problem, and they are a leading cause of death in patients with familial adenomatous polyposis who have undergone colectomy. We report a case of a patient with familial adenomatous polyposis who had extensive and aggressive desmoid disease and whose management was further complicated by a large intrahepatic desmoid. There are no previous reports of desmoids occurring in the liver.
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Affiliation(s)
- S B Middleton
- Polyposis Registry, Imperial Cancer Research Fund Colorectal Cancer Unit, St. Mark's Hospital, London, United Kingdom
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37
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Church JM, McGannon E. Prior pregnancy ameliorates the course of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis. Dis Colon Rectum 2000; 43:445-50. [PMID: 10789737 DOI: 10.1007/bf02237185] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Intra-abdominal desmoid tumors occur in 12 percent of patients with familial adenomatous polyposis. A minority grow quickly and are lethal, most are relatively inert, and some cause problems by obstructing adjacent organs. Desmoid tumors may be estrogen-dependent, and estrogen-blocking drugs are part of the usual treatment of these tumors. This study was performed to examine the effect of pregnancy on the course of patients with familial adenomatous polyposis and intra-abdominal desmoids. METHODS All females with familial adenomatous polyposis and an intra-abdominal desmoid treated or followed up at this institution were eligible. Stable, asymptomatic desmoids were followed up yearly with examination and CT scan. Growing or symptomatic desmoids were followed up at least every six months. Maximum tumor size was grouped as follows: <10 cm, 10 to 20 cm, and >20 cm. A change in tumor size was defined as a change of +/-50 percent or more of maximum diameter. Stable tumors showed no change in diameter during the study period; variable growth was defined as a significant change in either direction that was followed by a return to previous dimensions or a stabilization of growth. Rapid growth was a doubling of diameter within three months. Pregnant females were compared with nonpregnant females. Subgroups of females were matched for age at diagnosis of desmoid. RESULTS Twenty-two females had never been pregnant, whereas 25 had been pregnant at least once. Eleven pairs were matched for age. There were no differences between groups in the incidence of extracolonic manifestations of familial adenomatous polyposis, family history of desmoids, number or type of surgeries done for familial adenomatous polyposis, length of follow-up, or time from surgery to desmoid diagnosis. Desmoids in pregnant females had a significantly more benign course: 18 were stable (vs. 6 nonpregnant females), 2 had variable growth (vs. 10), 1 had rapid growth (vs. 5), and 4 disappeared (vs. 1). There were also trends to smaller, less symptomatic tumors requiring treatment less often in pregnant females. CONCLUSIONS Pregnancy seems to ameliorate the course of abdominal desmoid tumors significantly in females with familial adenomatous polyposis. This finding raises questions about the most appropriate hormonal treatment for these tumors. Perhaps progesterone or prolactin therapy should be tried, alone or in combination with estrogen. If further studies confirm these findings, females with a family history of desmoid tumors should not be advised against pregnancy.
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Affiliation(s)
- J M Church
- David G. Jagelman Inherited Colorectal Cancer Registries, Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio, USA
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38
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Kulaylat MN, Karakousis CP, Keaney CM, McCorvey D, Bem J, Ambrus JL. Desmoid tumour: a pleomorphic lesion. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1999; 25:487-97. [PMID: 10527597 DOI: 10.1053/ejso.1999.0684] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Desmoid tumour (DT) is an uncommon locally invasive non-metastasizing neoplastic lesion. The aetiology of this tumour is unknown and its treatment is controversial. Twelve cases of DT are presented and the literature is reviewed. METHODS Twelve cases of DT treated at our institution during a 3.5-year period are analysed and the literature reviewed. Ten patients were referred with a primary tumour, one with local recurrence and one patient with a second primary desmoid tumour. One patient had multiple mesenteric DT (familial adenomatous polyposis coli-FAP), and in the remaining 11 patients the tumour was located in the abdominal wall in four, at an extremity in three, in the upper back in two patients, in the pelvis in one and retroperitoneally in one. RESULTS The largest mesenteric DT was marginally excised en bloc with total jejunectomy. In the remaining 11 DT, complete excision to microscopically tumour-free margins was possible in nine cases and to microscopically involved margins in two cases. At a mean follow-up of 22 months (range 7-38 months), one patient was alive with stable disease (Gardner's syndrome), 10 patients were alive and free of recurrence and one patient (9%) developed local recurrence which was re-excised-she is disease-free 10 months later. CONCLUSIONS Complete excision is the main modality of treatment for primary and recurrent DT. This is feasible in most cases except for tumours involving the base of the bowel mesentery. Surgical resection alone achieved local control of the tumour in most of the patients in this series (92%).
