Aggressive fibromatosis in the head and neck region: Benign tumor with often mutilating effects

Postoperative Development of Desmoid Tumor After Surgical Correction of Adult Spinal Deformity: Case Report and Review of Literature

BACKGROUND

Desmoid tumors are known to be rare and relatively slow growing with locally invasive histology and high recurrence rates. A rare subset of these tumors occurs adjacent to the spinal column after surgery. Since 1961, only 6 cases of postoperative paraspinal desmoid tumor have been reported. This report is the first to describe the occurrence of a paraspinal desmoid tumor after surgical correction of a spinal deformity.

CASE DESCRIPTION

A 56-year-old woman with multiple sclerosis reported 2-3 years of progressively worsening mid and low back pain that was worse with standing and ambulation and almost completely relieved with lying flat. Standing anteroposterior scoliosis radiographs revealed a thoracolumbar spinal deformity, which was surgically corrected with a T4 pelvis spinal fixation and fusion. At her 2-year postoperative clinic visit the patient reported good improvement in her preoperative symptoms but felt a fullness in her right upper back and neck that was nontender. Magnetic resonance imaging revealed a large tumor in this region. The tumor was resected en bloc, and pathology noted a 14.5 cm × 8.7 cm × 4.2 cm mass with spindle cell proliferation and positive staining for β-catenin (mutated gene found in 85% of desmoid tumors).

CONCLUSIONS

This is the first report of a postoperative desmoid tumor after spinal deformity correction and the seventh reported case in the spine literature. All reported cases have been women aged 39-57 years. The patient will be followed closely with magnetic resonance imaging given the known high local recurrence rate of this tumor.

Desmoid Tumor Presenting as a Typical Cervical Dumbbell Tumor:A Case Report and Literature Review

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.

Facial fibromatosis: benign and aggressive, yet treatable!

Fibromatosis or desmoid tumors are locally aggressive neoplasms that have a propensity for local invasion and recurrence. The mainstay of treatment is excision with negative margins and the role of radiotherapy is controversial. Desmoids arising in the head and neck area are rare and pose a dilemma to the surgeon due to large number of vital structures that preclude resection with wide margins. This leads to a high incidence of recurrence. We present a case of a 24-year-old male who presented with an asymptomatic left sided facial swelling causing cosmetic deformity. A subcutaneous lipoma/fibroma/neuroma was suspected and a fine needle aspiration done was inconclusive. Computed tomography revealed a subcutaneous swelling that was excised. Histopathology revealed it to be a desmoid tumor. At the end of 4-year-follow-up, he has no local recurrence.

Orbital Desmoid-Type Fibromatosis: A Case Report and Literature Review

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.

Medical treatment of mammary desmoid-type fibromatosis: which benefit?

Background

Breast fibromatosis is a rare disease characterized by monoclonal fibroblast proliferation. It has no ability to metastasize but has a high local recurrence rate and often infiltrates surrounding tissues. Surgical treatment is the reference, but recently, new targeted therapies have emerged. We report an original case of a patient with breast fibromatosis who received exclusive medical treatment. Our aim was to analyze these treatments based on the clinical and radiological outcome, iatrogenic effects, and pharmacological action.

Case presentation

We report the case of a 19-year-old woman who developed a desmoid-type fibromatosis of the lower inner quadrant of the right breast, measuring 50 × 25 mm (i.e., a volume of 27.4 cm³). Initial surgery was not possible because of potential esthetic and functional prejudice. Thus, she had an exclusive medical treatment including several lines: NSAIDs with tamoxifen and triptorelin, followed by sorafenib, then interferon α2b, and finally sunitinib. With tyrosine-kinase inhibitors (TKIs) (sunitinib), a significant partial response was observed (57% reduction of the maximal tumoral volume). For each treatment, we provided the clinical and radiological outcome in association with known pharmacological action.

