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Torres BS, Brown HG, Nuñez J, Abongwa C, Hajjar FM, Sawh-Martinez RF, Lopez J. Pediatric Desmoid Tumor of the Head and Neck: A Systematic Review and Modified Framework for Management by Age Group. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6122. [PMID: 39258285 PMCID: PMC11384049 DOI: 10.1097/gox.0000000000006122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/01/2024] [Indexed: 09/12/2024]
Abstract
Background Unlike in adults, pediatric head and neck desmoid tumors (DTs) have greater capacity to interfere with normal anatomical development. Therefore, adequate interventions and management must be defined. We aimed to provide the most comprehensive systematic review on pediatric head and neck DTs to date, including assessment of lesion location predominance, intervention, and management, and examination of any associations between age and outcomes like surgical margin status, recurrence, and complications. Methods A systematic literature review was conducted between January 1990 and December 2023 using PubMed, Scopus, and MEDLINE databases following the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines. We aimed to elucidate intervention and management strategies by studying various outcomes in 0-11 and 12-21 year olds. Results The literature search yielded 44 studies, totaling 121 patients. Most head and neck DTs localized to the mandible, cranium, and neck; occurred early (P = 4.18 years); and underwent local resection with positive margins. Older and younger patients shared no difference in complication or recurrence rates. Conclusions We found recurrence is likely to occur with positive margins. Because standard treatment of DTs is surgical resection with negative margins, if technically feasible with reasonable associated morbidity, we suggest additional resection of the tumor to achieve negative margins. We also recommend more robust follow-up data collection, not only due to desmoid's high recurrence and data paucity in patients older than 12 years, but also, to better establish best management practices.
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Affiliation(s)
- Bryan S Torres
- From the School of Medicine, Tulane University, New Orleans, La
| | - Hannah G Brown
- School of Medicine, University of Central Florida, Orlando, Fla
| | - Julisa Nuñez
- School of Medicine, Georgetown University, Washington, D.C
| | - Chenue Abongwa
- Division of Medical Oncology, AdventHealth for Children, Orlando, Fla
| | - Fouad M Hajjar
- Division of Medical Oncology, AdventHealth for Children, Orlando, Fla
| | - Rajendra F Sawh-Martinez
- Division of Pediatric Plastic and Reconstructive Surgery, Department of Pediatric Surgery, AdventHealth for Children, Orlando, Fla
| | - Joseph Lopez
- Division of Pediatric Plastic and Reconstructive Surgery, Department of Pediatric Surgery, AdventHealth for Children, Orlando, Fla
- Division of Pediatric Head and Neck Surgery, Department of Pediatric Surgery, AdventHealth for Children, Orlando, Fla
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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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Yalla P, Rathod P, Rojesara M, Pawar A, Devarajan JA, Pandya SJ. A Spindle Cell Tumour that Took us for a Spin!: A Case Report and Short Review of Management of Head and Neck Desmoid Fibromatosis. Indian J Otolaryngol Head Neck Surg 2023; 75:4028-4031. [PMID: 37974872 PMCID: PMC10646034 DOI: 10.1007/s12070-023-04008-5] [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: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 11/19/2023] Open
Abstract
Head and neck desmoid fibromatosis is a rare type of benign but locally aggressive tumour that has varied presentations and is difficult to manage with a high chance of causing morbidity to the patient. This report highlights the importance of proper diagnosis and surgical planning before embarking on a strenuous surgical resection.
