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Brown HG, Torres BS, Nuñez J, Wong RJ, Hajjar FM, Abongwa C, Sawh-Martinez RF, Lopez J. Total Resection of Pediatric Desmoid Tumor of the Left Neck with Utilization of 3D Virtual Surgical Planning. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5763. [PMID: 38784831 PMCID: PMC11111389 DOI: 10.1097/gox.0000000000005763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/06/2024] [Indexed: 05/25/2024]
Abstract
A 13-year-old girl with a painful left neck mass was referred to our institution due to suspicions of malignancy. The patient reported pain that accompanied her frequent neck spasms. Computed tomography revealed a large, soft-tissue mass in the left neck, deep to the sternocleidomastoid. The lesion anteriorly displaced the internal carotid artery and both displaced and crushed the internal left jugular vein. Uniquely, a three-dimensional virtual reality model combining magnetic resonance imaging and computed tomography data was used to determine the lesion's resectability and visualize which structures would be encountered or require protection while ensuring total resection. During operation, we confirmed that the mass also laterally displaced the brachial plexus, cranial nerves X and XI, and spinal nerves C3-C5 (including the phrenic) of the cervical plexus. Postsurgical pathological analysis confirmed a diagnosis of desmoid tumor, also known as aggressive fibromatosis, whereas DNA sequencing revealed a CTNNB1 mutation, a somatic genetic marker found in approximately 90% of desmoid tumor cases. When possible, the most widely used method for the treatment of desmoid tumors has been gross resection. Chemotherapy, radiotherapy, and local excision are also used in the treatment of fibromatoses when complete resection is judged infeasible. In this case, a complete surgical resection with tumor-free surgical margins was performed. A standard cervical approach with a modified posterolateral incision site was implemented to avoid a conspicuous anterior neck scar. No flap, nerve repair, or reconstruction was warranted. At 1 year of postsurgical follow-up, the patient showed minimal scarring and no signs of recurrence.
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Affiliation(s)
- Hannah G. Brown
- From University of Central Florida, College of Medicine, Orlando, Fla
| | | | - Julisa Nuñez
- Georgetown University, School of Medicine, Washington, D.C
| | - Richard J. Wong
- Head and Neck Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Fouad M. Hajjar
- Pediatric Medical Oncology, AdventHealth for Children, Orlando, Fla
| | - Chenue Abongwa
- Pediatric Medical Oncology, AdventHealth for Children, Orlando, Fla
| | | | - Joseph Lopez
- Pediatric Head & Neck Surgery, Department of Pediatric Surgery, AdventHealth for Children, Orlando, Fla
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2
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Kasliwal A, Ahuja P, Jain K. Desmoid Fibromatosis of Maxillary Sinus Masquerading as Nasal Polyp: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1355-1360. [PMID: 38440630 PMCID: PMC10909069 DOI: 10.1007/s12070-023-04347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 03/06/2024] Open
Abstract
Desmoid fibromatosis is also known as aggressive fibromatosis. It is a neoplastic monoclonal proliferation of fibroblasts, with an incidence of 2 to 4 per million per year. Its incidence peaks at 8 years of age and in the third/fourth decades of life. Here we discussed a patient in third decade of life who presented with unilateral nasal blockage with a picture suggestive of sinonasal polyposis on examination. On histopathology, he was diagnosed with Desmoid fibromatosis. Though a rare entity, Desmoid fibromatosis should be kept in mind as a differential diagnosis for appropriate patient management. As per our knowledge, in India this is the first documented case of desmoid fibromatosis arising from maxillary sinus.
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Affiliation(s)
- Ashwath Kasliwal
- Department of Otorhinolaryngology, Eternal Heart Care Centre, Jaipur, India
| | - Paridhi Ahuja
- Department of Otorhinolaryngology, Eternal Heart Care Centre, Jaipur, India
| | - Khushi Jain
- Department of Pathology, Dr. K.C. Kasliwal Ear Nose Throat Centre, Jaipur, India
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3
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Bakde AM, Gunasekaran V, Anand A, Meshram N. Large Multicentric Synchronous Extra-Abdominal Fibromatosis of the Leg and Foot: A Case Report. Indian J Radiol Imaging 2024; 34:167-171. [PMID: 38106877 PMCID: PMC10723971 DOI: 10.1055/s-0043-1772849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Extra-abdominal fibromatosis is an uncommon, benign locally aggressive fibrous soft-tissue tumor that usually occurs in the shoulders, chest wall, back, thigh, and head and neck affecting the young adult population. It is commonly located in the subcutaneous tissue and may infiltrate the adjacent skeletal muscles. We hereby report a rare case of a large extra-abdominal fibromatosis of the leg and foot in a 38-year-old woman. The patient presented with a large voluminous lesion clinically and on imaging, which was difficult to diagnose. Magnetic resonance imaging (MRI) was very helpful in diagnosing the lesion. It revealed a large relatively well-defined, lobulated hypointense mass in the posterior compartment of the leg with extension into the lower thigh and foot with local infiltration into the gastrocnemius and soleus muscles. An incisional biopsy was performed, and the mass was diagnosed on pathological examination as a spindle-shaped fibroblast proliferation suggesting extra-abdominal fibromatosis.
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Affiliation(s)
- Ashwini M. Bakde
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vignesh Gunasekaran
- Department of Radiodiagnosis, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
| | - Aarti Anand
- Department of Radiodiagnosis, Govt. Medical College and Hospital, Nagpur, Maharashtra, India
| | - Nisha Meshram
- Department of Pathology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
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4
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Kornreich L, Orbach D, Nicolas N, Brisse HJ, Berlanga P, Defachelles AS, Mansuy L, Verite C, Saumet L, Karanian M, Corradini N. Oral vinorelbine in young patients with desmoid-type fibromatosis. TUMORI JOURNAL 2023; 109:511-518. [PMID: 37114926 DOI: 10.1177/03008916231169806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Desmoid-type fibromatosis are rare intermediate tumors in children and adolescents. Owing to local aggressiveness and relapse, systemic treatment for symptomatic advanced or progressive forms is recommended. Following promising results in adult patients, oral vinorelbine is investigated in young patients. METHODS A retrospective review of young patients (<25 years old) with advanced or progressive desmoid type fibromatosis treated with oral vinorelbine in eight large centers of the Société Française des Cancers de l'Enfant was performed. In addition to tumor assessment according to RECIST 1.1, pre-treatment and during-treatment imagery were reviewed centrally to assess tumor volume and estimate fibrosis score through the change in percentage in hypoT2 signal intensity. RESULTS From 2005 to 2020, 24 patients (median age 13.9 years [range, 1.0-23.0]) received oral vinorelbine. Median number of prior systemic lines of treatment was 1 (range, 0-2), mainly based on intravenous low dose methotrexate and vinblastine. Before vinorelbine initiation, all patients had a progressive disease: radiological for 19, radiological and clinical (pain) for three and only clinical for two. Oral vinorelbine was delivered for a median duration of 12 months (range, 1-42). The toxicity profile was favorable, with no grade 3-4 event. Overall response estimated on 23 evaluable patients according to RECIST 1.1 criteria was three partial responses (13%), 18 stabilization (78%) and two progressive disease (9%). Overall progression-free survival was 89.3% (95% confidential intervals 75.2-100) at 24 months. Four stable tumors according to standard RECIST criteria displayed a partial response with > 65% tumor volume reduction. Among 21 informative patients, the estimated fibrosis score decreased for 15 patients, was stable for four patients and increased for two patients. CONCLUSION Oral vinorelbine seems to be effective to control advanced or progressive desmoid type fibromatosis in young patients, with a well-tolerated profile. These results support testing this drug as first-line alone or in combination to improve response rate while preserving quality of life.
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Affiliation(s)
- Laure Kornreich
- Department of Pediatric Hematology and Oncology-IHOPe, Léon Bérard Center, Lyon, France
| | - Daniel Orbach
- SIREDO Oncology Center Care- Innovation and Research for Children and AYA with Cancer- PSL Research University, Institut Curie, Paris, Île-de-France, France
| | - Nayla Nicolas
- Imaging Department, Institut Curie, Paris, Île-de-France, France
| | - Hervé J Brisse
- Imaging Department, Institut Curie, Paris, Île-de-France, France
| | - Pablo Berlanga
- Gustave Roussy Cancer Campus, Department of Children and Adolescents Oncology, Villejuif, Île-de-France, France
| | | | - Ludovic Mansuy
- Children's University Hospital, Department of Pediatric Hematology and Oncology, Nancy, France
| | - Cécile Verite
- Pediatric Hematology Department, Bordeaux University Hospital, Bordeaux, Aquitaine, France
| | - Laure Saumet
- Department of Pediatric Onco-Hematology, University Hospital of Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Marie Karanian
- Department of Biopathology, Léon Bérard Center, Lyon, Rhône-Alpes, France
- Université Claude Bernard Lyon 1, Université Lyon, Cancer Research Center of Lyon, France
| | - Nadège Corradini
- Department of Pediatric Hematology and Oncology-IHOPe, Léon Bérard Center, Lyon, France
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5
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Curry DE, Al-Sayed AA, Trites J, Wheelock M, Acott PD, Midgen C, Johnson LB, Bezuhly M. Oral Losartan After Limited Mandibulectomy for Treatment of Desmoid-Type Fibromatosis. EAR, NOSE & THROAT JOURNAL 2023; 102:NP49-NP52. [PMID: 33491484 DOI: 10.1177/0145561320987641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Desmoid-type fibromatosis (DF) is a rare soft tissue lesion with an annual incidence of 2 to 4 per million population and peak incidence occurring at approximately 4.5 years of age. While benign, the tumor has a locally aggressive infiltrative growth pattern and a high rate of recurrence. Given the functional and aesthetic implications of excision and reconstruction in the facial skeleton, novel medical treatment options are highly desirable. We describe the case of a 3-year-old boy who presented with an enlarging, asymptomatic mass involving the left mandible. Biopsy revealed an immunohistochemical profile consistent with DF. Despite the high likelihood of recurrence, conservative, mandible-sparing en bloc resection and limited mandibulectomy were performed. Pathological and immunohistochemical analysis of the resection specimen revealed DF with grossly positive margins and elevated expression of angiotensin II type 1 receptor. Postoperative medical treatment with the angiotensin receptor blocker losartan was initiated. The patient remains medically stable and disease progression-free on repeat imaging at 20 months post-resection. We describe for the first time the successful use of the angiotensin blocker losartan following conservative surgery for management of DF.
