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Zubor P, Henriksen CM, Økstad ME, Cerskuviene E, Visnovsky J, Kajo K, Valkov A, Lind KO. Desmoid Fibromatosis of the Anterior Abdominal Wall in Pregnancy: A Case Report and Review of the Literature. Diseases 2024; 12:27. [PMID: 38248378 PMCID: PMC10814966 DOI: 10.3390/diseases12010027] [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: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
A desmoid tumor (DT) is a rare benign neoplasm arising from muscle aponeurosis, associated mostly with trauma or pregnancy. DT has an infiltrative and locally aggressive growth pattern and usually does not metastasize. However, it has a high recurrence and complication rate. When it occurs in pregnancy, the pregnancy and delivery is taken as an individual case for optimal management by physicians and midwifes, who need to be cautious in finding the optimal delivery mode for the patient, which depends on the tumor size, location, behavior, and past history. The authors report a case of 29-year-old pregnant woman who previously underwent systemic oncological treatment for a large abdominal wall desmoid tumor and became pregnant afterwards. The history of DT presented a follow-up and delivery challenge. Observational management was chosen with an elective cesarean section at week 38 + 4 of pregnancy with uncomplicated postpartum follow-up. The authors detail the clinical management and chosen therapeutic approach; chemotherapy can be a choice in the treatment options for patients with DTs, although the majority of DTs are treated surgically with subsequent mesh plastic. Moreover, the authors provide a systematic review of the literature focused on the treatment management of DTs in pregnant women during pregnancy and the postpartum period, as pregnancy-associated desmoid tumors are a specific condition, where the optimal management is not well established, despite some guidelines for non-pregnant patients.
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Affiliation(s)
- Pavol Zubor
- Department of Obstetrics and Gynecology, Nordland Hospital, 8450 Stokmarknes, Norway
- OBGY Health & Care Ltd., 01001 Zilina, Slovakia
| | | | - Maren Elvenes Økstad
- Department of Obstetrics and Gynecology, Nordland Hospital, 8450 Stokmarknes, Norway
| | - Erika Cerskuviene
- Department of Obstetrics and Gynecology, Nordland Hospital, 8450 Stokmarknes, Norway
| | - Jozef Visnovsky
- Faculty of Health Care, Catholic University, 03401 Ruzomberok, Slovakia
- VISNOVSKI Ltd., 03601 Martin, Slovakia
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, 81250 Bratislava, Slovakia;
| | - Andrey Valkov
- Department of Clinical Pathology, University Hospital of Northern Norway, 9019 Tromsø, Norway;
| | - Kristen Olav Lind
- Department of Obstetrics and Gynecology, Nordland Hospital, 8450 Stokmarknes, Norway
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2
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Kanavou T, Mastorakos DP, Mastorakos PD, Faliakou EC, Athanasiou A. Imaging of the Reconstructed Breast. Diagnostics (Basel) 2023; 13:3186. [PMID: 37892007 PMCID: PMC10605380 DOI: 10.3390/diagnostics13203186] [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: 08/17/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
The incidence of breast cancer and, therefore, the need for breast reconstruction are expected to increase. The many reconstructive options available and the changing aspects of the field make this a complex area of plastic surgery, requiring knowledge and expertise. Two major types of breast reconstruction can be distinguished: breast implants and autologous flaps. Both present advantages and disadvantages. Autologous fat grafting is also commonly used. MRI is the modality of choice for evaluating breast reconstruction. Knowledge of the type of reconstruction is preferable to provide the maximum amount of pertinent information and avoid false positives. Early complications include seroma, hematoma, and infection. Late complications depend on the type of reconstruction. Implant rupture and implant capsular contracture are frequently encountered. Depending on the implant type, specific MRI signs can be depicted. In the case of myocutaneous flap, fat necrosis, fibrosis, and vascular compromise represent the most common complications. Late cancer recurrence is much less common. Rarely reported late complications include breast-implant-associated large cell anaplastic lymphoma (BIA-ALCL) and, recently described and even rarer, breast-implant-associated squamous cell carcinoma (BIA-SCC). In this review article, the various types of breast reconstruction will be presented, with emphasis on pertinent imaging findings and complications.