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Affiliation(s)
- Poojitha Yalla
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Priyank Rathod
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Mitkumar Rojesara
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ajinkya Pawar
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Jebin Aaron Devarajan
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shashank J Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Velez Torres JM, Mata DA, Briski LM, Green DC, Cloutier JM, Kerr DA, Montgomery EA, Rosenberg AE. Sinonasal Myxoma: A Distinct Entity or a Myxoid Variant of Desmoid Fibromatosis? Mod Pathol 2023; 36:100189. [PMID: 37059229 DOI: 10.1016/j.modpat.2023.100189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/23/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
Sinonasal myxoma (SNM) is a rare benign mesenchymal tumor that arises in the sinonasal cavity or maxilla and almost exclusively affects young children. Currently, it is considered a specific entity, but its molecular characteristics have not been reported. Lesions diagnosed as SNM and odontogenic myxoma/fibromyxoma (OM/OFM) were identified from the participating institutions, and the clinicopathologic features were recorded. Immunohistochemistry for β-catenin was performed on all cases with available tissue. Next-generation sequencing (NGS) was performed on all SNM cases. Five patients with SNM were identified, including 3 boys and 2 girls with an age range of 20-36 months (mean: 26 months). The tumors were well-defined, centered in the maxillary sinus, surrounded by a rim of woven bone, and composed of a moderately cellular proliferation of spindle cells oriented in intersecting fascicles in a variably myxocollagenous stroma that contained extravasated erythrocytes. Histologically, the tumors resembled myxoid desmoid fibromatosis. Three tested cases showed nuclear expression of β-catenin. In 3 tumors, NGS revealed intragenic deletions of APC exons 5-6, 9 and 15, or 16, respectively, with concurrent loss of the other wild-type copy of APC, predicted to result in biallelic inactivation. The deletions were identical to those that occur in desmoid fibromatosis, and copy-number analysis raised the possibility that they were germline. In addition, one case showed possible deletion of APC exons 12-14, and another case exhibited a CTNNB1 p.S33C mutation. Ten patients with OM/OFM were identified, including 4 women and 6 men (mean age: 42 years). Seven tumors involved the mandible, and 3 the maxilla. Histologically, the tumors differed from SNM, and all cases lacked nuclear expression of β-catenin. These findings suggest that SNM represents a myxoid variant of desmoid fibromatosis that often arises in the maxilla. Because the APC alterations might be germline, genetic testing of the affected patients should be considered.
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Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, and University of Miami Miller School of Medicine, Miami, FL, USA.
| | | | - Laurence M Briski
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, and University of Miami Miller School of Medicine, Miami, FL, USA
| | - Donald C Green
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jeffrey M Cloutier
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, and University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, and University of Miami Miller School of Medicine, Miami, FL, USA
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5
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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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6
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Downie EM, Amend CE, Miranda A, Burkat CN. Treatment of Orbital Desmoid-type Fibromatosis With Sorafenib. Ophthalmic Plast Reconstr Surg 2022; 38:e144-e147. [PMID: 35470290 DOI: 10.1097/iop.0000000000002186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Desmoid-type fibromatosis is a rare tumor, particularly in the orbit, with fewer than 10 cases of primary orbital desmoid-type fibromatosis reported in the literature. The authors present a case of an infant who presented with rapid onset of OD proptosis, disc edema, and hyperopic shift who was found to have a retrobulbar desmoid-type fibromatosis. After initial biopsy, due to risk of vision loss with complete excision, the tumor was treated with sorafenib, a tyrosine kinase inhibitor. During the course of treatment with sorafenib, the tumor stabilized and then regressed in size. To the authors' knowledge, this is the first reported case of orbital desmoid-type fibromatosis to be treated with sorafenib.
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Affiliation(s)
- Elaine M Downie
- Oculoplastic, Facial Cosmetic, and Orbital Surgery, Department of Ophthalmology and Visual Sciences
| | - Christina E Amend
- Division of Pediatric Hematology, Medical Oncology and Palliative Care
| | - Alexander Miranda
- Pediatric Ophthalmology, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Cat N Burkat
- Oculoplastic, Facial Cosmetic, and Orbital Surgery, Department of Ophthalmology and Visual Sciences
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7
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Zhao J, Cheng F, Yao Z, Zheng B, Niu Z, He W. Surgical Management of a Giant Desmoid Fibromatosis of Abdominal Wall With Vessels Invasion in a Young Man: A Case Report and Review of the Literature. Front Surg 2022; 9:851164. [PMID: 35478728 PMCID: PMC9037953 DOI: 10.3389/fsurg.2022.851164] [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: 01/09/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDesmoid fibromatosis (DF) is a rare clonal proliferation of fibroblasts and myofibroblasts. It develops in the connective tissues and does not metastasize but may infiltrate adjacent structures. Because of the rarity of these tumors and the unpredictable natural history of the disease, well-defined and precise guidelines of the optimal treatment for DF have not been formulated.Case PresentationHere, we present a giant abdominal DF that invaded the right spermatic cord and iliac vessels. The lesion was excised with external iliac artery dissection; however, the vein was sacrificed. The abdominal wall defect was then repaired with a polypropylene mesh. The lesional cells are positive for β-catenin.ConclusionsIn the past decades, there has been a change in the treatment of DF. The “wait and see” policy has been considered initially in most cases. Surgical intervention remains a valid option for symptomatic lesions. The optimal regimes of the tumor should not take the risk of making the patient more symptomatic than the lesion itself.