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Affiliation(s)
- Dennis E Curry
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed A Al-Sayed
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan Trites
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Margaret Wheelock
- Division of Plastic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philip D Acott
- Division of Nephrology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Craig Midgen
- Department of Pathology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Liane B Johnson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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6
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Raghani MJ, Agarwal SS, Ansari HMN. Infantile fibromatosis of the mandible- Is radical treatment justified? Natl J Maxillofac Surg 2023; 14:136-139. [PMID: 37273428 PMCID: PMC10235749 DOI: 10.4103/njms.njms_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/06/2023] Open
Abstract
Infantile fibromatosis is characterized by proliferation of fibrous soft tissue with a potential of invading the adjacent structures but lacks the ability to metastasize, thus making it a fairly benign lesion with borderline characteristics. The pathology resembles sarcomatous growth, therefore making it difficult for the clinician to correctly diagnose. There are two variants of extra-abdominal desmoid juvenile and adult variant depending upon the age group it predominately involves. Fibromatosis is comparatively a rare tumour with unpredictable growth and varying local recurrence rates. The mass usually grows slowly, rapid growth and recurrences being mostly associated with the juvenile forms. The disease may present as single or multifocal lesion with widespread distribution, thus requiring whole body scans to identify any insidious growth elsewhere. Here, we report a case of recurrent juvenile/infantile fibromatosis in a 2-year-old child, conservatively managed without any growth disturbance and signs of recurrence.
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Affiliation(s)
- Manish J. Raghani
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subham S. Agarwal
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Hafiz M. N. Ansari
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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7
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Munnangi A, Kadapathri A, Pillai V, Bhat S, Rajeswarie RT, Shetty V, Subramanium N, Kolur T, Bhushan R V. Isolated Infratemporal Fossa Desmoid Fibromatosis: A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:2609-2613. [PMID: 36452559 PMCID: PMC9702405 DOI: 10.1007/s12070-020-02294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022] Open
Abstract
Desmoid fibromatosis (DF) arising from musculoaponeurotic structures rarely affects the head and neck region with the abdomen being the most common site of origin. These are benign tumors with locally infiltrative nature usually presenting as painless swellings that are rapidly growing. The infratemporal fossa DF is an extremely rare location with few clinical reports. This article discusses the management of a 2-year-old child with DF of the infratemporal fossa (ITF) along with literature review.
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Affiliation(s)
- Ashwini Munnangi
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | - Sunil Bhat
- Pediatric Hematology/Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | | | - Trupti Kolur
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
| | - Vidya Bhushan R
- Head and Neck Oncology, Mazumdar Shaw cancer center, Bangalore, India
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8
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Santiago Báez OA, Martínez Bernal AA, Ruiz Medina PE, Aponte Ortiz JA, Ortiz Justiniano VN. Surgical management of recurrent desmoid tumor in a young male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Geisenhainer K, Klenke D, Moser N, Kurbad O, Bremmer F, Kauffmann P, Schliephake H, Brockmeyer P. Desmoid fibromatosis in the pharyngeal wall: A case report and literature review. Clin Case Rep 2022; 10:e05268. [PMID: 35028152 PMCID: PMC8741869 DOI: 10.1002/ccr3.5268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Desmoid fibromatosis (DF) is one of the rarest locally aggressive growing benign tumor entities. We present an overview of the literature and a rare clinical case of a 22-year-old female patient, who was diagnosed with aggressive DF in the left pharyngeal wall at the age of 4 years old.
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Affiliation(s)
- Katharina Geisenhainer
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GreifswaldGreifswaldGermany
| | - Daniela Klenke
- Department of OrthodonticsUniversity Medical Center GoettingenGoettingenGermany
| | - Norman Moser
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GoettingenGoettingenGermany
| | - Oliver Kurbad
- Department of ProsthodonticsUniversity Medical Center GoettingenGoettingenGermany
| | - Felix Bremmer
- Institute of PathologyUniversity Medical Center GoettingenGoettingenGermany
| | - Philipp Kauffmann
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GoettingenGoettingenGermany
| | - Henning Schliephake
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GoettingenGoettingenGermany
| | - Phillipp Brockmeyer
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center GoettingenGoettingenGermany
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10
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Rationale for the use of tyrosine kinase inhibitors in the treatment of paediatric desmoid-type fibromatosis. Br J Cancer 2021; 124:1637-1646. [PMID: 33723397 PMCID: PMC8110972 DOI: 10.1038/s41416-021-01320-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
In children with desmoid-type fibromatosis (DTF) in whom disease progression occurs after an initial watch-and-wait strategy, prolonged low-dose chemotherapy using vinblastine and methotrexate (VBL-MTX) is currently the standard of care. These conventional drugs have been prospectively evaluated but their efficacy and safety profiles are limited, and alternative therapeutic options are therefore essential. Based on the results of clinical trials, the use of tyrosine kinase inhibitors (TKIs) in the treatment of DTF is currently considered only in adult patients. TKIs such as imatinib show superior therapeutic efficacy to VBL-MTX and tolerable short-term side effects for the treatment of adult DFT, supporting the concept of the use of TKIs for the treatment of paediatric DFT. Moreover, new-generation TKIs, such as pazopanib and sorafenib, have shown improved therapeutic efficacy compared to imatinib in adult non-comparative studies. A tolerable safety profile of TKI therapy in children with disease entities other than DTF, such as leukaemia, has been reported. However, the efficacy and, in particular, the long-term safety of TKIs, including childhood-specific aspects such as growth and fertility, for the treatment of children with DTF should be investigated prospectively, as DFT therapy requires long-term drug exposure.
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11
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Proença F, Constantino C, Lemos MM, Borges A. Paediatric desmoid tumour of the head and neck: a complete response to chemotherapy and the paradigm shift towards non-surgical management. BMJ Case Rep 2021; 14:14/1/e237509. [PMID: 33436358 PMCID: PMC7805379 DOI: 10.1136/bcr-2020-237509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Desmoid tumours are rare locally aggressive mesenchymal tumours with a high local recurrence rate, particularly in the head and neck locations. We present the case of a 5-year-old child with a locally invasive inoperable desmoid tumour of the masticator space who underwent a low-dose chemotherapy regimen for 17 months, obtaining a long-term complete response. Definitive evidenced-based treatment guidelines are lacking. Therefore, paediatric patients should be managed by specialised multidisciplinary teams to try to achieve the best tumour control while minimising treatment associated morbidity and mortality. Available treatment options include surgery, radiotherapy and different systemic medical therapies. Whereas traditionally, surgery was the mainstay of treatment, more conservative options have increasingly shown adequate tumour control with little associated morbidity. In this decision making it is mandatory to take into account the patient's age, tumour location and extension, and potential short-term and long-term treatment-related sequelae to minimise functional and cosmetic compromise.
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Affiliation(s)
- Filipa Proença
- Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Claudia Constantino
- Department of Paediatrics, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Maria Manuel Lemos
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Alexandra Borges
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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12
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Xu K, Zhao QK, Liu JS, Zhou DH, Chen YL, Zhu XY, Su M, Huang KQ, Du W, Zhao HY. Misdiagnosis of ligamentoid fibromatosis of the small mesenteric: A case report. World J Clin Cases 2020; 8:5758-5764. [PMID: 33344571 PMCID: PMC7716297 DOI: 10.12998/wjcc.v8.i22.5758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ligamentoid fibromatosis is a rare borderline tumor that occurs in the muscles, fascia, and aponeurosis. It is a kind of soft tissue tumor of fibrous origin, also known as invasive fibromatosis, desmoid fibroma, neurofibromatosis, etc. The tumor is between benign and malignant tumors and rarely has distant metastasis. Its characteristics are mainly local invasion, destruction and growth and easy recurrence. The World Health Organization defines it as a fibroblast cloning value-added lesion originating from deep soft tissue, which causes local invasion and growth leading to tissue reconstruction, extrusion and destruction of important structures and organs. The incidence rate accounts for 0.03% of all tumors and less than 3% of all soft tissue tumors. Definite diagnosis mainly depends on postoperative pathology. Surgical resection is still the main way to treat the disease, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence.
