Fibromatosis of the mandible: case report and review of previous publications

Pediatric Desmoid Tumor of the Head and Neck: A Systematic Review and Modified Framework for Management by Age Group

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.

Maxillary Fibromatosis: A Rare Clinical Report and Its Review of Literature

Fibromatosis is a rare locally aggressive benign tumour which arises from the musculoaponeurotic structures throughout the body. In the oral and maxillofacial region, It has been described under a variety of synonyms, including 'extra articular desmoids', 'desmoids tumours', 'grade-1 fibrosarcomas','non metastasizing fibrosarcoma'and 'aggressive fibromatosis'. The pecularity of this entity in paranasal sinuses is that it is rare in this location and are locally aggressive with higher rates of recurrence in a relatively restricted area.The purpose of this study is to present a rare case report and reviewing the literature of this entity.

Aggressive fibromatosis in the submandibular region of a child

Aggressive fibromatosis is proliferation of well‐differentiated fibroblasts. Submandibular region is rare location for fibromatosis. We report a case of a rapidly growing mass in submandibular region of 5‐year‐old girl, excised surgically and ascertained to be aggressive fibromatosis on histological examination. Recovery was uneventful, and she was disease‐free in 6‐month follow‐up.

Desmoid-type fibromatosis of the head and neck in children: a case report and review of the literature

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.

[Desmoplastic fibroma of the zygoma]

INTRODUCTION

Desmoplastic fibroma is a benign and rare intraosseous tumor. This lesion is locally aggressive and has a high tendency to recur.

OBSERVATION

The authors report the diagnostic and therapeutic management of a 26-year-old female patient who presented with a desmoplastic fibroma of the zygoma.

DISCUSSION

This localization is extremely rare and only 2 cases have been reported. The clinical and radiological signs are pauci-specific. The diagnosis is most often established according to anatomopathology and immunohistochemistry results. The recommended management is extensive surgical resection.

Well differentiated nonmetastasizing fibrosarcoma (aggressive fibromatosis) of mandible: a rare case report and a literature review

Fibromatosis in the maxillofacial region is a very rare occurrence among diverse pathologic conditions, and because of the rarity of this tumor, definite treatment regimen is not established, which may be a contributing factor for a high recurrence rate. Fibromatosis may attain a large size and cause compression, infiltration, and destruction of adjacent structures. Such growth behavior presents severe management problems, especially in the head and neck region, where the presence of many vital structures within a small space makes the patient susceptible to the effects of the fibromatosis, likewise making complete excision difficult. We report the case of a 28-year-old female patient with aggressive desmoid fibromatosis involving the mandible, with a literature review of postoperative pharmacologic management to prevent recurrence.

Oral and maxillofacial desmoid-type fibromatoses in an eastern Chinese population: a report of 20 cases

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.

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40 years (1968-2008)

BACKGROUND

Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies.

METHODS

An evidence-based literature review was conducted from the last 40 years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded.

RESULTS

Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87 years, and 57.32% of the described cases that involved the head and neck were found in patients under 11 years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen.

CONCLUSION

No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studies.

Desmoid tumors of the pediatric mandible: case report and review

Desmoid tumors are benign fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. These rare neoplasms have been shown to account in 0.03% of all cancers. Twenty-five percent of all desmoid tumors occur in children under 15 years of age. The infrequency of these tumors has limited studies to case reports and retrospective reviews dictating the authors recommended treatments and management. We present a case report of desmoid tumor involving the left mandible in a 14-month-old infant. His treatment course included 2 excisions, removal of the free rib graft secondary to persistence of the tumor, and wound dehiscence, and later a free fibular osteomyocutaneous flap for reconstruction. We then retrospectively reviewed all published data of desmoid tumor involving the pediatric mandible since 1950 to 2007 in the PubMed database. Forty cases have been reported, which had a M:F ratio of 1:1 with an average age of 5.3 (standard deviation [SD] +/- 4.5) years. There appeared to be left-sided predominance of desmoid tumors in the pediatric mandible with a ratio of 3:1. The mean size of the tumors was 4.6 cm (SD +/- 2.1) at the largest diameter. We have tabulated the relevant data of all the cases including the methods of treatment and recurrence. It is found that when compared with conservative management, radiation therapy, chemotherapy, and curettage or surgical local excisions as treatment options the most efficient treatment was partial mandiblectomy, which resulted in complete tumor dissipation with no tumor recurrence. In summary, this is the largest review of the pediatric desmoid tumor of the mandible to date where we provide for the first time an algorithm for the management and treatment of the pediatric desmoid tumor of the mandible.