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Affiliation(s)
- Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fajuan Cheng
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhigang Yao
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bin Zheng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Wei He orcid.org/0000-0002-4272-2891
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8
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Peroša N, Urbančič J, Felbabić T, Stefanović M, Pižem J, Bošnjak R. Desmoid-type fibromatosis of paranasal sinuses with intracranial extension in a child-acase-based review. Childs Nerv Syst 2021; 37:3673-3680. [PMID: 34611763 DOI: 10.1007/s00381-021-05200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Desmoid-type fibromatosis (DF) is clonal fibroblastic proliferation that arises in the deep soft tissues, tends to reoccur, and is locally invasive. Desmoid-type fibromatosis of paranasal sinuses with intracranial extension is a rare condition that is even rarer in a small child. We aim to share with the reader our literature review, decision-making, and endoscopic endonasal operation procedure that combined gained us favorable results against this benign tumor with unpredictable natural history and disease course. CASE REPORT We describe the decision-making process in the management of a 3-year-old boy with a history of sudden vision loss and vomiting. MR showed an expansive well-delineated homogeneous tumor in the sphenoid sinus with intracranial extension and optic nerves compression. The diagnosis of a sporadic form of desmoid-type fibromatosis was made using genetic testing of tumor tissue. A total gross removal was carried out with endoscopic endonasal microsurgical approach. At a 3-month follow-up, the patient is without any signs of recurrance. CONCLUSION The treatment of children with desmoid-type fibromatosis requires a multidisciplinary approach by clinicians experienced with the management of pediatric cancer. While the desmoid-type fibromatosis is a benign, locally invasive tumor, observation should be the first step in the management. In case of life-threatening or symptomatic cases, operations that preserve function and structure should be the first choice for this benign tumor with unpredictable natural history and disease course.
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Affiliation(s)
- Nina Peroša
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Felbabić
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Milica Stefanović
- Department of Oncology and Haematology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jože Pižem
- Faculty of Medicine, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
| | - Roman Bošnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
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Zhao CX, Dombrowski ND, Perez-Atayde AR, Robson CD, Afshar S, Janeway KA, Rahbar R. Desmoid tumors of the head and neck in the pediatric population: Has anything changed? Int J Pediatr Otorhinolaryngol 2021; 140:110511. [PMID: 33271436 DOI: 10.1016/j.ijporl.2020.110511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pediatric head and neck desmoid tumors are rare neoplasms that can cause significant morbidity due to infiltration of vital anatomic structures. The goal of this study is to review presentation, evaluation, and management of these tumors. METHODS Retrospective study of children with head and neck desmoid tumors treated from 1999 to 2018 and literature review. RESULTS 11 patients (5 boys, 6 girls) were included. Presentation included firm neck mass (n = 8), trismus (n = 2) and tongue lesion (n = 1). All patients had preoperative imaging with CT (n = 2), MRI (n = 1) or both (n = 8). Five patients underwent needle biopsy, five had open biopsy and one was diagnosed on pathology from primary excision. Seven patients were treated by primary surgical resection, with positive surgical margins in six cases due to proximity to vital neurovascular structures. None needed chemotherapy, had disease recurrence or progression. Three patients with unresectable disease were treated with chemotherapy. One patient was monitored with imaging without any treatment and did not have disease progression. Follow-up ranged from 6 months to 6 years (median 21 months). Ten patients (7 surgical, 2 chemotherapy, 1 observation) were either disease-free or had stable disease at last follow-up. CONCLUSION Pediatric head and neck desmoid tumors, though rare and histologically benign, are locally infiltrative and aggressive. When feasible, surgical treatment results in good disease control despite positive margins. A balance between achieving negative margins and minimizing functional deficits should be considered. Chemotherapy can be successfully utilized in patients where surgery entails a high risk of morbidity and mortality.
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Affiliation(s)
- Cher X Zhao
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Boston, MA, United States; Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, MA, United States; Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Salim Afshar
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA, United States; Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, United States
| | - Katherine A Janeway
- Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States; Department of Otolaryngology, Harvard Medical School, Boston, MA, United States.