CASE SUMMARY The patient is a 57-year-old female. One week ago, she accidentally found a mass in the left upper abdomen while lying flat. There was no abdominal pain and abdominal distention, no fever, no black stool and blood in the stool and no nausea and vomiting. She had a 10-year history of glaucoma on the left side, underwent hysterectomy for uterine fibroids 5 years ago, had no hypertension, heart disease, diabetes, hepatitis or tuberculosis, had no history of smoking and had been drinking for 20 years.
CONCLUSION Accurate preoperative diagnosis is difficult, surgical resection is the main treatment, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence. The prognosis is still good, and the risk of recurrence of secondary surgery is greatly increased.
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Affiliation(s)
- Kai Xu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Qi-Kang Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Jing-Shan Liu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Dong-Hai Zhou
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xing-Yi Zhu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Ming Su
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Kun-Quan Huang
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Wen Du
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Hong-Yu Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
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13
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Duhil de Bénazé G, Vigan M, Corradini N, Minard-Colin V, Marie-Cardine A, Verite C, Defachelles AS, Thebaud E, Castex MP, Sirvent N, Bodet D, Mansuy L, Rome A, Petit A, Plantaz D, Jourdain A, Mary P, Carton M, Orbach D. Functional analysis of young patients with desmoid-type fibromatosis: Initial surveillance does not jeopardize long term quality of life. Eur J Surg Oncol 2020; 46:1294-1300. [PMID: 32173177 DOI: 10.1016/j.ejso.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With recent conservative strategies, prognosis of patients with desmoid-type fibromatosis (DTF) is about function preservation. We analyzed the long-term quality of life (QoL) of pediatric patients with DTF. METHODS All French young patients (<21years) treated between 2005 and 2016 for a DTF in the EpSSG NRSTS-05 study were analyzed. A first wait-and-see strategy was recommended. Patients' QoL was analyzed with the internationally validated Child Health Questionnaire (CHQ). We focused on the relevant subscales scores: physical functioning (PF), role social limitations physical (RP), bodily pain (BP), general health perception (GH) and physical (PhS) and psychosocial (PsS) summary measures. RESULTS Among the 81 patients, 52 families answered the CHQ (median delay since diagnosis = 6.2years; min2.2-max13.3 years). Median age at diagnosis was 11.5 years. Primary site: limbs (52%), head/neck (27%), or trunk (21%). Five year-Progression Free Survival was 39.1% (95%CI: 27.7-50.5%). As initial management for these 52 patients, 30 patients were first observed (57%), 13 had surgery (25%) and 9 received chemotherapy (18%). Total burden of therapy was exclusive surgery (9pts/18%), exclusive chemotherapy (18pts/35%), surgery + chemotherapy (13pts/25%), chemotherapy + radiotherapy (1 pt), surgery + chemotherapy + radiotherapy (1 pt), wait and see (10 pt). Regarding the parent forms, patients have significant lower PF (86.0vs.96.1; p = 0.03), RP (82.0vs.93.6; p = 0.04), GH (60vs.73; p < 0.005) and PhS (46.2 vs.53; p = 0.02) scores compared to healthy population. Comparison of QoL subscales scores according to initial strategy (wait-and-see vs.surgery/chemotherapy) did not reveal any difference (PF = 87.3vs.84.9; p = 0.80/RP = 83.4vs.78.7; p = 0.72/BP = 78.9vs.78.2; p = 0.95/GH = 59.7vs60; p = 0.97). Similar results were found using the children or adult forms. CONCLUSIONS Initial wait-and-see strategy does not affect long term functional impairment.
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Affiliation(s)
- G Duhil de Bénazé
- University Hospital of Nice- Archet 2, Department of Pediatric Hematology-Oncology, Nice, France; Institut Curie, SIREDO Oncology Center Care- Innovation and Research for Children and AYA with Cancer- PSL Research University, Paris, France.
| | - M Vigan
- Institut Curie- PSL Research University, Biometry Unit, Paris, France
| | - N Corradini
- IHOPe, Centre Régional de Lutte Contre le Cancer- Centre Léon Bérard, Lyon, France
| | - V Minard-Colin
- Gustave Roussy Cancer Campus, Department of Children and Adolescents Oncology, Villejuif, France
| | - A Marie-Cardine
- Rouen University Hospital, Department of Pediatric Hematology-Oncology, Rouen, France
| | - C Verite
- Bordeaux University Hospital, Pediatric Hematology Department, Bordeaux, France
| | - A S Defachelles
- Centre Oscar Lambret, Service D'Oncologie Pédiatrique, Lille, France
| | - E Thebaud
- University Hospital Nantes, Pediatric Oncology Department, Nantes, France
| | - M P Castex
- Children's Hospital of Toulouse- CHU Toulouse, Pediatric Hemato-oncology Department, Toulouse, France
| | - N Sirvent
- University Hospital of Montpellier, Department of Pediatric Onco-Hematology, Montpellier, France
| | - D Bodet
- Caen University Hospital, Department of Pediatric Hematology and Oncology, Caen, France
| | - L Mansuy
- Children's University Hospital, Department of Pediatric Hematology and Oncology, Nancy, France
| | - A Rome
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Marseille, France
| | - A Petit
- Assistance Publique-Hôpitaux de Paris AP-HP- GH HUEP- Armand Trousseau Hospital, Department of Pediatric Hematology and Oncology, Paris, France
| | - D Plantaz
- University Hospital Centre of Grenoble, Department of Pediatric Hematology-Oncology, Grenoble, France
| | - A Jourdain
- CHU Tours, Department of Pediatric Oncology and Hematology, Tours, France
| | - P Mary
- Pediatric Orthopedics Department, Armand Trousseau Hospital, Paris, France
| | - M Carton
- Institut Curie- PSL Research University, Biometry Unit, Paris, France
| | - D Orbach
- Institut Curie, SIREDO Oncology Center Care- Innovation and Research for Children and AYA with Cancer- PSL Research University, Paris, France
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Waldman RA, Finch J, Grant-Kels JM, Stevenson C, Whitaker-Worth D. Skin diseases of the breast and nipple. J Am Acad Dermatol 2019; 80:1467-1481. [DOI: 10.1016/j.jaad.2018.08.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
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Daram SP, Timmons C, Mitchell RB, Shah G. Desmoid Fibromatosis of the Maxilla. EAR, NOSE & THROAT JOURNAL 2019; 99:NP6-NP8. [PMID: 31937133 DOI: 10.1177/0145561318824239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shiva P Daram
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles Timmons
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gopi Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Luo N, He X, Li G, Liao Y, Tang Q, Ye R, Zhong D. Desmoid Tumor Presenting as a Typical Cervical Dumbbell Tumor:A Case Report and Literature Review. World Neurosurg 2019; 124:151-156. [PMID: 30639503 DOI: 10.1016/j.wneu.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dumbbell-shaped tumor is a type of the inner and outer cervical spinal canal tumor, and most of them are neurogenic tumors. Desmoid tumor is a rare tumor, and no case of them involving intervertebral foramen formed dumbbell-shaped in cervical spine have been reported before in English literature. Here we report a case of desmoid tumor arising in the cervical spine which is presented as typical dumbbell-shaped tumor. CASE DESCRIPTION A 47-year-old female was admitted to our department with a mass in her left neck. The tumor was initially thought to be a neurogenic cervical dumbbell tumor based on physical and radiological examination. Postoperative HE and immunohistochemical staining verified the diagnosis of a cervical dumbbell desmoid tumor, which had never been reported before. We report our experience and reviewed literature about desmoid tumor to share our experience and explore proper treatment option of such lesion. CONCLUSION Desmoid tumors in the head and neck may present as cervical dumbbell-shaped tumors. Before the treatment plan was undertaken, thorough examinations including surgical pathology were necessary.
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Affiliation(s)
- Ning Luo
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Xia He
- Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Guangzhou Li
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Yehui Liao
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Qiang Tang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Rupei Ye
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China
| | - Dejun Zhong
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, China.
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Abstract
RATIONALE Desmoid fibromatosis is a rare benign neoplasm arising from musculoaponeurotic structures with the potential to infiltrate local tissues and recur locally. While the commonly affected regions are the shoulder, chest wall and back, thigh, head and neck, localization in the foot is rare and only a few cases have been reported. Deep-seated lesions of foot tend to spread along the fascia and nerve or tendon sheaths. PATIENT CONCERNS We present a case of a 41-year-old female with a 3 years history of a slowly enlarging painful mass in the right foot. DIAGNOSES Desmoid fibromatosis was diagnosed based on clinical manifestations, imaging findings and pathological examinations. INTERVENTIONS The patient was treated by local incomplete resection. OUTCOMES The patient recovered well postoperatively and was well followed up at our outpatient department with no evidence of recurrence during 16 months of follow-up after local excision. LESSONS Surgical excision is recommended for symptomatic lesions located in the foot. However, it is difficult to excise thoroughly and periodic follow-up is needed to monitor for recurrence. Further study is warranted to determine whether patients benefit more from function preservation instead of complete resection.