Conclusions

TKI had been an interesting alternative option to initial surgery, providing at least a partial response and potentially allowing less mutilating surgery. However, no pharmacological mechanism can unequivocally explain TKI efficacy. In general, breast fibromatosis should be treated along with oncologist and interventional radiologists in a trans-disciplinary modality, thus offering an adapted treatment for this particular desmoid-type fibromatosis localization.

The medico-legal observation of an aggressive urogenital fibromatosis with isolated development not related to any traumatic event

Desmoid tumor is a fibroproliferative neoplasm with an intermediate malignancy and it can be localized in every bodily district: some locations are considered exceptional, like the urogenital localization. The Author point out a rare case of giant idiopathic scrotal fibromatosis that was found during an autopsy. A widower, that lived alone in poor hygienic conditions, was found dead in his house. The Judicial Authority ordered the autopsy, that was performed two days later at the Medico-Legal Section of Milan University. External examinations revealed only the considerable dimension of the scrotum (cm 24 × 41). The cause of death was fixed in a cardiac tamponade due to a natural heart laceration localized in correspondence of a transmural infarction. The toxicological exam resulted negative, while the histopathological and immunohistochemical analysis qualify the scrotal mass as a desmoids tumor. Due to the absence of predisposing conditions and of fibroproliferative infiltration in bladder and retroperitoneal space, the neoplasm was configured as an idiopathic desmoid tumor. The presented case gives the reason for the discussion concerning medico-legal aspects that are typical of rare neoplasms.

Vulvar fibromatosis: a clinical enigma

OBJECTIVE

To present a case of recurrent vulvar fibromatosis in an adolescent, discuss the specific difficulties of treating adolescents, and review the literature on available treatment.

METHODS

We present a case of recurrent vulvar fibromatosis in a 14-year-old girl, requiring several treatment modalities, including multiple surgeries, radiation therapy, and multiagent chemotherapy. We then discuss management strategies for these tumor types, and specifically examine how tumor location may impact their treatment.

RESULTS

Vulvar desmoids are extremely uncommon and they can be disfiguring and cause significant discomfort for women. Initial management of these tumors is surgical excision, yet failed surgery is often followed by other treatment modalities, including radiation, tyrosine kinase inhibitors, nonsteroidal anti-inflammatory drugs, hormonal therapy, and chemotherapy. This case clearly highlights the difficulties in managing these rare tumors, particularly in the adolescent population.

CONCLUSIONS

Desmoid tumors are nonmalignant, locally aggressive neoplasms most common in the 15 to 60 years age group. They are associated with high estrogen states, prior surgical trauma, and Gardner syndrome. Most commonly, desmoid tumors present in the abdominal wall, shoulder, neck, and chest, but can occur anywhere in the body. Given their rarity and lack of definitive therapy, vulvar desmoid tumors can be exceedingly difficult to treat, and are best managed with an interdisciplinary approach.

Desmoid tumor arising from omohyoid muscle: The first report for unusual complication after transaxillary robotic thyroidectomy

BACKGROUND

Transaxillary robotic (TAR) thyroidectomy has been performed for better aesthetic results by many surgeons. In this report, we describe a rare case of a desmoid tumor developed after TAR thyroidectomy, which is speculated to be a late-term complication.

METHODS AND RESULTS

A 61-year-old woman with a history of papillary microcarcinoma had experienced a large left neck mass that had grown over 2 years. The patient underwent TAR thyroidectomy (right lobectomy and isthmectomy) via the right axilla almost 2.5 years previously. Physical examination revealed a 6-cm, firm mass fixed to the left anterior neck. The mass was fixed to the omohyoid muscle. The 5.9- × 4.7- × 4.5-cm tumor with the surrounding muscles was excised in an en bloc fashion. Pathologic examination confirmed the diagnosis of a desmoid tumor.

CONCLUSION

This case suggests that desmoid tumors could develop late after TAR thyroidectomy. Thus, careful observation of the surgical wound may be necessary after TAR thyroidectomy.