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10
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Richards N, Herath J. Death Due to Obstruction of Airways by a Hyperplastic Polyp: An Unusual Complication of Treated Desmoid Fibromatosis. Acad Forensic Pathol 2020; 10:97-103. [PMID: 33282044 DOI: 10.1177/1925362120964084] [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: 05/15/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022]
Abstract
Desmoid fibromatosis (DF) is a rare, locally aggressive but benign clonal fibroblastic lesion of deep soft tissue. It can occur at any age. Extra-abdominal lesions are more common in the pediatric population, with equal sex predilection. Desmoid fibromatosis of the head and neck, particularly the anterior neck, is more difficult to manage because of the proximity to vital structures and may eventually require definitive airway management with insertion of a tracheostomy tube. Indwelling tracheostomy tubes carry their own set of complications. This is the case of a 21-month-old boy who died suddenly due to tracheal obstruction by a hyperplastic polyp. He was diagnosed with DF of the neck before he was 1 month old and required an indwelling tracheostomy tube as a result. Chronic tracheostomy intubation can be complicated by granulation tissue polyp or, less commonly, fibroepithelial polyp formation that can become large enough to cause airway obstruction. To the authors' knowledge, this is the first case of hyperplastic polyp causing fatal airway obstruction.
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11
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Issa SA, Abdulnabi HA. Extensive submandibular desmoid fibromatosis in a pediatric patient: A therapeutic challenge. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Ahmed AA, Vundamati D, Farooqi M, Repnikova E, Zinkus T, Hetherington M, Paulson L. Next-Generation Sequencing in the Diagnosis of Rare Pediatric Sinonasal Tumors. EAR, NOSE & THROAT JOURNAL 2019; 100:NP263-NP268. [PMID: 31550935 DOI: 10.1177/0145561319863371] [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] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the CTNNB1 gene consistent with desmoid fibromatosis. An 11-month-old male infant presented with a right nasal mass that extended through the cribriform plate into the anterior cranial fossa and involved the right ethmoid sinus and adjacent right orbit. Histology revealed an infiltrative atypical fibrous proliferation with focal calcifications that was negative for CTNNB1 and GNAS mutations. A novel RET E511K variant was identified in the tumor and later was also found in the germline and hence rendered of unknown significance. Both cases highlight the utility of next-generation sequencing in the evaluation of pediatric sinonasal spindle cell tumors that may have overlapping pathologic features. Reporting of rare or novel variants in tumor-only sequencing should be cautiously evaluated in children and pairing with germline sequencing may be needed to avoid the pitfall of assigning uncommon variants.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Divya Vundamati
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Midhat Farooqi
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Elena Repnikova
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Timothy Zinkus
- Department of Radiology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Maxine Hetherington
- Department of Pediatrics Hematology-Oncology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Lorien Paulson
- Department of Surgery, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
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13
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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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14
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Parulan MA, Sundar G, Ong YK, Yeo TT, Lee V, Kimpo MS. Sino-orbital desmoid tumor in a pediatric patient - Case report with review of literature. Orbit 2018; 38:477-485. [PMID: 30587044 DOI: 10.1080/01676830.2018.1556306] [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] [Indexed: 12/12/2022]
Abstract
We report a case of a 2-year-old female who presented with bilateral progressive proptosis, visual loss, nasal obstruction, and breathing difficulty. Magnetic resonance imaging revealed a large sino-orbital mass that was extending to the orbital apex and skull base. An initial diagnosis of rhabdomyosarcoma was made elsewhere on the basis of the presence of round and spindle cell tumor. Subsequent biopsy with immunohistochemical staining was positive for nuclear staining with β-catenin, shifting the diagnosis to a myofibroblastic tumor, favoring desmoid-type fibromatosis. With image guidance, near complete excision of tumor was performed by a multidisciplinary team, while respecting danger zones such as the skull base and the optic nerve. Following a recurrence over 2 months, additional excision was performed with a 6-month treatment of methotrexate and vinblastine. Desmoid tumor is a rare form of soft tissue tumor uncommonly seen in the orbital area. Although benign, it is known to be recurrent and infiltrative. Few data are known and further information will aid in the management of these tumors.