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Affiliation(s)
| | - Lu Fang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Li
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Aggressive fibromatosis in pediatric population-A case series. Int J Surg Case Rep 2018; 52:45-48. [PMID: 30316134 PMCID: PMC6187009 DOI: 10.1016/j.ijscr.2018.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
Desmoid tumor or aggressive fibromatosis (AF) is a benign tumor of borderline malignant condition, it is infiltrative, deep-seated and muscoloapo neurotic in nature. AF is commonly found among children below 15 years of age, affecting males more as compared to females. Primary surgery is not the treatment choice among patients with positive margins as the risk of recurrence is higher after surgery. However, radiation and chemotherapy may assist in maintaining local control of these tumors in such patients. Primary surgery with negative margins is the treatment choice for children with AF.
Introduction Aggressive fibromatosis or Desmoid fibromatosis is a benign tumor which originated form mesenchymal tissues of the body. This tumor has strong potential of recurrence and infiltration but it does not metastasize to other organs of the body. This case series is focused to determine the treatment outcomes for pediatric patients of aggressive fibromatosis. Methodology It is a retrospective case series conducted on 7 patients presented to section of Orthopedics, department of surgery of our institute in Karachi. We included all the cases of pediatric patients from 1 to 16 years, with biopsy proven fibromatosis from January 2000 to December 2015. Presentation of Cases Out of 7 pediatric patients, there were 6 (85.7%) males and 1 (14.3%) female patient. The median age was 6 years IQR (5–11) years. Gluteal region was the most common site of disease. Four patients (57.1%) had positive tumor margins while three (42.9%) had negative margins. Out of 7 patients, 4 patients (57.1%) had recurrent disease and they had positive margins. The median Disease Free survival time was 14 months and there was no expiry of patients. Conclusion & recommendation The conclusion of our study was that aggressive fibromatosis is more prevalent in children below 15 years of age and disease burden is higher in male gender. Positive margins after surgery indicate a high risk for disease recurrence therefore; primary surgery with negative margins is the treatment of choice for children with AF. However, we recommend that multicenter trials should be conducted in the future to clarify the role of adjuvant treatment for patients with pediatric AF.
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Orbital Desmoid-Type Fibromatosis: A Case Report and Literature Review. Case Rep Oncol Med 2018; 2018:1684763. [PMID: 29707396 PMCID: PMC5863316 DOI: 10.1155/2018/1684763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Desmoid-type fibromatosis is a benign fibrous neoplasia originating from connective tissue, fascial planes, and musculoaponeurotic structures of the muscles. Currently, there is no evidence-based treatment approach available for desmoid fibromatosis. In this article, a case of a patient in the pediatric age affected by desmoid fibromatosis localized in the orbit is presented. The aim of the article is to describe this unusual and rare location for the desmoid fibromatosis and outline the principle phases in the decision-making process and the therapeutic alternatives for a patient affected by desmoid fibromatosis. Methods The protocol of this review included study objectives, search strategy, and selection criteria. The primary end point of this study was to analyze the head and neck desmoid fibromatosis. The secondary end point was to identify the available therapies and assess their specific indications. Results The mean age of patients was 18.9 years ranging from 0 to 66, and 52% were female. A bimodal age distribution was observed, and two age peaks were identified: 0–14 years (57%) and 28–42 years (18%). The most common involved areas were the mandible (25%) followed by the neck (21%). In 86% of the cases, the treatment was the surgical resection of the disease, and only in 5% of the cases, the surgical resection was followed by adjuvant radiotherapy. Conclusion The orbital location is extremely rare, especially in the pediatric population. The management of desmoid fibromatosis is based on the function preservation and the maintenance of a good quality of life, but in case of symptomatic patients or aggressive course of the disease or risk of functional damages, the surgical approach may be considered. Therapeutic alternatives to surgical resection are radiotherapy and systemic therapy.
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Letelier C, Gunther M, Alarcon A, Vera P, Kakarieka E, Pantoja R. Agressive pediatric myofibromatosis in a two-year-old child. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 119:216-219. [PMID: 29274401 DOI: 10.1016/j.jormas.2017.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/17/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aggressive paediatric myofibromatosis is an autosomal recessive disease characterized by fibroblastic proliferation from cells originated in muscle-aponeurotic tissue. Its etiology is unknown, and the average age of the reported cases is 7 years old. The tumor exhibits rapid painless growth and appears attached to muscle tissue and/or bone. The treatment of choice is conservative surgical excision despite of early relapses has been reported. OBSERVATION A 2-year-old patient, with no morbid history, presented with a large swelling in the left submandibular region, firm, neither defined limits nor inflammatory characteristics. Its size doubled 2 months after an incisional biopsy. CT images showed great compromise of the left mandibular body with expanded and thinned cortical bone. The MRI showed extension towards the pharynx. Histopathological findings were elongated fibroblastic and ovoid cells arranged in bundles and fascicles within fibromyxoid stroma, an image consistent with the diagnosis. The treatment consisted in a conservative exeresis of the tumor, preserving the jaw. Control 1 year after surgical removal shows no signs of relapse and the mandibular structure has been restored. DISCUSSION The large size of the lesion and bone involvement at such an early age evidenced a very aggressive lesion, however, supported by a previous biopsy, we performed a conservative treatment, which only caused the loss of a dental germ, impossible to take off from the intraosseous tumor. The control of this type of lesions requires a longer follow-up.
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Affiliation(s)
- C Letelier
- Department of buccal and maxillo-facial surgery, faculty of dentistry, university of Chile, Chile
| | - M Gunther
- Department of buccal and maxillo-facial surgery, faculty of dentistry, university of Chile, Chile
| | - A Alarcon
- Department of buccal and maxillo-facial surgery, faculty of dentistry, university of Chile, Chile; Maxillo-facial surgery service, San Borja-Arriarán clinical hospital, Chile
| | - P Vera
- Service of pediatric surgery, San Borja-Arriarán clinical hospital, Santiago, Chile
| | - E Kakarieka
- Anatomic pathology service, San Borja-Arriarán clinical hospital, Santiago, Chile
| | - R Pantoja
- Department of buccal and maxillo-facial surgery, faculty of dentistry, university of Chile, Chile; Maxillo-facial surgery service, San Borja-Arriarán clinical hospital, Chile.
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The EpSSG NRSTS 2005 treatment protocol for desmoid-type fibromatosis in children: an international prospective case series. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:284-292. [DOI: 10.1016/s2352-4642(17)30045-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/22/2022]
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Shkalim Zemer V, Toledano H, Kornreich L, Freud E, Atar E, Avigad S, Feinberg-Gorenshtein G, Fichman S, Issakov J, Dujovny T, Yaniv I, Ash S. Sporadic desmoid tumors in the pediatric population: A single center experience and review of the literature. J Pediatr Surg 2017; 52:1637-1641. [PMID: 28209418 DOI: 10.1016/j.jpedsurg.2017.01.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND/PURPOSE We present our long experience with desmoid tumors in children. METHODS Data were retrospectively collected from 17 children/adolescents treated for sporadic desmoid tumors at a tertiary pediatric hospital in 1988-2016. There were 10 girls and 7 boys aged 1-17years. Tumor sites included head and neck, trunk, extremity, and groin. Eight patients underwent radical resection, with complete remission in 7 and local relapse in one which was treated with chemotherapy. Four patients underwent incomplete surgical resection, three with adjuvant chemotherapy. Five patients underwent biopsy only and chemotherapy. Two of the 9 chemotherapy-treated patients also had intraarterial chemoembolization. Chemotherapy usually consisted of vincristine and actinomycin-D with or without cyclophosphamide or low-dose vinblastine and methotrexate. Two patients also received tamoxifen. RESULTS After a median follow-up of 3.3years, 10 patients were alive in complete remission, 5 had stable disease, and 2 had reduced tumor size. Five-year overall survival was 100%, and event-free survival, 87.5%. Ten were screened for CTNNB1 mutations. CTNNB1 gene sequencing yielded mutations in 5/10 samples tested: 3 T41A, 2 S45F. There was no association of CTNNB1 mutation with clinical outcome or prognosis. CONCLUSION Pediatric desmoid tumors are rare, with variable biologic behavior and morbidity. Treatment requires a multidisciplinary approach. LEVEL OF EVIDENCE LEVEL IV, treatment study.
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Affiliation(s)
- Vered Shkalim Zemer
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Helen Toledano
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Liora Kornreich
- Department of Imaging, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Enrique Freud
- Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eli Atar
- Department of Diagnostic Radiology, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Smadar Avigad
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Molecular Oncology, Felsenstein Medical Research Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Galina Feinberg-Gorenshtein
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Molecular Oncology, Felsenstein Medical Research Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Suzana Fichman
- Department of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Josephine Issakov
- Unit of Bone and Soft Tissue Tumors, Institute of Pathology, Sourasky Medical Center, Tel Aviv 64239, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tal Dujovny
- Pediatric Oncology Unit, Emek Medical Center, Afula 1834111, Israel
| | - Isaac Yaniv
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shifra Ash
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
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Desmoid tumours of the head and neck in children: Review of management. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:155-160. [PMID: 27988199 DOI: 10.1016/j.anorl.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Desmoid tumours of the head and neck in children are rare, local invasive and potentially fatal tumours. The purpose of this review is to discuss the management of these tumours in the light of a case series and a review of the literature. MATERIAL AND METHODS This retrospective study summarised the medical data of children treated for desmoid tumours of the head and neck between 1976 and 2014. RESULTS Five of the 6 children were treated by radical surgical resection, with positive surgical margins (R1) in 2 cases, followed by recurrence requiring further resection. One child with a very advanced lesion was treated by weekly methotrexate and vinorelbine chemotherapy for 18months, allowing 93% reduction of tumour volume without recurrence. CONCLUSIONS Desmoid tumours of the head and neck in children are more aggressive than their adult counterparts and are associated with high morbidity and mortality and a high recurrence rate. CT and MRI imaging assessment should preferably be performed before biopsy. External beam radiotherapy must be avoided in children as it is less effective than in adults, and is responsible for long-term cosmetic and functional sequelae and even a risk of second tumours. Treatment is surgical whenever radical resection is possible. In patients presenting an excessive risk of morbidity and mortality, chemotherapy devoid of long-term adverse effects (such as methotrexate in combination with a Vinca alkaloid) can be proposed. Long-term follow-up must be ensured due to the risk of recurrence.
