Primary giant congential infantile fibrosarcoma of the scalp: case report and review of literature

Congenital (infantile) fibrosarcoma of the scalp: a case series and review of literature

INTRODUCTION

Congenital infantile fibrosarcoma (CIFS) is a soft tissue sarcoma of infants mainly involving lower extremities usually presenting during the first year of life. A subset of cases occur in the head and neck, but scalp involvement is exceptionally rare.

PATIENTS AND METHODS

We report clinicopathological features of three cases of CIFS involving the scalp diagnosed between 2011 and 2012.

RESULTS

The ages of the three patients at the time of diagnosis ranged from 12 to 90 days (mean 48 days). All were males and presented with scalp swelling at birth which grew rapidly in size. The tumor was located in the left temporal region in two cases and the right temporoparietal region in one case. On imaging, underlying bone involvement was noted in two cases. The mean size of the resected tumors was 8 cm. All cases exhibited a cellular tumor arranged in sheets of uniform oval to spindle cells, increased mitosis, and hemangiopericytoma-like vessels. All patients are alive after a mean follow-up of 39.6 months. Recurrence was seen in one case due to incomplete excision. No metastasis was seen in any of the cases.

CONCLUSION

CIFS of the scalp is rare and carries a good prognosis. Underlying bone erosion is rare but was noted seen in two of our cases. A male predominance was seen in our cases.

Giant cranial and cerebellar hemangioma treated with propranolol

INTRODUCTION

Infantile hemangiomas are the most common benign tumors in children. However, cranial involvement of such lesions is rare. Current treatment options for hemangiomas in various locations that would be endangering or disfiguring include follow-up, surgical removal, or administration of corticosteroids, interferon-α, thalidomide, vincristine, propranolol, and laser therapy.

METHODS

We describe an infant who presented with an extensive cranial hemangioma (proven by a biopsy). The child was treated with propranolol.

RESULTS

Clinical and radiological follow-up for over a year showed significant reduction in tumor size without adverse clinical symptoms.

CONCLUSION

Propranolol is a valid treatment for large cranial hemangiomas, avoiding the risks involved in surgeries.

Congenital infantile fibrosarcoma: review of imaging features

BACKGROUND

Fibrosarcoma is a rare tumor in children with limited information on imaging features of these tumors in the literature.

OBJECTIVE

To retrospectively review the imaging features of histologically proven congenital infantile fibrosarcoma.

MATERIALS AND METHODS

The list of histologically confirmed congenital infantile fibrosarcomas between November 1999 and June 2013 was obtained from the oncology-pathology database. Imaging features and pathology reports of these tumors were reviewed. Patient charts were reviewed and clinical features, management and outcomes were recorded.

RESULTS

During the study period, 13 children (9 girls and 4 boys; age range: 0 day-16 months, median age: 2.5 months) with congenital infantile fibrosarcomas were available for complete radiological review. The translocation (t[12;15]) was present in 11/13 (84.6%) and absent in 2/13. Eight/thirteen (61.5%) tumors were located in extremities (5 in lower and 3 in upper), 3/13 in thoracolumbar paraspinal regions, and one each in abdomen and sternocleidomastoid muscle. Imaging features included iso- to hyperintensity on T1-W, hyperintensity on T2-W as compared to skeletal muscles and heterogeneous enhancement. Six (37.5%) tumors showed hemorrhagic components and 2 (15.4%) showed low intensity foci. None of the patients had evidence of regional or distant metastases at diagnosis. Management included surgical resection only (1/13) and combined surgery and chemotherapy (10/13). Overall survival was 100% with a median follow-up of 49.3 months.

CONCLUSION

Congenital infantile fibrosarcoma has nonspecific imaging characteristics but should be high on the differential diagnosis in a soft-tissue tumor presenting in infancy, located in an extremity and showing tumoral hemorrhage. Patients have a favorable outcome.