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Affiliation(s)
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Health System , Singapore , Singapore
| | - Yew Kwang Ong
- Department of Otolaryngology - Head & Neck Surgery, National University Health System , Singapore , Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Health System , Singapore , Singapore
| | - Victor Lee
- Department of Pathology, National University Health System , Singapore , Singapore
| | - Miriam Santiago Kimpo
- Department of Pediatric Oncology, National University Health System , Singapore , Singapore
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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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Lee JW, Bewley AF, Senders CW. Marginal versus segmental mandibulectomy for pediatric desmoid fibromatosis of the mandible - Two case reports and review of the literature. Int J Pediatr Otorhinolaryngol 2018; 109:21-26. [PMID: 29728178 DOI: 10.1016/j.ijporl.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
Desmoid fibromatosis (DF) is a rare, benign soft tissue neoplasm with high rate of local recurrence. Surgical management of DF in the head and neck can be challenging given the desire to balance the preservation of form and function with the need to minimize local recurrence by achieving complete resection. We present two contrasting cases which highlight the advantages of marginal mandibulectomy over segmental mandibulectomy in children with DF. We favor marginal mandibulectomy even with limited bone stock given the remarkable ability of children to generate new bone.
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Affiliation(s)
- Janet W Lee
- University of California Davis, Department of Otolaryngology, United States.
| | - Arnaud F Bewley
- University of California Davis, Department of Otolaryngology, United States
| | - Craig W Senders
- University of California Davis, Department of Otolaryngology, United States
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17
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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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18
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Chang B, Ha JF, Zopf D. Treatment of extensive post tonsillectomy oropharyngeal stenosis secondary to fibromatosis. Int J Pediatr Otorhinolaryngol 2018; 107:107-109. [PMID: 29501289 DOI: 10.1016/j.ijporl.2018.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy. We demonstrate that surgical resection with a clear margin allowed for alleviation of stenosis without recurrences reported since the procedure.
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Affiliation(s)
- Brian Chang
- Department of Pediatrics Otolaryngology Head & Neck Surgery, Michigan Medicine, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Jennifer F Ha
- University of Western Australia Department of Surgery, Stirling Highway, Nedlands, WA 6009, Australia; St John of God Hospital, 1 Barry Marshall Parade, Murdoch, WA 6150, Australia; Perth Children's Hospital, Roberts Road, Subiaco, WA 6008, Australia
| | - David Zopf
- Department of Pediatrics Otolaryngology Head & Neck Surgery, Michigan Medicine, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA.
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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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Nair KK, Chaudhuri K, Lingappa A, Shetty R, Vittobarao PG. Aggressive fibromatosis of the oral cavity in a 5 year old boy: a rare case report. Pan Afr Med J 2017; 27:47. [PMID: 28819469 PMCID: PMC5554660 DOI: 10.11604/pamj.2017.27.47.11739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/06/2017] [Indexed: 11/14/2022] Open
Abstract
Fibrous tissue proliferations express a wide spectrum of histologic and morphologic variation in both infants and adults. This ranges from hypertrophic scar formation at one end to malignant fibrosarcoma at the other end of the spectrum. Aggressive fibromatosis is an intermediate tumor which is in proximity to fibrosarcomas. These are locally invasive and often recur after excision, but do not metastasize. Histologically, they are characterized by proliferating fibroblasts with little mitotic activity. Aggressive fibromatosis in the head and neck region is not common, and very sporadically occurs in the oral cavity or jaw bones. Here we report a rare case of aggressive fibromatosis occurring in a 5 year old boy.
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Affiliation(s)
- Keerthi Krishnankutty Nair
- Department of Oral Medicine and Radiology SJM Dental College and Hospital, Chitradurga, Karnataka, India
| | - Kanad Chaudhuri
- Dental Surgeon, Lifeline Polyclinic Kalyani, Nadia, West Bengal, India
| | - Ashok Lingappa
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
| | - Ranjani Shetty
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
| | - Pramod Gujjar Vittobarao
- Department of Oral Medicine and Radiology Bapuji Dental College and Hospital MCC B Block, Davangere, Karnataka, India
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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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22
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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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23
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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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25
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Abstract
Aggressive (deep or desmoid-type) fibromatoses are locally infiltrative collagen-forming tumours with potential for recurrence but not metastasis. They exert their clinical effects primarily in relation to location and have variable biological behaviour. In sporadic cases there are somatic mutations in the β-catenin (CTNNB1) gene on 3p21, resulting in immunohistochemically demonstrable overexpression in nuclei. Fibromatosis in patients with familial adenomatous polyposis (FAP) harbours inactivating germline mutations in the desmoid region of the adenomatous polyposis coli (APC) gene on 5q21-q22. The differential diagnosis includes other myofibroblastic lesions, perineurioma, low grade fibromyxoid sarcoma and, in the abdomen, gastrointestinal stromal tumour and liposarcoma with 'low-grade' dedifferentiation. The primary management is surgical, though some desmoids cease to grow and can be watched. Other therapies have a role in stabilising growth or shrinking tumours. Although no single therapy is effective in all cases, available modalities including irradiation, hormonal therapy, chemotherapy, and receptor tyrosine kinase inhibition can be of value in appropriate clinicopathological subgroups.