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Wu WJ, Guo HQ, Yu GY, Zhang JG. Iodine-125 Interstitial Brachytherapy for Pediatric Desmoid-Type Fibromatosis of the Head and Neck: A Case Report. J Oral Maxillofac Surg 2016; 75:768.e1-768.e11. [PMID: 27875709 DOI: 10.1016/j.joms.2016.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
Abstract
Desmoid-type fibromatosis (DF) is a locally aggressive benign soft tissue tumor. It is rarely observed in the head and neck region and is particularly uncommon in the parotid gland. This report describes the case of a 32-month-old girl with DF of the head and neck. The tumor was resected with gross residual tumors. Recurrence occurred 3 months later and then the patient was treated with iodine-125 interstitial brachytherapy. The tumor was completely absent 6 months after brachytherapy. No recurrence was found 60 months after brachytherapy during follow-up. No severe toxicities or growth abnormalities were observed. Very-low-dose rate brachytherapy as the sole modality could be a reasonable alternative for the treatment of inoperable DF of the head and neck, which avoids the risk of cosmetic deformity caused by surgery, especially in pediatric patients. In addition, long-term follow-up is recommended.
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Affiliation(s)
- Wen-Jie Wu
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hua-Qiu Guo
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian-Guo Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Wang YC, Wong JU. Complete remission of pancreatic head desmoid tumor treated by COX-2 inhibitor-a case report. World J Surg Oncol 2016; 14:190. [PMID: 27450394 PMCID: PMC4957301 DOI: 10.1186/s12957-016-0944-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Desmoid tumors (DTs) are non-metastatic, locally aggressive neoplasms with high postoperative recurrence rates. The pancreas is an extremely rare location for DTs. The local control of DTs is challenging. Surgery and radiotherapy are currently the principal treatment modalities for DTs; however, some resections might not be radical, and radiotherapy has several drawbacks. Therefore, many studies have been focusing on the molecular pathways involved in DTs in order to develop molecular-targeted therapies or chemotherapy. Cyclooxygenase-2 (COX-2) has been demonstrated to play a role in the growth of DTs, and the pharmacologic blockade of COX resulted in decreased cell proliferation in desmoid cell cultures in vitro. Case presentation Herein, we report a 57-year-old woman who presented with recurrent epigastric pain and weight loss. An abdominal computed tomography scan showed an approximately 10-cm mass over the pancreatic head region and dilatation of the pancreatic duct. Tumor biopsy and bypass surgery were performed. A DT was confirmed on pathologic analysis. After resection, we prescribed treatment with the COX-2 inhibitor celecoxib. The patient showed complete remission and there was no local recurrence or distant metastasis within the 24-month follow-up period. Conclusions The outcome of this case study is encouraging, and long-term follow-up studies are required to establish the effect of treatment with celecoxib on the prognosis of DTs.
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Affiliation(s)
- Yu-Chieh Wang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Jia-Uei Wong
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.
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Zheng Z, Jordan AC, Hackett AM, Chai RL. Pediatric desmoid fibromatosis of the parapharyngeal space: A case report and review of literature. Am J Otolaryngol 2016; 37:372-5. [PMID: 27040413 DOI: 10.1016/j.amjoto.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%-15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common. We present a case of a 14-month-old male with an 8-cm desmoid tumor in the right parapharyngeal space and provide an overview of diagnosis and management of pediatric head and neck fibromatosis. This is the largest desmoid tumor of the parapharyngeal space in the youngest patient described in the literature.
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Affiliation(s)
- Zhong Zheng
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Adrienne C Jordan
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Alyssa M Hackett
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Raymond L Chai
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA; Institute of Head, Neck and Thyroid Cancer, Mount Sinai Beth Israel, New York, NY, USA.
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Miyashita H, Asoda S, Soma T, Munakata K, Yazawa M, Nakagawa T, Kawana H. Desmoid-type fibromatosis of the head and neck in children: a case report and review of the literature. J Med Case Rep 2016; 10:173. [PMID: 27286970 PMCID: PMC4902910 DOI: 10.1186/s13256-016-0949-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022] Open
Abstract
Background Desmoid-type fibromatosis is defined as an intermediate tumor that rarely occurs in the head and neck of children. There is no doubt as to the value of complete surgical excision for desmoid-type fibromatosis. However, in pediatric patients, surgeons may often be concerned about making a wide excision because of the potential for functional morbidity. Some studies have reported a lack of correlation between margin status and recurrence. Therefore, we discussed our findings with a focus on the state of surgical margins. Case presentation We report an unusual case of a 9-month-old Japanese girl who prior to presenting at our hospital underwent debulking surgery twice with chemotherapy for desmoid-type fibromatosis of the tongue at another hospital. We performed a partial glossectomy and simultaneous reconstruction with local flap and achieved microscopic complete resection. We also reviewed available literature of pediatric desmoid-type fibromatosis in the head and neck. Conclusions We described successful treatment for the refractory case of pediatric desmoid-type fibromatosis. The review results showed that some microscopic incomplete resections of tumors in pediatric patients with desmoid-type fibromatosis tended to be acceptable with surgical treatment.
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Affiliation(s)
- Hidetaka Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Seiji Asoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kanako Munakata
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiromasa Kawana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
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Aggarwal G, Shukla S, Maheshwari A, Mathur R. Desmoid tumour: a rare etiology of intestinal obstruction. Pan Afr Med J 2016; 22:158. [PMID: 26889339 PMCID: PMC4742044 DOI: 10.11604/pamj.2015.22.158.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 10/15/2015] [Indexed: 11/11/2022] Open
Abstract
Intestinal obstruction is a frequently encountered entity in surgical practice. The signs & symptoms, many a times, are suggestive of the level of obstruction, making the diagnosis of obstruction evident. There are various causes of intestinal obstruction which diversify to an enormous extent, stamping on the famous paradigm for the mysterious nature of the abdomen being referred to as the Pandora's Box. In accordance with the above saying, we report a rare case of a desmoid tumour, presenting as intestinal obstruction, which entices us to strongly believe the same.
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Affiliation(s)
- Gaurav Aggarwal
- Department of Surgery, MGM Medical College & MY Hospital, Indore, India
| | - Sumit Shukla
- Department of Surgery, MGM Medical College & MY Hospital, Indore, India
| | - Ankur Maheshwari
- Department of Surgery, MGM Medical College & MY Hospital, Indore, India
| | - Rajkumar Mathur
- Department of Surgery, MGM Medical College & MY Hospital, Indore, India
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Pawluś A, Szymańska K, Kaczorowski K, Sokołowska-Dąbek D, Olchowy C, Markiewicz BD, Zaleska-Dorobisz U. A Rare Case of Aggressive Fibromatosis Infiltrating Dorsal Muscles in a 6-Year-Old Patient - CT, MRI and Elastography Evaluation. Pol J Radiol 2015; 80:164-7. [PMID: 25866593 PMCID: PMC4381854 DOI: 10.12659/pjr.893002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/07/2014] [Indexed: 01/02/2023] Open
Abstract
Background The term fibromatosis or desmoid tumor refers to a group of benign fibrous growths without metastatic potential but with a significant risk of local recurrence. These lesions typically present infiltrative growth pattern with local invasion of adjacent tissues. This tendency is the reason for a relatively high rate of local recurrence, even after surgical removal. Fibromatosis is a very rare condition in general population but occurs more frequently in one of the familial cancer predispositions known as familial adenomatous polyposis (FAP) or Gardner syndrome. There are two main groups of fibromatosis: superficial (small, slow-growing lesions) and deep, also known as aggressive fibromatosis (large, rapid-growing lesions). Case Report We report a case of a 6-year-old boy suffering from an aggressive form of fibromatosis. The patient developed a large pathological mass extending from the neck to the loins. After incisional biopsy and histpoathological examination of the sample, a diagnosis of aggressive fibromatosis was established. During the whole diagnostic process, different imaging techniques including CT, MRI and sonoelastography were used. As the surgical treatment was not possible, the patient was finally qualified for chemotherapy. Conclusions Eventual diagnosis of aggressive fibromatosis is based on histopathological examination. However, it is an important condition that should be included in differential diagnosis of soft-tissue masses found in diagnostic imaging. Radiologists should be careful especially in defining the margins of infiltration in case of potential surgical treatment.
