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Patel A, Varga G, Mallela AN, Abou-Al-Shaar H, Bukowinski A, Mamauag E, Zambrano EV, Greene S. Paraspinal Desmoid Tumor in a Pediatric Patient with No Surgical History: A Case Report. Asian J Neurosurg 2024; 19:87-93. [PMID: 38751393 PMCID: PMC11093639 DOI: 10.1055/s-0043-1771366] [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] [Indexed: 05/18/2024] Open
Abstract
Desmoid tumors are locally aggressive, benign neoplasms originating in connective tissues. Although the exact pathophysiology remains unknown, antecedent trauma or surgery are believed to be important contributing factors. The occurrence of paraspinal desmoid tumor in pediatric patients is extremely uncommon. Here, we present an exceedingly rare case of a pediatric patient with no surgical or family history who developed a paraspinal desmoid tumor. A 9-year-old female patient presented with 4 months of progressive back pain, right lower extremity weakness, and numbness. Spinal imaging revealed a left epidural paraspinal mass compressing her thoracic spinal cord and extending into the left thoracic cavity. A multidisciplinary approach with neurosurgery and thoracic surgery enabled gross total resection of the lesion. The patient had complete resolution of her symptoms with no signs of residual tumor on postoperative imaging. Pathology revealed a desmoid tumor that avidly stained for beta-catenin. On her last follow-up, she developed a recurrence, to which she was started on sorafenib therapy. Desmoid tumors are rare connective tissue neoplasms that often occur after local tissue trauma, such as that caused by surgery. This report presents a rare case of a pediatric paraspinal desmoid tumor that occurred in a patient with no surgical or family history. Such tumors should undergo surgical resection for symptomatic relief and tissue diagnosis. Close clinical and radiographic surveillance are essential in these patients due to the high recurrence rates of desmoid tumor.
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Affiliation(s)
- Aneek Patel
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Gregory Varga
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Arka N. Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Andrew Bukowinski
- Department of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Erica Mamauag
- Department of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eduardo V. Zambrano
- Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Stephanie Greene
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Remedios E, Sommerfield D, Fellingham W, Powers N, Stannage K, Hii JWS. Paraspinal desmoid fibromatosis after lumbar epidural analgesia. Anaesth Rep 2021; 9:e12129. [PMID: 34396135 DOI: 10.1002/anr3.12129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 14-year-old girl with cerebral palsy presented for bilateral lower limb surgery for spasticity. A lumbar epidural catheter was sited under general anaesthesia on the third attempt and used intra-operatively with good effect. A local anaesthetic infusion was used for postoperative analgesia but was noted to be leaking under the dressing with a patchy, unilateral block. The catheter was therefore removed on the second postoperative day. Following discharge, the patient progressively developed new back and leg pain for which she was re-admitted seven weeks later. This was investigated and initially thought to be myositis of the erector spinae muscles on magnetic resonance imaging. When the patient failed to respond to treatment, a muscle biopsy demonstrated desmoid fibromatosis. Trauma may cause or accelerate the development of desmoid fibromatosis, which has also been theorised to arise from scar tissue in previously injured areas. We hypothesise that challenging epidural placement or the leakage of the local anaesthetic agent into the surrounding muscular tissue, inducing local myonecrosis, could have been the triggering or accelerating event in tumour development. This may be the first reported case of extra-abdominal desmoid fibromatosis in association with epidural placement.
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Affiliation(s)
- E Remedios
- Perth Children's Hospital Perth Australia
| | - D Sommerfield
- Department of Anaesthesia Perth Children's Hospital Perth Australia.,Telethon Kids Institute Perth Australia
| | - W Fellingham
- Department of Anaesthesia Perth Children's Hospital Perth Australia
| | - N Powers
- Department of Radiology Perth Children's Hospital Perth Australia
| | - K Stannage
- Department of Orthopaedic Surgery Perth Children's Hospital Perth Australia
| | - J W S Hii
- Perth Children's Hospital Perth Australia.,Perioperative Medicine Team Telethon Kids Institute Perth Australia
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De Vloo P, De Vlieger J, Vander Poorten V, Sciot R, van Loon J, Van Calenbergh F. Desmoid tumors in neurosurgery: a review of the literature. Clin Neurol Neurosurg 2014; 129:78-84. [PMID: 25576767 DOI: 10.1016/j.clineuro.2014.12.007] [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: 11/18/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
Desmoid tumors (DTs) are rare myofibroblastic neoplasms, which are mostly sporadic, but sometimes associated with familial adenomatous polyposis syndrome. Neurosurgical cases of DT have been very scarce. We review the literature concerning neurosurgical DTs and describe the first case of a cicatricial DT after the resection of vestibular schwannoma, presenting as a painful swelling in the retrosigmoid scar. Contrary to other localizations in the body, standard-of-care wide margin resection cannot be performed in intracranial and spinal DTs. Therefore, maximally safe resection followed by radiotherapy when tumor margins are not free can be proposed as a treatment strategy in neurosurgical DTs.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Jan De Vlieger
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Furlan JC, Valiante T, Dickson B, Kiehl TR. Paraspinal desmoid-type fibromatosis as a cause of low back pain. Spine J 2013; 13:1958-9. [PMID: 24176807 DOI: 10.1016/j.spinee.2013.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/24/2013] [Accepted: 08/14/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Julio C Furlan
- Division of Neurology, Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; Department of Genetics and Development, Toronto Western Research Institute, 399 Bathurst St, McL 12-407 Toronto, ON M5T 2S8, Canada; Lyndhurst Centre, Toronto Rehabilitation Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
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