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de Bree E, Zoras O, Hunt JL, Takes RP, Suárez C, Mendenhall WM, Hinni ML, Rodrigo JP, Shaha AR, Rinaldo A, Ferlito A, de Bree R. Desmoid tumors of the head and neck: a therapeutic challenge. Head Neck 2014; 36:1517-26. [PMID: 24421052 DOI: 10.1002/hed.23496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/22/2013] [Accepted: 09/09/2013] [Indexed: 12/23/2022] Open
Abstract
Desmoid tumor, or aggressive fibromatosis, is a rare, histologically benign, fibroblastic lesion that infrequently presents in the head and neck. Desmoid tumors often grow locally, invasively, and may, in rare instances, be fatal secondary to invasion into critical structures, such as airway or major vessels. The most common treatment is surgery, but desmoid tumors are characteristically associated with a high local recurrence rate after resection. Although the margin status seems to be of importance, operations that avoid function loss and esthetic disfigurement should be the primary goal. The efficacy of postoperative radiotherapy is controversial. Its potential benefit should be carefully balanced against possible radiation-induced adverse effects. Alternative treatment modalities, such as primary radiotherapy and medical treatment or a wait-and-see policy, may be preferable to mutilating surgery. Considering all the aforementioned, it seems obvious that desmoid tumors of the head and neck present a therapeutic challenge and require an individualized approach.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
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27
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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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Flucke U, Tops BBJ, van Diest PJ, Slootweg PJ. Desmoid-type fibromatosis of the head and neck region in the paediatric population: a clinicopathological and genetic study of seven cases. Histopathology 2013; 64:769-76. [PMID: 24206198 DOI: 10.1111/his.12323] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/05/2013] [Indexed: 12/22/2022]
Abstract
AIMS Desmoid-type fibromatosis (desmoid) is a locally aggressive (myo)fibroblastic lesion. It represents one of the more common fibrous tumours in children and adolescents. The head and neck region is more often involved than in adults. METHODS AND RESULTS We investigated the clinicopathological and genetic characteristics of seven paediatric desmoids at this anatomical site, including two cases of desmoplastic fibroma located in the mandible. There were two females and five males with an age range of 1.5-8 years. The sites of the soft tissue lesions were sinonasal (n = 4) and paramandibular (n = 1). All cases showed typical morphology and nuclear β-catenin expression. CTNNB1 gene sequencing, performed successfully in five cases, revealed mutations in three cases with one p.T41A (bone lesion), one p.S37A and one novel mutation, p.D32V (sinonasal soft tissue lesions). Six patients were treated by excision with positive margins in five cases. Follow-up, available for six patients (median 4 years), showed no evidence of disease in four cases, slow progression in one case, and recurrence with stable disease in the last case. CONCLUSIONS Our study provides evidence of genetic similarities in desmoid and desmoplastic fibroma. Additionally, we expanded the spectrum of mutations in CTNNB1 with one novel desmoid mutation.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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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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Soto-Miranda MA, Sandoval JA, Rao B, Neel M, Krasin M, Spunt S, Jenkins JJ, Davidoff AM, Ver Halen JP. Surgical Treatment of Pediatric Desmoid Tumors. A 12-Year, Single-Center Experience. Ann Surg Oncol 2013; 20:3384-90. [DOI: 10.1245/s10434-013-3090-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Indexed: 01/19/2023]
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Shumway BS, Eskan MA, Bernstein ML. Recurrent gingival fibrous lesions: comparison of 2 cases and potential need for additional classification. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e287-96. [PMID: 23582456 DOI: 10.1016/j.oooo.2013.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
Historically, the classification of localized gingival fibrous lesions has been inconsistent, leading to multiple naming schemes and confusion among pathologists. Currently, lesions are broadly grouped into localized hyperplastic lesions and true neoplasms. Although some cases are clearly defined histologically (i.e., peripheral ossifying fibroma, peripheral odontogenic fibroma), another set of "reactive" fibrous lesions exhibit overlapping histologic features including nondistinctive fibrosis and inflammation. This group can exhibit recurrence, classically related to a local stimulus. However, when local factors are absent, recurrence suggests inherent neoplastic potential. Herein, we describe 2 recurrent fibrous gingival masses, one of which reportedly recurred 3 times with no obvious inciting agent. The histologic appearance of both lesions was similarly distinctive but not well classifiable, while the immunohistochemical profile indicated divergent lesions. This highlights the need for further study of recurrent gingival fibrous lesions to better predict independent growth potential.