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Affiliation(s)
- Aleksander Pawluś
- Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland ; Department of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Kinga Szymańska
- Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland
| | | | - Dąbrówka Sokołowska-Dąbek
- Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland ; Department of Radiology, Wrocław Medical University, Wrocław, Poland
| | - Cyprian Olchowy
- Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland ; Department of Radiology, Wrocław Medical University, Wrocław, Poland
| | | | - Urszula Zaleska-Dorobisz
- Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland ; Department of Radiology, Wrocław Medical University, Wrocław, Poland
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Woltsche N, Gilg MM, Fraissler L, Liegl-Atzwanger B, Beham A, Lackner H, Benesch M, Leithner A. Is wide resection obsolete for desmoid tumors in children and adolescents? Evaluation of histological margins, immunohistochemical markers, and review of literature. Pediatr Hematol Oncol 2015; 32:60-9. [PMID: 25264623 DOI: 10.3109/08880018.2014.956905] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Desmoid fibromatosis is a benign fibroblastic neoplasm with high recurrence rates predominantly observed in pediatric and adolescent patients. The use of wide resection margins has been discussed controversially in literature. In addition, data on non-surgical treatment is limited as phase III studies are still missing. Nineteen patients under the age of 18 years were identified. Tumor location, surgical treatment for primary or recurrent tumors, resection margins, medical neo-/adjuvant treatment, time to recurrence as well as immunohistochemical markers (estrogen receptor, ER α and β, progesterone and androgen receptors, somatostatin, Ki-67, c-kit, platelet-derived growth factor receptors, PDGFRs, α and β, β-catenin) were evaluated. The mean age at diagnosis was 6.6 years, with a mean follow-up of 114 months. Recurrences were detected in four out of nineteen patients. Surprisingly, the recurrence rate was not influenced by type of resection used (R0, R1/2). All samples were tested negative for ER α, somatostatin, and progesterone receptor. In contrast, a majority of tumors showed positive results for PDGFR α and β and β-catenin. No correlation between positive immunohistochemical markers and tumor recurrences was detectable. In conclusion, recurrence rates are not depending on resection type and immunohistochemical markers seem to behave differently in children and adolescents in contrast to adult patients.
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Affiliation(s)
- Nora Woltsche
- Department of Orthopedic Surgery, Medical University of Graz , Graz , Austria
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Weiss A, Gill J, Goldberg J, Lagmay J, Spraker-Perlman H, Venkatramani R, Reed D. Advances in therapy for pediatric sarcomas. Curr Oncol Rep 2015; 16:395. [PMID: 24894064 DOI: 10.1007/s11912-014-0395-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric sarcomas are relatively rare malignancies individually. As a group they are typically approached with combination chemotherapies in addition to local control. Fortunately, these malignancies have been approached through careful clinical trial collaboration to define risk groups and appropriately deliver local control measures and systemic therapies. Although local disease is typically approached with curative intent, therapy typically lasts over 6 months and has significant associated morbidities. It is more difficult to cure metastatic disease or induce sustained remissions. In this article, we discuss recent advances in the understanding of the disease process and highlight recent and future cooperative group trials in osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, nonrhabdomyosarcoma soft tissue sarcomas, and desmoid tumor as well as discuss promising therapeutic approaches such as epigenetics and immunotherapy.
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Affiliation(s)
- Aaron Weiss
- Division of Pediatric Hematology-Oncology, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA,
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Briand S, Barbier O, Biau D, Bertrand-Vasseur A, Larousserie F, Anract P, Gouin F. Wait-and-see policy as a first-line management for extra-abdominal desmoid tumors. J Bone Joint Surg Am 2014; 96:631-8. [PMID: 24740659 DOI: 10.2106/jbjs.m.00988] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extra-abdominal desmoid tumors are rare, locally aggressive neoplasms without metastatic potential. There is no clear consensus regarding their optimal management. The disappointing results of current treatments and the ability of extra-abdominal desmoid tumors to spontaneously stabilize have increasingly drawn interest toward conservative management. The objective of this study was to evaluate a wait-and-see policy as a first-line management for extra-abdominal desmoid tumors. METHODS This two-center retrospective study involved fifty-five patients with a histologically proven extra-abdominal desmoid tumor. The primary outcome was the cumulative probability of dropping out from the wait-and-see policy. The wait-and-see policy included aggressive management of symptoms. We conducted a review of the relevant published series in which a watchful-waiting strategy was used. RESULTS The cumulative probability of dropping out from the wait-and-see policy was 9.6% at the time of the last follow-up. Spontaneous arrest of tumor growth was noted for forty-seven patients (85%) over the course of the study. Half of the tumors were stabilized at one year, and a potential to increase beyond three years was a sporadic event (one case). Regrowth was found in two patients (4%). CONCLUSIONS A wait-and-see policy is an effective front-line management for patients with primary or recurrent extra-abdominal desmoid tumor. These tumors tend to stabilize spontaneously, on average after one year of evolution, and the cumulative probability of the failure of a wait-and-see policy is approximately 10%.
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Affiliation(s)
- Sylvain Briand
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
| | - Olivier Barbier
- Department of Orthopaedic Surgery, Begin Military Hospital, 69 avenue de Paris, 94163 Saint Mandé, France. E-mail address:
| | - David Biau
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - Axelle Bertrand-Vasseur
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
| | - Frédérique Larousserie
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - Philippe Anract
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - François Gouin
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
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Wang W, Koirala U, Ma S, Liu G, Ding M, Hu X, Lei D. Age-Based Treatment of Aggressive Fibromatosis in the Head and Neck Region. J Oral Maxillofac Surg 2014; 72:311-21. [DOI: 10.1016/j.joms.2013.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022]
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Ferrari A, Alaggio R, Meazza C, Chiaravalli S, de Pava MV, Casanova M, Cavaliere E, Bisogno G. Fibroblastic tumors of intermediate malignancy in childhood. Expert Rev Anticancer Ther 2014; 13:225-36. [DOI: 10.1586/era.12.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Peña S, Brickman T, StHilaire H, Jeyakumar A. Aggressive fibromatosis of the head and neck in the pediatric population. Int J Pediatr Otorhinolaryngol 2014; 78:1-4. [PMID: 24290952 DOI: 10.1016/j.ijporl.2013.10.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aggressive fibromatosis, previously referred to as desmoid tumor, is a rare tumor. It is classified as benign, however, has a high potential for local invasion and recurrence. It is most commonly found in the abdomen, with an origin in the head and neck accounting for less than a quarter of the total cases. METHODS Literature review using PubMed and OVID and a combination of the words, "desmoid", "fibromatosis", "pediatric", "children", and "head and neck". RESULTS Annual occurrence is 0.2 - 0.4 per 100,000, with origins in the head and neck accounting for 10-25%. Since 1954, 97 cases of pediatric head and neck fibromatosis were reported. The age range was from birth to 16 years, with the average being 4 years and 5 months old. The overwhelming majority of tumors were of the mandible (38%). 74% patients underwent a large resection as the primary treatment modality. The most common treatment complication was tumor recurrence (16%). CONCLUSIONS Fibromatosis is a rare tumor of muscoloaponeurotic origin. Surgery is the mainstay of treatment; however recurrence rates are high, even despite negative surgical margins.
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Affiliation(s)
- Sarah Peña
- Department of Otorhinolaryngology, Louisiana State University-Health Science Center, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Todd Brickman
- Department of Otorhinolaryngology, Louisiana State University-Health Science Center, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Hugo StHilaire
- Department of Plastic Surgery, Louisiana State University-Health Science Center, New Orleans, LA 70112, USA
| | - Anita Jeyakumar
- Department of Otorhinolaryngology, Louisiana State University-Health Science Center, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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Chu HH, Hwang PH, Jeong YJ, Chung MJ. Abdominal fibromatosis in a young child: a case study and review of the literature. KOREAN JOURNAL OF PATHOLOGY 2013; 47:472-6. [PMID: 24255636 PMCID: PMC3830995 DOI: 10.4132/koreanjpathol.2013.47.5.472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 12/03/2022]
Abstract
Fibromatoses comprise many different entities of well-differentiated fibroblastic proliferation with variable collagen production and form a firm nodular mass. Abdominal fibromatosis is distinguishable from other forms of fibromatosis because of its location and its tendency to occur in women of childbearing age during or following pregnancy. Abdominal fibromatosis in children is an extremely rare condition. A 15-month-old boy presented with an abdominal wall mass that had recently increased in size. Mass excision was perfomed. The tumor was 4.3×4.1 cm and partly circumscribed. Histologically, the tumor was composed of parallel long fascicles of spindle-cells with a uniform appearance. The edges of the resected mass were infiltrative, and the surgical margins were positive. Mitotic figures were <1/10 high power fields. No cellular atypia or necrosis was present. The tumor cells were positive for vimentin and nuclear β-catenin staining.