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Affiliation(s)
- M N Kulaylat
- State University of New York at Buffalo, Erie County Medical Center, Buffalo, New York 14215, USA
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Total reconstruction of the femoral canal and the inguinal wall after resection of a recurrent desmoid tumor. Hernia 1999. [DOI: 10.1007/bf01195317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Affiliation(s)
- J G Guillem
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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41
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Ozuner G, Hull TL. Familial desmoids in association with adrenal and ovarian masses and leiomyomas: report of three cases. Dis Colon Rectum 1999; 42:529-32. [PMID: 10215057 DOI: 10.1007/bf02234182] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Desmoid tumors are rare occurrences. However, they are more commonly seen in patients with familial adenomatous polyposis. The purpose of this article is to review three cases of abdominal desmoids in association with adrenal, ovarian masses, leiomyoma, and neurologic involvement in three sisters with familial adenomatous polyposis. METHOD A case study was done of these sisters, their siblings, and their parents. RESULTS All three sisters had desmoid tumors and no evidence of familial adenomatous polyposis. All three sisters had ovarian pathology, two had adrenal masses, one had a fibroadenoma of the breast, one had a leiomyoma of the stomach, and two had neurologic involvement. Additionally, male siblings, parents, and grandparents had no evidence of desmoids or familial adenomatous polyposis. CONCLUSION This constellation of symptoms in the affected sisters may reflect a separate gene defect predisposing to desmoid tumors or a varying expression of the adenomatous polyposis coli gene.
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Affiliation(s)
- G Ozuner
- Good Samaritan Hospital, Suffern, New York, USA
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Iwama T, Konishi M, Iijima T, Yoshinaga K, Tominaga T, Koike M, Miyaki M. Somatic mutation of the APC gene in thyroid carcinoma associated with familial adenomatous polyposis. Jpn J Cancer Res 1999; 90:372-6. [PMID: 10363573 PMCID: PMC5926080 DOI: 10.1111/j.1349-7006.1999.tb00757.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report the existence of both germline and somatic mutations of the APC gene in thyroid carcinomas from familial adenomatous polyposis (FAP) patients. One papillary thyroid carcinoma from a 210-year-old woman, with germline mutation of the APC gene (TCA to TGA at codon 1110), showed a somatic mutation of AAAAC deletion between codons 1060 and 1063. Another somatic mutation of CAG to TAG at codon 886 was also found in one of multiple thyroid carcinomas from a 26-year-old woman with attenuated FAP and germline mutation at codon 175 (C deletion). This is the first evidence that total absence of the normal function of the APC gene is involved in development of thyroid carcinomas in FAP.
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Affiliation(s)
- T Iwama
- Department of Surgery, Kyoundo Hospital, Sasaki Institute, Tokyo
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Simpson JL, Petropolis AA, Styles AR, Zabawski EJ, Cockerell CJ. Extra-abdominal desmoid tumor: an unusual subcutaneous lesion presenting as shoulder pain. Int J Dermatol 1998; 37:780-4. [PMID: 9802690 DOI: 10.1046/j.1365-4362.1998.00538.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J L Simpson
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA
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Delpla PA, Rouge D, Durroux R, Rouquette I, Arbus L. Soft tissue tumors following traumatic injury: two observations of interest for the medicolegal causality. Am J Forensic Med Pathol 1998; 19:152-6. [PMID: 9662111 DOI: 10.1097/00000433-199806000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of tumors of the soft tissues developing at the site of a previous traumatic injury occurring a few years earlier are reported. One was finally diagnosed as aggressive fibromatosis and the other as low-grade fibrosarcoma. Among the pathogenic mechanisms and the etiologic factors involved in such tumors, the posttraumatic causality is discussed, and in addition to the initial trauma, the role of iterative surgery in the first case and mineral muscular inclusions in the second case are examined. The different therapeutic approaches of such lesions are also reviewed.