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Affiliation(s)
- Brian S Shumway
- Assistant Professor, Oral and Maxillofacial Pathology, Department of Surgical and Hospital Dentistry, University of Louisville, Louisville, KY, USA.
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Desmoid-type fibromatosis in the head and neck: CT and MR imaging characteristics. Neuroradiology 2013; 55:351-9. [DOI: 10.1007/s00234-012-1037-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/03/2012] [Indexed: 10/27/2022]
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Zaki Z, Benali A, Belmlih A, Ridal M, Alami N. [Desmoid infantile mandibular fibromatosis]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2012; 113:458-460. [PMID: 23017280 DOI: 10.1016/j.stomax.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 02/28/2012] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION A desmoid tumor, or aggressive fibromatosis, is a benign fibrous tumor with a high potential for locoregional extension. This tumor is very rarely located in the mandible. OBSERVATION A 2-year-old boy presented with an extensive mandibular desmoid tumor. The diagnosis was proved on histological examination. Two years after surgery, there was no recurrence. DISCUSSION Aggressive fibromatosis is rarely located in the mandible. The differential diagnosis with malignant tumors is difficult. Surgery is the first-line treatment. However, alternative therapies should be considered, especially in children, to avoid mutilating operations.
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Affiliation(s)
- Z Zaki
- Service d'ORL et de chirurgie cervico-faciale, CHU Hassan II, 30000 Fès, Maroc.
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Arya AN, Saravanan B, Subalakshmi K, Appadurai R, Ponniah I. Aggressive fibromatosis of the mandible in a two-month old infant. J Maxillofac Oral Surg 2012; 14:235-9. [PMID: 25861188 DOI: 10.1007/s12663-012-0460-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/16/2012] [Indexed: 01/03/2023] Open
Abstract
Aggressive fibromatosis is a benign spindle cell tumor with locally infiltrative behavior and tendency to recur. It has overlapping features with other spindle cell lesions and hence it is pertinent to be distinguished from them as they have different treatment modalities. We report a rare case involving the mandible of a two-month old infant with histopathological, immunohistochemical and imaging features.
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Affiliation(s)
- Achamangalam Nandakumar Arya
- Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Balasubramaniam Saravanan
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Krishnamurthi Subalakshmi
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Rajendiran Appadurai
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
| | - Irulandy Ponniah
- Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, 600 003 India
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Shekdar KV, Mirsky DM, Kazahaya K, Bilaniuk LT. Magnetic resonance imaging of the pediatric neck: an overview. Magn Reson Imaging Clin N Am 2012; 20:573-603. [PMID: 22877956 DOI: 10.1016/j.mric.2012.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Evaluation of neck lesions in the pediatric population can be a diagnostic challenge, for which magnetic resonance (MR) imaging is extremely valuable. This article provides an overview of the value and utility of MR imaging in the evaluation of pediatric neck lesions, addressing what the referring clinician requires from the radiologist. Concise descriptions and illustrations of MR imaging findings of commonly encountered pathologic entities in the pediatric neck, including abnormalities of the branchial apparatus, thyroglossal duct anomalies, and neoplastic processes, are given. An approach to establishing a differential diagnosis is provided, and critical points of information are summarized.
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Affiliation(s)
- Karuna V Shekdar
- Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 324 South 34th Street, Philadelphia, PA 19104, USA.
