Pediatric head and neck fibrosarcomas: A demographical, treatment, and survival analysis and review of a rare case

Abdominal wall congenital infantile fibrosarcoma: A rare case report and literature review

Congenital infantile fibrosarcoma is a rare malignant soft tissue tumor, accounting for less than 1%-2% of childhood cancers. Although it can arise from any body part, an abdominal wall origin is exceptionally rare. This case report presents a case of congenital infantile fibrosarcoma originating from the abdominal wall. To the best of our knowledge, this is only the second reported case of abdominal wall congenital infantile fibrosarcoma. Unlike adult fibrosarcoma, infantile fibrosarcoma has a good prognosis with less metastasis. Early diagnosis and management are critical for improving outcomes in such rare cases.

Prenatal ultrasound diagnosis of congenital infantile fibrosarcoma and congenital hemangioma: Three case reports

BACKGROUND

Congenital infantile fibrosarcoma (CIF) and congenital hemangioma (CH) have similarities on prenatal ultrasound and are rare.

CASE SUMMARY

We report 3 cases of fetuses with superficial hypervascular tumors, confirmed by postnatal pathology as CIF (1 case) and CH (2 cases, including 1 in a twin fetus). In Case 1, a mass with a rich blood supply in the fetal axilla was discovered by prenatal ultrasound at 28+0 wk of gestation. The postpartum pathological diagnosis was CIF, the mass was surgically removed, and the prognosis of the child was good. In Case 2, at 23+1 wk of gestation, a mass was discovered at the base of the fetus's thigh on prenatal ultrasound. The postpartum pathological diagnosis was CH. After conservative treatment, the mass shrank significantly. Case 3 occurred in a twin fetus. At 30+0 wk of gestation, prenatal ultrasound revealed a bulging mass with a rich blood supply on the abdominal wall of one of the fetuses. Three weeks later, the affected fetus died, and the unaffected baby was successfully delivered by emergency cesarean section. The affected fetus was pathologically diagnosed with CH.

CONCLUSION

Prenatal ultrasound can provide accurate information, such as the location, size and blood supply of a surface mass in a fetus. We found similarities between CIF and CH in prenatal ultrasound findings. Although it is difficult to distinguish these conditions by prenatal ultrasound alone, for superficial hypervascular tumors that rapidly increase in size in a short period, close ultrasound monitoring of the fetus is required to quickly address possible adverse outcomes.

Epidemiological trends and survival outcomes for dermatofibrosarcoma protuberans of the head and neck region

BACKGROUND

Given the rarity of dermatofibrosarcoma protuberans (DFSP) of the head and neck, the incidence and prognosis specific to this region are poorly defined. The purpose of this study was to determine epidemiology, clinicopathological characteristics, and prognostic factors of patients with DFSP of the head and neck region, using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

A cohort analysis was performed for primary head and neck DFSP reported to the SEER database between 2000 and 2018. Overall survival was determined using Kaplan-Meier analysis while Cox regression modeling was used to examine predictive factors.

RESULTS

A total of 681 cases were reported to the SEER database between 2000 and 2018. Incidence rates decreased over time. Overall survival was 94%, and disease-specific survival was 99% at 5 years. Cases of head and neck DFSP were found to occur more frequently in males. There was no difference in incidence rates between White patients and Black patients. Age ≥ 60 years old, tumor size, and living location were the most significant predictors of overall survival.

CONCLUSIONS

This analysis of DFSP of the head and neck demonstrates a downward trend in incidence, higher age-standardized incidence in males, and similar race-based incidences, which differs from data reported on DFSP of other anatomic locations.

Pediatric dermatofibrosarcoma protuberans: A clinicopathologic and genetic analysis of 66 cases in the largest institution in Southwest China

Background

Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous tumor in children. Most published articles are sporadic or small series and lack systematically molecular analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions.

Methods

All patients diagnosed with DFSP aged ≤ 18 years were retrospectively reviewed from January 2006 to May 2022.