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Affiliation(s)
- Hyun Hee Chu
- Department of Pathology, Chonbuk National University Medical School, Jeonju, Korea
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de Laffolie J, Hirschburger M, Reiter A, Wagner H. Intrathorakale Fibromatose vom Desmoidtyp bei einem 2-Jährigen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-013-1015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Skapek SX, Anderson JR, Hill DA, Henry D, Spunt SL, Meyer W, Kao S, Hoffer FA, Grier HE, Hawkins DS, Raney RB. Safety and efficacy of high-dose tamoxifen and sulindac for desmoid tumor in children: results of a Children's Oncology Group (COG) phase II study. Pediatr Blood Cancer 2013; 60:1108-12. [PMID: 23281268 PMCID: PMC4646066 DOI: 10.1002/pbc.24457] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/03/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Desmoid fibromatosis (desmoid tumor, DT) is a soft tissue neoplasm prone to recurrence despite complete surgical resection. Numerous small retrospective reports suggest that non-cytotoxic chemotherapy using tamoxifen and sulindac may be effective for DT. We evaluated the safety and efficacy of tamoxifen and sulindac in a prospective phase II study within the Children's Oncology Group. PROCEDURES Eligible patients were <19 years of age who had measurable DT that was recurrent or not amenable to surgery or radiation. The primary objective was to estimate progression-free survival (PFS). Patients received tamoxifen and sulindac daily for 12 months or until disease progression or intolerable toxicity occurred. Response was assessed by magnetic resonance imaging. RESULTS Fifty-nine eligible patients were enrolled from 2004 to 2009; 78% were 10-18 years old. Twenty-two (38%) were previously untreated; 15 (41%) of the remaining 37 enrolling with recurrent DT had prior systemic chemotherapy and six (16%) had prior radiation. No life-threatening toxicity was reported. Twelve (40%) of 30 females developed ovarian cysts, which were asymptomatic in 11 cases. Ten patients completed therapy without disease progression or discontinuing treatment. Responses included four partial and one complete (5/59, 8%). The estimated 2-year PFS and survival rates were 36% (95% confidence interval: 0.23-0.48) and 96%, respectively. All three deaths were due to progressive DT. CONCLUSIONS Tamoxifen and sulindac caused few serious side effects in children with DT, although ovarian cysts were common. However, the combination showed relatively little activity as measured by response and PFS rates.
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Affiliation(s)
- Stephen X. Skapek
- Division of Pediatric Hematology/Oncology, University of Texas Southwestern Medical Center, and the Center for Cancer and Blood Disorders, Children’s Medical Center, Dallas, Texas,Correspondence to: Stephen X. Skapek, MD, Division of Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063.
| | - James R. Anderson
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska
| | - D. Ashley Hill
- Department of Pathology and Center for Genetic Medicine Research, Children’s National Medical Center, and Department of Integrative Systems Biology, George Washington University, Washington, District of Columbia
| | - David Henry
- University of Kansas Medical Center, Kansas City, Kansas
| | - Sheri L. Spunt
- Department of Oncology, St. Jude Children’s Research Hospital, and the Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - William Meyer
- Jimmy Everest Section of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Simon Kao
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Fredric A. Hoffer
- Department of Radiology, University of Washington, Seattle, Washington,Quality Assurance Review Center, Providence, Rhode Island
| | - Holcombe E. Grier
- Department of Hematology/Oncology, Dana-Farber Cancer Institute and Children’s Hospital, Boston, Massachusetts
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - R. Beverly Raney
- Children’s Cancer Hospital and Division of Pediatrics, UT MD Anderson Cancer Center, Houston, Texas
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Honeyman JN, Theilen TM, Knowles MA, McGlynn MM, Hameed M, Meyers P, Crago AM, La Quaglia MP. Desmoid fibromatosis in children and adolescents: a conservative approach to management. J Pediatr Surg 2013; 48:62-6. [PMID: 23331794 DOI: 10.1016/j.jpedsurg.2012.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Desmoid fibromatosis is associated with frequent recurrence and significant morbidity, but no metastases. To examine the impact of initial non-operative management on event-free survival (EFS) in children, we reviewed our institutional experience with this tumor. METHODS We retrospectively reviewed our institutional database for pediatric cases of desmoid fibromatosis treated between 1970 and 2010. Survival was analyzed using the Kaplan-Meier method and log-rank test. RESULTS Ninety-three patients were identified, with a median follow-up of 6 years. Median age at diagnosis was 16 years. Forty-seven patients presented with primary tumors, and forty-six had recurrent or progressing disease. Five-year OS was 100%, and 5-year EFS was 31.8%, with a median time to event of 1.48 years. There was no significant difference in 5-year EFS between patients who were managed expectantly and those who initially received treatment (21% versus 34%, P=.09). Sex, race, history of trauma, or familial adenomatous polyposis, multifocality, tumor size, tumor location, and resection status did not correlate with EFS. CONCLUSION Our findings support a conservative initial approach in the management of desmoid fibromatosis. In patients at risk for morbid procedures, upfront resection should be reserved for select tumors that demonstrate aggressive growth or cause serious symptoms.
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Affiliation(s)
- Joshua N Honeyman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Aldrink JH, Nicol K, Wang W, Teich S. Fibrous soft tissue tumors: factors predictive of recurrence. J Pediatr Surg 2013; 48:56-61. [PMID: 23331793 DOI: 10.1016/j.jpedsurg.2012.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 10/13/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Fibrous soft tissue tumors (FSTT) of infancy and childhood present a challenge to surgeons due to ambiguous histological interpretation, propensity for local recurrence, and uncertainty regarding appropriate therapy. METHODS Records were reviewed for patients diagnosed and treated for FSTT at our institution from 1992 to 2010. Data included demographics, tumor location, operative treatment, histopathology, margin status, mitotic index, and recurrence. RESULTS Eighty-six patients underwent treatment of FSTT. Mean follow-up time was 62 months (range 1 to 201 months). There were 11 recurrences (13%), with a mean time to recurrence of 23 months. Extremity and digital lesions were most likely to recur with 21% of such lesions recurring compared to 7% of lesions located elsewhere. Recurrences were seen more frequently in older children. Despite the presence of positive margins in 92% of cases, margin status, histopathology, and mitotic index were not significant predictors of recurrence. CONCLUSIONS Digital and extremity fibrous soft tissue tumors and tumors of older children have an increased risk for local recurrence. Margin status did not predict recurrence rates in this series. While the surgical goal is to obtain complete local resection with clear margins, this may be challenging in particular locations and may not ultimately impact recurrence.
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Affiliation(s)
- Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH 43205, USA.
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Shih LY, Wei CK, Lin CW, Tseng CE. Postoperative retroperitoneal desmoid tumor mimics recurrent gastrointestinal stromal tumor: A case report. World J Gastroenterol 2012; 18:6172-6. [PMID: 23155350 PMCID: PMC3496898 DOI: 10.3748/wjg.v18.i42.6172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/23/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a locally invasive, myofibroblastic, nonmetastatic tumor. Its pathogenesis remains unclear and it may involve genetic abnormalities, sex hormones and traumatic injury, including surgery. Postoperative intra-abdominal desmoid tumor is rare, especially in the retroperitoneum. We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor. Sporadic trauma-related intra-abdominal desmoid tumors reported in the English literature are also reviewed. Despite an extremely low incidence, postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation. However, it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors, and surgical resection is the treatment option depending on the anatomic location.
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Zhou Y, Zhang Z, Fu H, Qiu W, Wang L, He Y. Clinical management of pediatric aggressive fibromatosis involving the mandible. Pediatr Blood Cancer 2012; 59:648-51. [PMID: 22556010 DOI: 10.1002/pbc.24145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/27/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric aggressive fibromatosis (AF) is a rare, benign tumor with locally infiltrative growth. Therefore, how to prevent reoccurrence while maintaining the mandible contour and continuity as much as possible is very important when the mandible is involved. PROCEDURE We selected 10 pediatric patients with AF involving the mandible in our department between January 2001 and December 2011. Patient clinical data, including patient characteristics, symptoms at presentation, management, and treatment outcome, were reviewed. RESULTS Patients' ages ranged from 3 to 16 years with six males and four females. According to imaging, there were three cases where the tumor adhered to the mandible; the periosteum was resected with the tumor, followed by cryotherapy or cauterization. Another five cases involved the destruction of the periosteum and the cortical plate. Resection of the involved mandible with the tumor was performed, and the margin was trimmed. In the last two cases, the tumor had invaded the whole ramus, and the immediate iliac graft was operated on after resecting the lesions. Neither radiotherapy (RT) nor chemotherapy was used. There was no recurrence or contour defect of the face. The function of the mandible was not affected, and only one case showed a slight limitation when opening the mouth. CONCLUSIONS For the treatment of pediatric AF, we recommend complete tumor resection. As for the involved mandible, preserving the mandible contour and continuity as much as possible and providing adjunctive therapy, such as cryotherapy or cauterization, are vital. RT is not recommended.