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Affiliation(s)
| | - Dimitrios P Mastorakos
- 2nd Breast Surgery Unit, Mitera Hospital, 15123 Athens, Greece
- Athens Breast Clinic, 11527 Athens, Greece
| | | | - Eleni C Faliakou
- 2nd Breast Surgery Unit, Mitera Hospital, 15123 Athens, Greece
- Athens Breast Clinic, 11527 Athens, Greece
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Vorstenbosch J, Chu JJ, Ariyan CE, McCarthy CM, Disa JJ, Nelson JA. Clinical Implications and Management of Non-BIA-ALCL Breast Implant Capsular Pathology. Plast Reconstr Surg 2023; 151:20e-30e. [PMID: 36194076 PMCID: PMC9797444 DOI: 10.1097/prs.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
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Affiliation(s)
- Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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4
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Onafowokan OO, Aujla R, Eastley N, Ashford RU. Desmoid fibromatosis associated with Endobutton use for anterior cruciate ligament reconstruction. BMJ Case Rep 2022; 15:e250747. [PMID: 35580938 PMCID: PMC9114958 DOI: 10.1136/bcr-2022-250747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Oluwatobi O Onafowokan
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Randeep Aujla
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Nicholas Eastley
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Robert U Ashford
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK
- Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
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Costa PA, Marbin S, Costa BMLA, Espejo-Freire AP, Saul EE, Barreto-Coelho P, Allen A, Hakim MO, Goel N, D'Amato GZ, Subhawong T, Trent JC. A nonrandom association of breast implants and the formation of desmoid tumors. Breast J 2021; 27:768-775. [PMID: 34453383 DOI: 10.1111/tbj.14276] [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: 05/11/2021] [Revised: 07/10/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies suggest that surgical breast augmentation with implants is a risk factor for breast desmoid tumors. The statistical strength of this correlation is unknown, as evidence is limited to anecdotal reports. METHODS Patients with breast desmoid tumors and a history of breast implants seen at a single center between 2000 and 2021 were identified via radiology, breast, and sarcoma databases. The standardized incidence ratio (SIR) was calculated to assess the correlation between breast desmoid tumors and breast implants. The cases were pooled with published cases for analyses. Progression-free survival curves and hazard ratios were estimated using the Kaplan-Meier method and Cox proportional-hazards modeling. RESULTS Fourteen patients from one institution and 66 cases in the literature were identified. All patients were female, and the mean age was 38 years old (range 20-66). 63 patients (82%) underwent resection, 9 (12%) received chemotherapy, 3 (4%) received sorafenib, 11 (14%) received hormonal therapy, and 3 (4%) underwent active surveillance. After resection, the 2-year recurrence-free survival rate was 77% (95% CI 65%-89%). The recurrence risk was lower for resection with no residual tumor (R0) compared to microscopic (R1) or macroscopic (R2) residual tumor (HR: 0.15; 95% CI 0.02-0.8; p < 0.05). The SIR was 482 (95% CI 259-775) to 823 (95% CI 442-1322), suggesting a 482-823 times higher risk of developing a breast desmoid tumor after breast augmentation than the general population. CONCLUSION We present a nonrandom association between breast implants and desmoid tumors. Whether the tumors arise from the surgical trauma or the implant's biomaterial is unknown. When surgery is indicated, negative margins reduce the risk of recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Neha Goel
- University of Miami, Miami, Florida, USA
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Comment on "Breast Implant-associated Anaplastic Large Cell Lymphoma Incidence: Determining an Accurate Incidence". Ann Surg 2021; 274:e865-e866. [PMID: 33443893 DOI: 10.1097/sla.0000000000004742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Complicaciones infrecuentes de las prótesis de mama. RADIOLOGIA 2020; 62:266-279. [DOI: 10.1016/j.rx.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
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Sánchez Rubio N, Lannegrand Menéndez B, Duque Muñoz M, Montes Fernández M, Ciudad Fernández M. Uncommon complications of breast prostheses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lorenzen J, Cramer M, Buck N, Friedrichs K, Graubner K, Lühr CS, Lindner C, Niendorf A. Desmoid Type Fibromatosis of the Breast: Ten-Year Institutional Results of Imaging, Histopathology, and Surgery. Breast Care (Basel) 2020; 16:77-84. [PMID: 33708054 DOI: 10.1159/000507842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Desmoid type fibromatoses has proven to be a diagnostic and therapeutic challenge, as they often appear primarily as a carcinoma of the breast with a high recurrence risk. Patients A digital archive search was performed for the period from 2009 to the end of 2018. Inclusion criteria consisted of histological examination of at least the surgical specimen in the reference pathology department and at least a second opinion diagnosis in the reference radiology department. Results A total of 14 women and 1 man underwent surgery on desmoid type fibromatosis of the breast. The average patient age was 49 years (range: 22-72 years). The mean tumor size was 2.2 cm (range: 0.8-4.2 cm). The tumor was detectable in mammography in 12 out of 13 patients and in all 15 patients in sonography. MRI was performed preoperatively in 6 patients; in all of the patients, the tumor was visualized with inhomogeneous contrast enhancement. In the imaging procedures, all desmoid type fibromatoses were classified as suspicious. Performing the core biopsy, preoperative histology confirmed desmoid fibromatosis in 12 out of 15 patients. Nuclear stain for ß-catenin was positive in 7 out of 10 patients. Negative staining was found for AE1/A3 in 10 out of 10 and CD34 in 12 out of 12 patients. In all of the patients, a single-stage operation without the detection of border-forming tumor margins was performed. The follow-up interval ranged from 16 to 96 months (mean: 44.86 months, median: 43 months). In this follow-up period, no patient was diagnosed with desmoid tumor recurrence. Conclusion In imaging, desmoid type fibromatosis of the breast has typical malignancy-related criteria. Extensive preoperative diagnostics enable the planning of complete primary excision of the lesion and reduce the recurrence risk.
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Affiliation(s)
| | | | - Nina Buck
- Radiologische Allianz, Hamburg, Germany
| | | | - Kirsten Graubner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | | | - Christoph Lindner
- Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
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Slavnova EN, Saribekyan EK, Surkova VS, Ortabaeva DR, Goryushkina OB, Petrov AN. [Complex morphological (cytological, histological) diagnostics of desmoid fibroma associated with a breast implant (case report from practice).]. Klin Lab Diagn 2020; 65:228-230. [PMID: 32227728 DOI: 10.18821/0869-2084-2020-65-4-228-230] [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: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 11/17/2022]
Abstract
A rare clinical observation of desmoid fibroma associated with a breast implant is presented. When making a morphological (cytological, histological) diagnosis at the light-optical level before surgery, a differential morphological diagnosis was performed between cicatricial changes, the stromal component of the phyloid tumor and desmoid fibroma. Only immunohistochemistry allowed us to establish a diagnosis of desmoid fibroma, since tumor cells expressed diffusely SMA, focally desmin, and most importantly, ß-catenin expression was observed in some cells.
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Affiliation(s)
- E N Slavnova
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
| | - E K Saribekyan
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
| | - V S Surkova
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
| | - D R Ortabaeva
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
| | - O B Goryushkina
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
| | - A N Petrov
- P. Hertsen's Moscow Oncology Research Institute - branch of the National Medical Research Centre оf Radiology of the Ministry of Public Health of Russian Federation
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Grubstein A, Rapson Y, Zer A, Gadiel I, Atar E, Morgenstern S, Gutman H. MRI
diagnosis and follow‐up of chest wall and breast desmoid tumours in patients with a history of oncologic breast surgery and silicone implants: A pictorial report. J Med Imaging Radiat Oncol 2018; 63:47-53. [DOI: 10.1111/1754-9485.12829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ahuva Grubstein
- Department of Imaging Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yael Rapson
- Department of Imaging Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Alona Zer
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Institute of Oncology Davidoff Cancer Center Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
| | - Itay Gadiel
- Department of Imaging Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
| | - Eli Atar
- Department of Imaging Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Pathology Department Rabin Medical center Beilinson Hospital Petach Tikva Israel
| | - Haim Gutman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Surgery B Surgical Oncology Unit Rabin Medical Center – Beilinson Hospital Petach Tikva Israel
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