Results

A total of 66 cases (32 male and 34 female patients) were identified, with ages ranging from 0.3 to 18 years (median, 13 years). Tumor locations predominantly occurred on the trunk (38/66, 57.6%), followed by the extremities (20/66, 30.3%) and head/neck (8/66, 12.1%). Histological findings revealed classic (41/66, 62.1%), myxoid (4/66, 6.1%), pigmented (6/66, 9.1%), plaque-like (3/66, 4.5%), giant cell fibroblastoma (GCF; 6/66, 9.1%), and fibrosarcomatous (6/66, 9.1%) variants of DFSP. Immunochemistry revealed minority tumors (9/66, 13.6%) showing patchy or negative staining for CD34. Fluorescence in situ hybridization (FISH) indicated that 49 of 53 tested cases including all detected biopsy specimens (11/11) contained COL1A1-PDGFB fusion, in which the average copy number gain of COL1A1-PDGFB was 0.68. There were four cases negative for COL1A1-PDGFB rearrangement, one of which was found to harbor a novel COL3A1-PDGFB fusion by next-generation sequencing (NGS). Treatment for 63 patients comprised 40 marginal excisions and 23 wide local excisions (WLEs), including 1 with imatinib therapy. Follow-up information was available on 49 patients with a duration of 12-161 months (median, 60 months). Fourteen patients developed tumor recurrence, all with initial marginal excisions. The others survived with no evidence of disease.

Conclusions

This study of pediatric DFSP indicates certain discrepancies in clinicopathologic characteristics between children and adults. The majority of pediatric DFSPs contain COL1A1-PDGFB fusion, the same as their adult counterparts. The COL3A1-PDGFB chimerism might be associated with the special morphology of GCF, which needs further investigation. FISH is valuable in biopsy tissues and cases with atypical CD34 immunostaining, while supplementary NGS could be helpful to identify the cytogenetically cryptic DFSP. Overall, an urgent accurate diagnosis is needed to formulate an optimal therapeutic strategy in the pediatric population.

The Giant Infantile Fibrosarcoma of Fetal Oropharynx and Anterior Neck

Introduction: Infantile fibrosarcoma (IFS) usually arises in the extremities during the first 12 months of life and responds well to surgery. It is unusual in the oropharynx or the prenatal period. Case report: A giant solid mass was first detected in the oropharynx and anterior neck at 24 weeks of gestation by ultrasound and fetal MRI. An EXIT procedure with intrapartum intubation with appropriate supportive therapy was successful. The diagnosis of IFS was made postpartum, and the lesion responded to neoadjuvant chemotherapy. Conclusion: IFS may arise as early as 24 weeks of gestation. In this case, an EXIT procedure allowed postpartum diagnosis with subsequent treatment.

Surgical treatment of pediatric rhabdomyosarcoma in the parameningeal-nonparameningeal region

OBJECTIVES

Rhabdomyosarcoma (RMS) involving the parameningeal-nonparameningeal region (PNP) is relatively rare in pediatric patients (PPs). The current study aimed to report the outcomes of RMS-PNP-PPs who received surgical resection combined with concurrent flap reconstruction.

METHODS

A retrospective study was conducted concerning RMS-PNP-PPs who received combined skull-maxillofacial resection with flap reconstruction during the period from 2012 to 2016. Predictive factors for recurrence-free survival (RFS), metastasis-free survival (MFS), and overall survival (OS) were preliminarily identified by Kaplan-Meier analysis.

RESULTS

A total of 16 RMS-PNP-PPs were finally enrolled; recurrence, metastasis and death were found in 7, 7 and 5 patients, respectively. Following surgical ablation involving the skull base and maxillofacial region, reconstruction was performed with a local flap in 9 patients, a latissimus dorsi flap in 3 patients, and an anterolateral thigh flap in 4 patients. Through univariate analysis, we demonstrated that the primary site + surgical margins, postoperative RT/CT + Ki-67/Bcl-2 IHC, and surgical margins + Ki-67/Bcl-2 IHC could be used as the preliminarily prognostic factors for RFS, MFS and OS, respectively.

CONCLUSIONS

RMS-PNP-PPs showed poor prognosis even when surgical resection combined with flap reconstructions was performed. Achieving a clear surgical margin and good conduction of postoperative RT/CT should be taken into consideration to acquiring a better surgical outcome.