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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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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Kattentidt Mouravieva AA, Geurts-Giele IRR, de Krijger RR, van Noesel MM, van de Ven CP, van den Ouweland AMW, Kromosoeto JNR, Dinjens WNM, Dubbink HJ, Smits R, Wagner A. Identification of Familial Adenomatous Polyposis carriers among children with desmoid tumours. Eur J Cancer 2012; 48:1867-74. [PMID: 22305464 DOI: 10.1016/j.ejca.2012.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/24/2011] [Accepted: 01/04/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Desmoid tumours are rare mesenchymal tumours with unpredictable progression and high recurrence risk. They can occur sporadically or in association with Familial Adenomatous Polyposis (FAP), which is caused by germline APC mutations. The Wnt/β-catenin pathway has a central role in the pathogenesis of desmoid tumours. These tumours can occur due to either a somatic CTNNB1 or APC mutation but can also be the first manifestation of FAP. Because germline APC analysis is not routinely performed in children with desmoid tumours, the diagnosis FAP may escape detection. The aim of this study is to form guidelines for the identification of possible APC germline mutation carriers among children with desmoid tumours, based on CTNNB1 mutation analysis and immunohistochemical analysis (IHC) for β-catenin. PATIENTS AND METHODS We performed IHC of β-catenin and mutation analysis of CTNNB1 and APC in 18 paediatric desmoid tumours, diagnosed between 1990 and 2009 in the Erasmus MC, Rotterdam. RESULTS In 11 tumours, IHC showed an abnormal nuclear β-catenin accumulation. In this group a CTNNB1 mutation was detected in seven tumours. In two tumours with an abnormal nuclear β-catenin accumulation and no CTNNB1 mutation, an APC mutation was identified, which appeared to be a germline mutation. CONCLUSIONS Aberrant staining of β-catenin in paediatric desmoids helps to identify children at risk for FAP. We recommend to screen paediatric desmoid tumours for nuclear localisation of β-catenin and consequently for CTNNB1 mutations. For patients with nuclear β-catenin expression and no CTNNB1 mutations, APC mutation analysis should be offered after genetic counselling.
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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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Huh WW, Fitzgerald N, Mahajan A, Sturgis EM, Beverly Raney R, Anderson PM. Pediatric sarcomas and related tumors of the head and neck. Cancer Treat Rev 2011; 37:431-9. [DOI: 10.1016/j.ctrv.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 04/12/2011] [Accepted: 04/18/2011] [Indexed: 01/07/2023]
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Sobani ZA, Junaid M, Khan MJ. Successful management of aggressive fibromatosis of the neck using wide surgical excision: a case report. J Med Case Rep 2011; 5:244. [PMID: 21707981 PMCID: PMC3141701 DOI: 10.1186/1752-1947-5-244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. CASE PRESENTATION We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis. CONCLUSION Due to the rarity of the condition no guidelines are available on the indications and extent of each modality. Due to its aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, we suggest that aggressive surgery is a viable management option and may be successfully used as a single modality treatment.
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Affiliation(s)
- Zain A Sobani
- Medical College, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Longhi A, Errani C, Battaglia M, Alberghini M, Ferrari S, Mercuri M, Molinari M. Aggressive Fibromatosis of the Neck Treated with a Combination of Chemotherapy and Indomethacin. EAR, NOSE & THROAT JOURNAL 2011; 90:E11-5. [DOI: 10.1177/014556131109000610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes de-bulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.
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Affiliation(s)
- Alessandra Longhi
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milva Battaglia
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Alberghini
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Mercuri
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Molinari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
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Min R, Zun Z, Lizheng W, Minjun D, Shengwen L, Wenjun Y, Chenping Z. Oral and maxillofacial desmoid-type fibromatoses in an eastern Chinese population: a report of 20 cases. ACTA ACUST UNITED AC 2011; 111:340-5. [PMID: 21247785 DOI: 10.1016/j.tripleo.2010.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 09/26/2010] [Accepted: 10/13/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary desmoid-type fibromatoses arising from the oral and maxillofacial region are uncommon and hold the character of local invasion and regional recurrence. The purpose of this study was to analyze the clinicoepidemiologic characteristics of this rare disease in an eastern Chinese population. STUDY DESIGN Epidemiological and clinicopathological data on 20 patients were reviewed from the hospital records and analyzed accordingly. RESULTS Twelve males and 8 females with a ratio of 3:2 were involved. The mandible was the most common site of presentation. Suspected malignant change was found in 6 cases and an extremely high recurrence rate was also found in up to 53%. Abnormally high blood levels of alkaline phosphatase were found in 65% of patients, which had a close relation with tumor malignant change. CONCLUSION Chinese people are more susceptible to desmoid-type fibromatoses and are at an extremely high risk of regional malignant change. Elevated serum alkaline phosphatase levels may be taken as an indicator for malignant transformation.
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Affiliation(s)
- Ruan Min
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, P R China
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