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Affiliation(s)
- P A Delpla
- Unité Médico-Judiciaire, CHU Rangueil, Toulouse, France
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Chen YJ, Tam KW, Chen CS, Wu CH, Chen SC, Chan WP, Fang CL, Liu JD, Pan S. Case report: Spontaneous isolated mesenteric fibromatosis presenting as megaduodenum. J Gastroenterol Hepatol 1998; 13:383-6. [PMID: 9641301 DOI: 10.1111/j.1440-1746.1998.tb00650.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
A case of spontaneous isolated mesenteric fibromatosis presenting as megaduodenum is reported. The lesion was small, only 2 cm in its greatest diameter. However, because of its location near the ligament of Treitz and because of its characteristic infiltrative growth pattern, the tumour involved the distal duodenum and resulted in acute angulation and obstruction early in its course. We successfully resected the mass and the patient is in fair physical condition 6 months after operation.
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Affiliation(s)
- Y J Chen
- Department of Surgery, Taipei Medical College Hospital, Taiwan.
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Affiliation(s)
- G E Tomlinson
- University of Texas Southwestern Medical Center, Department of Pediatrics, Dallas 75235-9063, USA
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Avisse C, Elbaz M, Pluot M, Flament JB. Desmoid tumor of the abdominal wall: Report of seven cases. Hernia 1997. [DOI: 10.1007/bf01234752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Antiestrogens and nonsteroidal antiinflammatory drugs have been shown to be effective in adult patients with unresectable or recurrent desmoid tumors. It appears that the growth of these tumors is influenced by estrogen, and that antiestrogen treatment may inhibit further proliferation of tumor cells. Nonsteroidal antiinflammatory drugs are thought to be effective through their interference with prostaglandin metabolism. METHODS Two children with unresectable desmoid tumors (aggressive fibromatosis) were treated with tamoxifen (1 mg/kg orally, twice daily) and diclofenac (2 mg/kg rectally, twice daily). RESULTS At last follow-up, tumor regression and growth arrest were maintained for more than 51 months in 1 child with rapidly growing recurrent fibromatosis of the thoracic wall. Another child with an inoperable desmoid tumor of the submandibular region had stable disease since the initiation of treatment. CONCLUSIONS This is the first report describing this treatment approach in childhood fibromatosis. Combined therapy with endocrine therapy and nonsteroidal antiinflammatory drugs may be a nonaggressive alternative to chemotherapy and radiotherapy in the treatment of children with inoperable desmoid tumors.
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Affiliation(s)
- H Lackner
- Department of Pediatrics, University of Graz, Austria
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Abstract
Clinical desmoid disease affect approximately 10 per cent of patients with familial adenomatous polyposis (FAP); the subclinical rate is unknown. Desmoids are probably neoplastic rather than regenerative in origin and may arise in association with germline or somatic mutations at or beyond codon 1444 of the APC gene. Intra-abdominal desmoids behave unpredictably but are an important cause of death in those with FAP. Signal intensity on magnetic resonance imaging reflects tumour cellularity, which in part determines progression, and this may help management. Surgical treatment of advanced desmoids is hazardous, but medical treatments have limited success. Chemotherapy with doxorubicin and dacarbazine is currently under evaluation.
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Affiliation(s)
- S K Clark
- Polyposis Registry, St Mark's Hospital, Harrow, Middlesex, UK
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Serpell JW, Paddle-Ledinek JE, Johnson WR. Modification of growth of desmoid tumours in tissue culture by anti-oestrogenic substances: a preliminary report. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:457-63. [PMID: 8678875 DOI: 10.1111/j.1445-2197.1996.tb00782.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tamoxifen and toremifene have been used in patients with advanced desmoid tumours with response rates of 51%. METHODS We developed an experimental model of desmoid tumour cells in tissue culture to study their effect. Four cell lines were established in tissue culture. All native and corresponding cultured tumours were oestrogen receptor negative. Tumour 1 was from a 22 year old with familial adenomatous polyposis (FAP) and recurrent abdominal wall desmoid tumours. She remains disease free on tamoxifen 4 years following surgery. Both her mother and sister also have shown regression of their FAP-associated desmoid tumours at the menopause and on tamoxifen, respectively. We assessed the effect of tamoxifen on desmoid tumours in tissue culture at 780 ng/mL. The results were assessed by cell density counting. RESULTS Tumours 1 and 2 have responded with an approximately. 50% reduction in growth to tamoxifen at 780 ng/mL. CONCLUSIONS This apparent growth inhibitory effect of tamoxifen on two desmoid tumour cell lines appears to be independent of oestrogen and correlates with the in vivo effect of tamoxifen on three desmoid tumours in an FAP family.
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Affiliation(s)
- J W Serpell
- Department of Surgery, Monash University, Alfred Hospital, Prahran, Australia
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