Infantile fibromatosis of the mandible: a case report

We report an aggressive tumour in a 5-year-old girl causing facial disfigurement. Imaging confirmed a solid, diffusely enhancing mass at the right internal pterygoid muscle, infiltrating the adjacent bone. Surgical excision and reconstruction of the mandible were performed. Histology revealed aggressive infantile fibromatosis. No recurrence was noted 7 months later. Infantile fibromatosis may mimic malignancies and should be considered in aggressive mandibular soft tissue masses, in order to carefully plan biopsy and reconstructive surgery.

[Mandibular aggressive fibromatosis]

INTRODUCTION

Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors.

CASE REPORT

A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection.

DISCUSSION

Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.

Superficial Fibromatosis Mimicking Subcutaneous Hematoma: An Unusual and Difficult Diagnosis in a Patient with Mild Hemophilia A

We present a 16-year-old boy with mild hemophilia A who developed superficial fibromatosis mimicking subcutaneous hematoma of the right upper dorsal region of the foot. This condition is very rare. Hematoma originally developed after the patient sprained the right ankle. Although cast immobilization and replacement therapy with factor VIII (FVIII) concentrates reduced the symptoms, the swelling and pain reappeared in the same region 4 weeks after the cast was removed. A clinical diagnosis of intramuscular hemorrhage was made. Despite readministration of regular FVIII concentrates and cast immobilization, the patient experienced a relapse after removal of the second cast. Magnetic resonance imaging demonstrated a tumor in the extensor digitorum brevis muscle of the right foot with high intensity on T2-weighted images. Marginal excision resulted in symptom resolution. A histopathologic examination of the tissue showed proliferation of fibroblastic cells with abundant collagen bundles. When a mass is found under the skin in hemophilia A patients, an etiology other than bleeding can be overlooked because subcutaneous hemorrhage in limited areas often results in a mass; however, the possibility of rare soft tissue tumors in hemophilia patients should be kept in mind.

[Aggressive fibromatosis in the jaw and facial region with bone involvement. A review]

BACKGROUND

Aggressive fibromatosis (AF) involving bones of the head is rare and surgery is often complicated by a high recurrence rate. Interdisciplinary treatment is of the utmost importance to avoid extensive, mutilating resection. Two cases emphasize the difficulties in the management.

CASE REPORTS

A 67-year-old woman was referred to our unit with a blepharochalasis of the left upper palpebra and a palsy of the face on the left side. Her medical history included 12 operations over the previous 4 years for an extensive AF.

MATERIAL AND METHODS

Our review includes all case reports of AF involving bones of the head published between 1960 and 2004. Additionally, our two cases are presented. Signs, symptoms and outcome were analyzed in relation to different treatment options.

CONCLUSION

According to the literature, surgery is the most common treatment for AF in the head and neck region. Alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations.

Complications of mandibular reconstruction in childhood: Report of a case of Juvenile Aggressive Fibromatosis

Juvenile aggressive fibromatosis is an acquired disease affecting young children. There are two types: superficial and deep; the first is not aggressive whilst the second invades other tissues deeply. This is a case report of the deep variant of juvenile aggressive fibromatosis of the lateral mandible affecting a 24-month-old young female patient. The tumour has been treated surgically by resection of the mandible and reconstruction with a rib-graft. To by-passs resorption of the rib-graft and to re-establish the correct three-dimensional shape of the facial skeleton, osteodistraction of the reconstructed mandible was performed six months post-peratively. In this article the surgical techniques to reconstruct the mandible in young children are discussed.

Aggressive fibromatosis of the mandible: a case report

An extensive tumour in a 7-year-old girl, leading to severe disfigurement, proved to be an aggressive fibromatosis on histological examination. Eighteen months after surgery there was no evidence of recurrent disease. This suggests that tumour resection and reconstruction of the mandible had been successful. Contrary to some reports, tumour resection led to curative therapy whereas radiotherapy failed.

Agressive fibromatosis involving the mandible—Case report and review of the literature

BACKGROUND

Aggressive fibromatosis (AF) involving the mandible is rare, and surgery is often complicated by a high recurrence rate.

CASE REPORT

A 4-year-old boy was referred because of a fast growing painless mass which involved the entire left angle of the mandible. Excisional biopsy revealed AF, and local excision of the tumor was performed. Six months after surgery a recurrence was detected. The tumor was determined to be unresectable and the boy was treated with low-dose chemotherapy including methotrexate and vinblastine for 1 year. With combined chemotherapy and surgical debulking, mutilating surgical resection will be delayed as long as possible or until completion of facial growth.

CONCLUSION

According to the literature, surgery is the most common treatment of AF in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations.