1
|
Bouhamama A, Wdowik Q, Grillet F, Brahmi M, Sunyach MP, Vaz G, Meeus P, Gouin F, Corradini N, Dufresne A, Chabaud S, Blay JY, Pilleul F. Prognostic Factors for Local Recurrence after Cryoablation of Desmoid Tumors. J Vasc Interv Radiol 2023; 34:1538-1546. [PMID: 37182669 DOI: 10.1016/j.jvir.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To determine the risk factors for local of adult patients treated for desmoid tumors by cryoablation. MATERIALS AND METHODS Eighty-four patients treated for nonabdominopelvic desmoid tumors by cryoablation from July 2012 to July 2020 were included in a retrospective study. The population was composed of 64 women (76.19%) and 20 men (23.81%), aged from 16 to 75 years (median, 35 years ± 14.25). Each patient underwent preprocedural gadolinium-enhanced magnetic resonance imaging and was followed up to 36 months with the same technique. Clinical features, such as tumor size and previous treatment, epidemiological features, and the technical parameters of cryoablation, were studied. RESULTS Local relapse was found in 19 (22.62%) of 84 patients. The 12-, 24-, and 36-month progression-free survival rates were 89% (95% confidence interval [CI], 79-94), 74% (95% CI, 60-83), and 68% (95% CI, 53-79), respectively. In univariate analysis, significant prognostic factors associated with local recurrence were non-abdominal wall location (P = .042), debulking strategy (P = .0105), risk of visceral injury (P = .034) or peripheral nerve injury during cryoablation (P = .033), previous radiation therapy (P = .043), and treatment before 2016 (P = .008). In multivariate analysis, abdominal wall tumors displayed the best outcome, whereas the neck and trunk showed a high rate of recurrence (hazard ratio, 7.307 [95% CI, 1.396-38.261]). CONCLUSIONS The local recurrence of desmoid tumors after cryoablation depends on a number of prognostic factors, in particular, a non-abdominal wall location of the tumor and previous local treatment such as surgery or radiation therapy.
Collapse
Affiliation(s)
| | - Quentin Wdowik
- Department of Radiology, Centre Léon Bérard, Lyon, France
| | - Franck Grillet
- Department of Radiology, Centre Léon Bérard, Lyon, France.
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Gualter Vaz
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - François Gouin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Nadege Corradini
- Department of Pediatric Oncology, Centre Léon Bérard, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Sylvie Chabaud
- Department of Biostatistics, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Frank Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France
| |
Collapse
|
2
|
Lehnhardt M, Weskamp P, Sogorski A, Reinkemeier F, von Glinski M, Behr B, Harati K. [Aggressive Fibromatosis: Retrospective Analysis of 110 Patients]. HANDCHIR MIKROCHIR P 2023; 55:106-113. [PMID: 36758581 DOI: 10.1055/a-1948-2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Aggressive fibromatosis, histologically classified as benign due to the absence of metastasis, is characterised by locally invasive and destructive growth with high recurrence rates after resection. For this reason, prognostic recurrence factors, in particular the extent of resection, are much debated, and treatment decisions seem challenging for interdisciplinary tumour conferences. Between the years 2000 and 2020, 110 patients with aggressive fibromatosis of the extremities or trunk received surgical treatment at BG University Hospital Bergmannsheil (Bochum, Germany). Univariate analyses were performed to detect any potential prognosis factors. The median follow-up time was 5.9 years. A total of 57 (51.8%) of these patients developed recurrence during this period. The 5-year recurrence-free survival was 52.9% (95% CI: 42.4-62.3) in the entire cohort. In R0-resected patients, the 5-year recurrence-free survival (RFS) was significantly better (p<0.001) at 69.2% compared with patients with R1 or R2-resected tumours (32.6%). Beyond that, no other significant influencing factors were identified. The results of this study indicate that R0 resection or R0 resectability were associated with a significantly better local control. The therapeutic recommendation for resection should be made individually by an interdisciplinary tumour board in due consideration of tumour progression, possible therapeutic alternatives, and foreseeable functional impairment.