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Affiliation(s)
- Yong Zhou
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Desmoid fibromatosis in pediatric patients: management based on a retrospective analysis of 59 patients and a review of the literature. Sarcoma 2012; 2012:475202. [PMID: 22924016 PMCID: PMC3420075 DOI: 10.1155/2012/475202] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/14/2012] [Accepted: 06/14/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Only limited data are available concerning desmoid tumor in children. Methods. Fifty-nine children and adolescents with desmoid tumor treated in 2 French cancer centers with a very long followup were retrospectively reviewed. Results. Median age was 6 years (range, 0-15). Tumors mainly involved the limbs (42%). Five cases occurred in a context of genetic disorder. Surgery was first-line treatment in 80% of cases. Resection was microscopically complete in 3 patients (pts), with a microscopic residue in 19 pts and a macroscopic residue in 35 cases. Various adjuvant therapies were used. Overall response to all systemic therapies was 33%. Thirty-eight patients developed one or more recurrences or progressions. After a median followup of 8.5 years, 34 patients were alive in complete remission (CR), including 16 first CR. Seven patients died, 6 from refractory disease and 1 from colorectal carcinoma in a genetic context. Ten-year progression-free survival (PFS) and overall survival were 31% and 88%, respectively. In univariate analysis, age less than 10 years and head-neck site were favorable prognostic factors for PFS. Conclusions. When surgery is required, surgical margins must be negative. Low-dose chemotherapy can be proposed as adjuvant therapy. Prospective trials must be developed to evaluate long-term response and side effects.
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Felice FD, Musio D, Caiazzo R, Dipalma B, Grapulin L, Semproni CP, Tombolini V. An unusual case of fatty liver in a patient with desmoid tumor. World J Gastroenterol 2012; 18:3173-6. [PMID: 22791954 PMCID: PMC3386332 DOI: 10.3748/wjg.v18.i24.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 03/02/2012] [Accepted: 05/06/2012] [Indexed: 02/06/2023] Open
Abstract
A desmoid tumor, also known as aggressive fibromatosis, is a rare benign neoplasm that arises from fascial or musculoaponeurotic tissues. It can occur in any anatomical location, most commonly the abdominal wall, shoulder girdle and retroperitoneum. The typical clinical presentation is a painless mass with a slow and progressive invasion of contiguous structures. It is associated with a high local recurrence rate after resection. Many issues regarding the optimal treatment of desmoid tumors remain controversial. Aggressive surgical resection with a wide margin (2-3 cm) remains the gold standard treatment with regard to preserving quality of life. Radiotherapy alone has been shown to be effective for the control of unresectable or recurrent lesions. Desmoid tumors tend to be locally infiltrative, therefore, the fields must be generous to prevent marginal recurrence. The radiation dose appropriate for treating desmoid tumors remains controversial. We present a 25-year-old Caucasian man with local recurrence of a desmoid tumor after repeated surgical resection, treated with radiotherapy. The patient achieved complete tumor regression at 4 mo after radiotherapy, and he is clinically free of disease at 12 mo after the end of treatment, with an acceptable quality of life. The patient developed short bowel syndrome as a complication of second surgical resection. Consequently, radiotherapy might have worsened an already present malabsorption and so led to steatohepatitis.
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Federici S, Mordenti M, Domenichelli V, Pelusi G, Straziuso S, Pericoli R. Successful combined treatment for giant mesenteric desmoid tumor: case report and review of the literature. J Pediatr Surg 2012; 47:e25-30. [PMID: 22703821 DOI: 10.1016/j.jpedsurg.2012.01.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 12/02/2011] [Accepted: 01/19/2012] [Indexed: 11/26/2022]
Abstract
Mesenteric aggressive fibromatosis, also known as abdominal desmoid tumor (DT), is a rare monoclonal neoplasm arising from muscoloaponeurotic structures, caused by a generalized defect in growth regulation of the connective tissue. Childhood abdominal DT is very rare (1), and the mesenteric localization is one of the rarest forms (approximately 5% of total cases). Despite its benign microscopic appearance and nonmetastasizing behavior, abdominal DT shows a high risk of recurrence (30%-80%) (2) and local aggressive growth. We report a case of a 7-year-old girl with a giant mesenteric fibromatosis, with multiple recurrence after surgical resections, successfully treated with low-dose of vinblastine (3-6 mg/m(2) per week) and methotrexate (20-30 mg/m(2) per week) for 24 months (every 7 days for 11 months and every 2 weeks for the last 13 months). After a follow-up of 47 months from the end of treatment, the child is in good health and in complete remission. Prolonged therapy with low-dose methotrexate and vinblastine appears to control abdominal DT and is associated with stable disease in patients with tumor unresponsive to surgery.
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47
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Honeyman JN, Quaglia MPL. Desmoid tumors in the pediatric population. Cancers (Basel) 2012; 4:295-306. [PMID: 24213241 PMCID: PMC3712683 DOI: 10.3390/cancers4010295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022] Open
Abstract
Desmoid tumors are benign soft tissue tumors associated with locally aggressive growth and high rates of morbidity, but they do not metastasize via lymphatic or hematogenous routes. While most of the data on desmoid tumors originates in the adult literature, many of the findings have been applied to the management of pediatric patients. This article discusses the epidemiology, etiology, clinical presentation, pathology, and treatment of this rare tumor in the pediatric population and includes a literature review of the most recent large series of pediatric patients with desmoid tumors.
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Affiliation(s)
- Joshua N Honeyman
- Department of Surgery, Pediatrics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Pounds N, Skapek SX. Desmoid-type fibromatosis in children: a step forward in the cooperative group setting. Am Soc Clin Oncol Educ Book 2012:593-7. [PMID: 24451802 DOI: 10.14694/edbook_am.2012.32.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Desmoid-type (aggressive) fibromatosis (desmoid tumor) is a soft tissue neoplasm that can occur in both children and adults. Although it is formally classified as an intermediate-grade neoplasm because of its propensity for locally invasive growth, it can lead to severe and life-threatening problems. Because metastases do not arise from desmoid tumor, therapeutic interventions have historically focused on surgery or radiation to achieve local tumor control. These approaches may be ineffective or impractical for some children. In those cases, systemic therapy with cytotoxic or noncytotoxic therapy has been used. Because of the relative rarity of this neoplasm in children, knowledge on the use of chemotherapy is based largely on anecdotal reports or retrospective series. Limited conclusions can be drawn, though, from these types of reports. In the last 10 years, two prospective phase II clinical trials of chemotherapy for children with desmoid tumor have been conducted in cooperative clinical trials centered in North America. We review the results of those clinical trials and suggest future directions for systematically approaching this disease to better define the role of chemotherapy for children with desmoid tumor.
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Affiliation(s)
- Natalie Pounds
- From the University of Texas Southwestern Medical Center and Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
| | - Stephen X Skapek
- From the University of Texas Southwestern Medical Center and Center for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX
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Wilks DJ, Mowatt DJ, Merchant W, Liddington MI. Facial paediatric desmoid fibromatosis: a case series, literature review and management algorithm. J Plast Reconstr Aesthet Surg 2011; 65:564-71. [PMID: 22154716 DOI: 10.1016/j.bjps.2011.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/04/2011] [Accepted: 09/15/2011] [Indexed: 11/15/2022]
Abstract
Desmoid fibromatosis (also known as infantile or aggressive fibromatosis) is a rare soft tissue tumour that is occasionally seen in children. Although histologically benign, its growth pattern is highly aggressive often showing invasion of surrounding musculature and bone. Frequently found in cosmetically sensitive areas, complete excision can present a challenging problem. However, incomplete surgical excision is associated with high recurrence rates and although the disease responds to chemo and radiotherapy, both carry significant risks in young children. The management of four paediatric desmoid fibromatoses occurring in the midface is discussed. The recent and pertinent literature is comprehensively reviewed and an algorithm for the management of paediatric desmoid fibromatoses is proposed.
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Affiliation(s)
- Daniel J Wilks
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Rutenberg MS, Indelicato DJ, Knapik JA, Lagmay JP, Morris C, Zlotecki RA, Scarborough MT, Gibbs CP, Marcus RB. External-beam radiotherapy for pediatric and young adult desmoid tumors. Pediatr Blood Cancer 2011; 57:435-42. [PMID: 21744472 DOI: 10.1002/pbc.22916] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND To report long-term outcomes following radiotherapy for desmoid tumors in children and young adults and identify variables impacting local-regional control and treatment complications. PROCEDURE From 1978 to 2008, 30 patients <30 years old were treated with radiotherapy for a pathologically confirmed desmoid tumor. The median age at radiotherapy was 23.7 years old (range, 10.3-29.9). Fifteen patients underwent definitive radiotherapy, 14 received radiotherapy after gross total resection, and 1 received preoperative radiotherapy. Sixteen patients received 1.8 Gy once daily and 14 received 1.2 Gy twice daily. Variables analyzed for prognostic value included gender, age at diagnosis, primary or recurrent presentation, age at radiotherapy, tumor site, tumor size, extent of resection, fractionation schedule, and radiotherapy dose. RESULTS The actuarial 15-year overall survival and local-regional control rates were 96% and 55%, respectively. Local-regional control in patients <18 years old at the time of radiotherapy was 20% versus 63% in those 18-30 years old (P = 0.08). Local-regional control rates for tumors receiving ≥ 55 Gy and < 55 Gy were 79% and 30%, respectively (P = 0.02). No other factors had a statistically significant association with local-regional control by univariate analysis. Twelve of 30 patients experienced grade 3-4 complications, including pathologic fractures, impaired range of motion, pain, and in-field skin cancers. CONCLUSIONS The role of radiotherapy in managing young patients with desmoid tumors remains unclear. Younger patient age is associated with inferior local-regional control following RT. In children and young adults, doses ≥55 Gy were associated with improved tumor control, but also lead to increased risk of complications.
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Affiliation(s)
- Michael S Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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