Collapse
Affiliation(s)
- Marcus Lehnhardt
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Pia Weskamp
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Alexander Sogorski
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Felix Reinkemeier
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Maxi von Glinski
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Björn Behr
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Kamran Harati
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Sarkomzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| |
Collapse
|
3
|
A Rare Paraspinal Desmoid Tumour following Instrumented Scoliosis Correction in an Adolescent. Case Rep Orthop 2021; 2021:6665330. [PMID: 33688443 PMCID: PMC7920716 DOI: 10.1155/2021/6665330] [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: 10/29/2020] [Revised: 01/14/2021] [Accepted: 02/13/2021] [Indexed: 11/20/2022] Open
Abstract
Desmoid tumours are benign neoplasms of myofibroblasts, often occurring after soft-tissue trauma. Rarely, desmoid tumours can occur following operative intervention, including spine surgery. In this case report, we describe the first reported case of desmoid tumour following scoliosis corrective surgery in an adolescent.
Collapse
|
4
|
Huned D, Tiwari RV, Lee LS. Unusual finding after treatment for testicular cancer. BMJ Case Rep 2021; 14:14/1/e233701. [PMID: 33419745 PMCID: PMC7799132 DOI: 10.1136/bcr-2019-233701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In the context of a post-treatment testicular germ cell tumour, an abdominal lesion found on surveillance CT studies led to a differential diagnosis, including recurrent germ cell tumour. We report the case of a 48-year-old man who was noted to have a new interval soft tissue lesion on a surveillance CT scan, 5 years after initial orchidectomy and chemotherapy. Excision of this lesion and histopathological review revealed an intra-abdominal desmoid.
Collapse
|
5
|
Cheung KT, Mitchell C, Wong E. Retroperitoneal liposarcoma in a nonagenarian. AUTOPSY AND CASE REPORTS 2020; 11:e2020224. [PMID: 34277489 PMCID: PMC8101656 DOI: 10.4322/acr.2020.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 12/19/2022] Open
Abstract
Retroperitoneal liposarcomas are rare tumors arising from the soft tissue of the retroperitoneum and are of mesenchymal cell origin. They can reach a large size prior to causing symptoms and generally have a poor prognosis. We present the case of a 93-year-old lady presenting with a large retroperitoneal liposarcoma at the site of a previous colonic anastomosis for the adenocarcinoma treatment. It caused minimal symptoms initially, but surgical resection was undertaken when the tumor was found to be growing significantly in size. However, due to the tumor's location and its invasion into surrounding structures, the resection was not feasible and subsequently abandoned. A retroperitoneal liposarcoma arising from the site of a previous colonic resection has not been previously described. A review of the diagnosis and current management of these lesions is also given.
Collapse
Affiliation(s)
- King Tung Cheung
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Catherine Mitchell
- Peter MacCallum Cancer Centre, Department of Pathology, Melbourne, Victoria, Australia
| | - Enoch Wong
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| |
Collapse
|
6
|
Dürr HR, Wirth L, Baur-Melnyk A, Knösel T, Roeder F, Jansson V, Klein A. Desmoid Tumors of the Foot: A Retrospective Study of Four Patients. J Am Podiatr Med Assoc 2020; 110:449527. [PMID: 33301582 DOI: 10.7547/19-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Desmoid-type fibromatosis (DF) is an aggressive (myo)fibroblastic neoplasm with an infiltrative growth pattern and a tendency for local recurrence. It is rarely seen at the foot. The aim of this retrospective study was to analyze clinical presentation, therapy, and outcomes in a consecutive series of four patients with DF at the foot. METHODS From 1994 to 2014, four patients had been surgically treated. The resection margin was marginal or even intralesional in all. One patient already had local recurrence at first presentation. The end point was either local recurrence or progression of residual disease. RESULTS The mean patient age was 27 years. In one patient, marginal excision healed the disease. In another patient, local recurrence after marginal resection necessitated distal phalanx amputation. Two other patients showed stable disease after either adjuvant radiotherapy or treatment with nonsteroidal anti-inflammatory drugs and tamoxifen. CONCLUSIONS If surgery is necessary, operative margins are less important than keeping function for the patient. Radiotherapy might be an option to avoid major amputation. The role of adjuvant radiotherapy is controversially discussed. A watchful wait-and-see policy seems to be justified by the published data but may be difficult for DF at the foot.
Collapse
|
7
|
Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Iyomasa S. Multiple mesenteric desmoid tumors after gastrectomy for gastric cancer: A case report and literature review. Int J Surg Case Rep 2018; 50:50-55. [PMID: 30081320 PMCID: PMC6083430 DOI: 10.1016/j.ijscr.2018.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Many patients with desmoids have an antecedent trauma, particularly surgical intervention for familial adenomatous polyposis. However, cases of mesenteric desmoid after gastrectomy are extremely rare. We present a case of multiple mesenteric desmoids after total gastrectomy for gastric cancer. PRESENTATION OF CASE A 70-year-old man had undergone a total gastrectomy for early stage gastric cancer. He had no other relevant medical history or family history. A year after gastrectomy, a computed tomography showed three mesenteric masses, and we performed careful observation. The 2-year postoperative examination indicated slowly growing masses. There were no other lesions except for the three masses. We decided to perform diagnostic surgery to evaluate the tumors. There were three mesenteric masses (1.5 cm, 4 cm and 1.5 cm in diameter). We performed partial small intestinal resections for each mass. Histological examination showed that the tumors were desmoids. A year after surgery, he was doing well with no evidence of recurrence of the desmoids or the gastric cancer. DISCUSSION Diagnosing intra-abdominal desmoid tumors is often difficult. Especially if a patient has a history of malignancy, it may be extremely difficult to differentiate multiple mesenteric desmoids from a cancer recurrence. In the current case, surgical resection was a useful treatment option as diagnostic therapy. CONCLUSIONS Multiple mesenteric desmoids could emerge after gastrectomy for gastric cancer, and surgical resection of the tumors is a useful option as a diagnostic therapy.
Collapse
Affiliation(s)
- Ryusei Yamamoto
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Hideo Matsubara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Hirokazu Kaneko
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Shinsuke Iyomasa
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| |
Collapse
|
8
|
Sabale A, Pralhadan A, Kalidos K, Ramachandran K. Bilateral perirenal space fibromatosis with renal infiltration: case report and review of literature. Radiol Case Rep 2016; 11:438-443. [PMID: 27920876 PMCID: PMC5128395 DOI: 10.1016/j.radcr.2016.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 12/19/2022] Open
Abstract
Fibromatosis and/or desmoid tumors which constitute less than 1% of all neoplasms and 3.0% of all soft-tissue tumors are pathologically benign proliferations of the fibroblasts but are locally aggressive with infiltrative type of growth and tendency toward recurrence. Bilateral symmetrical perirenal involvement has been described in many conditions which can be renal, subcapsular, or perirenal in origin. However, bilateral perirenal fibromatosis as an isolated presentation was very uncommon. We report an exceptionally rare case of bilateral perirenal fibromatosis with renal infiltration.
Collapse
|
9
|
Das S, Subhashini J, Isiah R, Kurian S. Mesenteric Fibromatosis Mimicking Metastasis: A Case Report and Review of Literature. J Gastrointest Cancer 2016; 43 Suppl 1:S73-6. [PMID: 21710175 DOI: 10.1007/s12029-011-9298-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Saikat Das
- Department of Radiation Oncology, Christian Medical College, Vellore, 632004, India.
| | - J Subhashini
- Department of Radiation Oncology, Christian Medical College, Vellore, 632004, India
| | - Rajesh Isiah
- Department of Radiation Oncology, Christian Medical College, Vellore, 632004, India
| | - Susy Kurian
- Department of Pathology, Christian Medical College, Vellore, 632004, India
| |
Collapse
|
10
|
Resection and Abdominal Wall Reconstruction of a Desmoid Tumor with Endometrioma Features. Case Rep Surg 2016; 2016:9453450. [PMID: 27247824 PMCID: PMC4877470 DOI: 10.1155/2016/9453450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/17/2016] [Indexed: 11/18/2022] Open
Abstract
Desmoid tumors are rare, musculoaponeurotic mesenchymal origin tumors arising from the proliferation of well-differentiated fibroblasts. Desmoid tumors may arise from any location with the abdominal cavity, abdominal wall and extremity locations being most frequent. We present the case of a 35-year-old female with a history of endometriosis who presented palpable abdominal mass and cyclic abdominal pain. Resection was performed for a presumed desmoid soft tissue tumor. Final pathology demonstrated desmoid histology admixed with abdominal wall endometriosis (endometrioma). This unique pathologic finding has only been rarely reported and is discussed with a brief review of the literature.
Collapse
|
11
|
Deep Neck Fibromatosis After Diskectomy and Cervical Fusion: Case Series and Review of the Literature. AJR Am J Roentgenol 2016; 206:1068-72. [PMID: 26914791 DOI: 10.2214/ajr.15.14864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to report head and neck deep fibromatosis as part of the differential diagnosis of a firm painful neck mass after cervical fusion and diskectomy. CONCLUSION Although they are rare tumors, fibromatosis tumors or desmoid tumors should be considered in a patient with a painful neck mass; a history of cervical spine surgery; and MRI findings showing a large, avidly enhancing, heterogeneous mass adjacent to surgical hardware that is hyperintense on T2-weighted imaging.
Collapse
|
12
|
Thway K, Abou Sherif S, Riddell AM, Mudan S. Fibromatosis of the Sigmoid Colon With CTNNB1 (β-Catenin) Gene Mutation, Arising at the Site of Ileocolic Anastomosis for Resection of Gastrointestinal Stromal Tumor. Int J Surg Pathol 2016; 24:264-8. [PMID: 26721303 DOI: 10.1177/1066896915620012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We describe a case of intra-abdominal fibromatosis, which occurred in a 44-year-old woman who had a previous history of gastrointestinal stromal tumor (GIST) of the sigmoid mesocolon, which was treated with imatinib and resection. A mass was detected at the site of ileocolic anastomosis of the previous small bowel resection and sigmoid colectomy, nearly 3 years later. Clinically, this was suspected to represent recurrent GIST and was excised, but histology and mutational analysis showed desmoid-type fibromatosis with a mutation in codon 41 of exon 3 of the CTNNB1 (β-catenin) gene. The occurrence of fibromatosis at the site of excision of GIST is very rare, but its recognition is important as the treatment of the two neoplasms differs significantly. As imaging cannot reliably distinguish between these 2 entities, histological diagnosis is crucial for correct clinical management.
Collapse
|
13
|
Słowik-Moczydłowska Ż, Rogulski R, Piotrowska A, Małdyk J, Kluge P, Kamiński A. Desmoid tumor of the pancreas: a case report. J Med Case Rep 2015; 9:104. [PMID: 25943401 PMCID: PMC4437747 DOI: 10.1186/s13256-015-0591-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/08/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Desmoid tumor is a rare, benign, usually asymptomatic fibromatous lesion. The etiology is unknown and the diagnosis is based on histopathological examination. The treatment is complete resection of the tumor. Pancreatic desmoid tumor is extremely rare. In the literature there have been only 11 cases described, most of them as solid or solid-cystic masses. We report the case of a patient with an isolated cystic pancreatic desmoid tumor that is, to the best of our knowledge, the second reported case. Case presentation A 13-year old Caucasian boy presented with recurrent pain of two months’ duration in the left hypochondrium of his abdomen. An ultrasound examination and computed tomography scan revealed the presence of a cystic mass located in his splenic hilum, tightly adjacent to the pancreatic tail. A splenic cyst was suspected. Operative findings showed a 10x10cm cystic mass tightly connected to the pancreatic tail and left colonic flexure, adherent to the spleen, splenic vein and artery. Distal splenopancreatectomy with en bloc resection of the left colonic flexure was performed. Histological analysis confirmed that the resection was complete. The mass had infiltrated the pancreatic parenchyma. All tumor cells were positive for anti-beta-catenin staining characteristic for desmoid tumor. No abnormalities in the spleen and colon were found. Conclusions Isolated sporadic pancreatic desmoid tumor with cyst formation is extremely rare and its diagnosis can be difficult, especially because of uncharacteristic symptoms and radiological findings, as in our patient. This case report should be of interest not only to surgeons, as the treatment of choice is radical resection, but also gastroenterologists, considering it is in close relation with familial adenomatous polyposis, and oncologists as the reason for differentiation with other pancreatic tumors.
Collapse
Affiliation(s)
- Żaneta Słowik-Moczydłowska
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Robert Rogulski
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Anna Piotrowska
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Przemysław Kluge
- Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland.
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| |
Collapse
|
14
|
Hechtman JF, DeMatteo R, Nafa K, Chi P, Arcila ME, Dogan S, Oultache A, Chen W, Hameed M. Additional Primary Malignancies in Patients with Gastrointestinal Stromal Tumor (GIST): A Clinicopathologic Study of 260 Patients with Molecular Analysis and Review of the Literature. Ann Surg Oncol 2015; 22:2633-9. [PMID: 25564173 DOI: 10.1245/s10434-014-4332-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of other primary neoplasms in gastrointestinal stromal tumor (GIST) patients is relatively high. Our aim was to better characterize the clinicopathologic and molecular relationships in a cohort of GIST patients. METHODS All GIST patients with tumor samples sent for molecular testing were identified via electronic medical records. Clinicopathologic characteristics of GIST and additional primary malignancies were analyzed. RESULTS Of 260 patients, 50 (19 %) had at least one additional primary malignancy. In 33 patients, separate primary neoplasms predated their GIST diagnosis and most commonly included: prostate (n = 9), breast (n = 8), and hematologic (n = 5). Renal (n = 4) and hematologic (n = 3) malignancies were the most frequent cancers identified after GIST diagnosis. The majority (8 of 12, 66 %) of malignancies diagnosed after GIST were found incidentally. Patients who developed other malignancies after GIST more often had KIT exon 11 mutations (100 vs. 66 %, P = 0.01). In comparison to patients with only GIST, patients with a second primary neoplasm of any chronology had GISTs with increased mitotic rate (≥5 per 50 high-power fields) (P = 0.0006). Literature review revealed colorectal cancer, gastric, prostate, renal, leukemia, and desmoid-type fibromatosis as the most common secondary neoplasms. CONCLUSIONS Nineteen percent of GIST patients develop other malignancies. This is the first report to describe a relationship between additional primary malignancy and both mutation and mitotic rate of GIST. Although the basis of these relationships remains to be investigated, caution in the clinical management of GIST patients with additional lesions is warranted.
Collapse
|
15
|
Abstract
Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. Because of rarity, these tumors pose a diagnostic and therapeutic challenge. These tumors may remain asymptomatic, but commonly present as a painless mass. There are no clear treatment guidelines. Surgical excision with wide margin is the preferred modality of treatment. Medical therapy is indicated for inoperable and recurrent tumors. There are several isolated case reports on mesenteric fibromatosis with different and unusual presentations and its complications. Though several studies have been published on extra-abdominal fibromatosis as well as on extramesenteric abdominal fibromatosis, but extensive research studies are still lacking on mesenteric fibromatosis. The aim of this article is to present current knowledge on mesenteric fibromatosis, our experience of four cases, and comprehensive review of available literature.
Collapse
|
16
|
Okamura A, Takahashi T, Saikawa Y, Mayanagi S, Fukuda K, Nakamura R, Wada N, Kawakubo H, Omori T, Takeuchi H, Sasaki A, Kitagawa Y. Intra-abdominal desmoid tumor mimicking gastric cancer recurrence: a case report. World J Surg Oncol 2014; 12:146. [PMID: 24884980 PMCID: PMC4018622 DOI: 10.1186/1477-7819-12-146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/29/2014] [Indexed: 01/09/2023] Open
Abstract
Intra-abdominal desmoid tumors are rare and most often occur in patients with a history of familial adenomatous polyposis, surgery, or pregnancy. We report a case of an intra-abdominal desmoid tumor mimicking the recurrence of gastric cancer. A 57-year-old male had undergone distal gastrectomy for advanced gastric cancer. Serum levels of carcinoembryonic antigen were found to be elevated 27 months after surgery. Computed tomography revealed a 15-mm mass in the mesentery of the transverse colon. In addition, radiotracer fluorodeoxyglucose uptake of the tumor was detected by positron emission tomography. The patient was diagnosed with gastric cancer recurrence, and chemotherapy consisting of cisplatin and S-1 was commenced. After five courses of chemotherapy, although no significant clinical response was seen, no new lesions were seen either. Thus, a curative resection of the recurrent tumor seemed possible, which was successfully performed. Histological examination of the resected specimen revealed spindle-shaped tumor cells with collagen fiber progression; no cancer cells were detected. The tumor was diagnosed as an intra-abdominal desmoid tumor. We report a rare case of an intra-abdominal desmoid tumor that mimicked a recurrent tumor arising from gastric cancer. In patients with history of surgery for intra-abdominal malignancies, it may be difficult to distinguish the recurrence of malignancy from desmoid tumors but the possibility of desmoid tumors must be considered in the differential diagnosis.
Collapse
Affiliation(s)
| | - Tsunehiro Takahashi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Briand S, Barbier O, Biau D, Bertrand-Vasseur A, Larousserie F, Anract P, Gouin F. Wait-and-see policy as a first-line management for extra-abdominal desmoid tumors. J Bone Joint Surg Am 2014; 96:631-8. [PMID: 24740659 DOI: 10.2106/jbjs.m.00988] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extra-abdominal desmoid tumors are rare, locally aggressive neoplasms without metastatic potential. There is no clear consensus regarding their optimal management. The disappointing results of current treatments and the ability of extra-abdominal desmoid tumors to spontaneously stabilize have increasingly drawn interest toward conservative management. The objective of this study was to evaluate a wait-and-see policy as a first-line management for extra-abdominal desmoid tumors. METHODS This two-center retrospective study involved fifty-five patients with a histologically proven extra-abdominal desmoid tumor. The primary outcome was the cumulative probability of dropping out from the wait-and-see policy. The wait-and-see policy included aggressive management of symptoms. We conducted a review of the relevant published series in which a watchful-waiting strategy was used. RESULTS The cumulative probability of dropping out from the wait-and-see policy was 9.6% at the time of the last follow-up. Spontaneous arrest of tumor growth was noted for forty-seven patients (85%) over the course of the study. Half of the tumors were stabilized at one year, and a potential to increase beyond three years was a sporadic event (one case). Regrowth was found in two patients (4%). CONCLUSIONS A wait-and-see policy is an effective front-line management for patients with primary or recurrent extra-abdominal desmoid tumor. These tumors tend to stabilize spontaneously, on average after one year of evolution, and the cumulative probability of the failure of a wait-and-see policy is approximately 10%.
Collapse
Affiliation(s)
- Sylvain Briand
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
| | - Olivier Barbier
- Department of Orthopaedic Surgery, Begin Military Hospital, 69 avenue de Paris, 94163 Saint Mandé, France. E-mail address:
| | - David Biau
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - Axelle Bertrand-Vasseur
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
| | - Frédérique Larousserie
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - Philippe Anract
- Departments of Orthopaedic Surgery (D.B. and P.A.) and Pathology (F.L.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail address for D. B
| | - François Gouin
- Departments of Orthopaedic Surgery (S.B. and F.G.) and Radiology (A.B.-V.), The University Hospital of Nantes, National Institute of Health and Medical Research, UMR-S 957, 1 Place Alexis Ricordeau, 44093 Nantes, France. E-mail address for S. Briand: sylv
| |
Collapse
|
18
|
Nagar M, Kaushal M, Shukla A, Deshmukh C, Kumar Mathur R, Munjal K. An interesting case of fibromatosis of neck with review of literature. Indian J Surg Oncol 2014; 4:378-81. [PMID: 24426762 DOI: 10.1007/s13193-013-0268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Milesh Nagar
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Manish Kaushal
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Arvind Shukla
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Chaitanya Deshmukh
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Raj Kumar Mathur
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Kavita Munjal
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh India
| |
Collapse
|
19
|
Johner A, Tiwari P, Zetler P, Wiseman SM. Abdominal wall desmoid tumors associated with pregnancy: current concepts. Expert Rev Anticancer Ther 2014; 9:1675-82. [DOI: 10.1586/era.09.98] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
20
|
Mubeen B, Majid S, Akhtar O, Dar R, Ashraf O. Paraspinal desmoid tumor in an 18 year old female. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/0975-7341.165292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Dhamangaonkar AC, Joshi D, Goregaonkar AB, Phalak M. Pelvic deformity secondary to tensor fascia lata tightness associated with desmoid tumor. Orthopedics 2013; 36:e1563-6. [PMID: 24579232 DOI: 10.3928/01477447-20131120-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The iliotibial band is a thick, condensed fascia that, when contracted, leads to a hip flexion, abduction, and external rotation contracture in addition to other joint contractures. Iliotibial band tightness occurs secondary to iliotibial band friction syndrome, which commonly occurs at the lateral femoral epicondylar region. However, a proximal cause of iliotibial band/tensor fascia lata friction syndrome leading to a secondary hip contracture is swelling around the hip; this swelling being a desmoid tumor has not been explicitly described in the literature. The authors present a rare case of a hip contracture in a 28-year-old active man who presented with a functionally disabling hip flexion contracture of 20° with further flexion possible up to 130°, a 45° abduction contracture, and a 20° external rotation contracture with further rotation possible up to 40° with a bony hard swelling in the left gluteal region. Ober’s test was positive. Opposite hip and spine examinations were normal. The goals of treatment were to establish the causality between the 2 and to diagnose the etiology of the gluteal mass. Radiographs were normal, with only a pelvic obliquity evident. Magnetic resonance imaging revealed an extra-articular mass abutting the iliac blade. Histopathology confirmed the mass to be a desmoid tumor in the left gluteal region. A wide surgical excision of the mass was performed with negative margins; no postoperative radiotherapy was administered. After rigorous physiotherapy, the hip deformity disappeared at 6 months and there was no evidence of recurrence at 2.5-year follow-up, with the patient able to sit cross-legged and squat.
Collapse
|
22
|
Abdominal wall fibromatosis associated with previous laparoscopic hernia repair. Hernia 2013; 17:669-72. [DOI: 10.1007/s10029-013-1067-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 10/29/2012] [Indexed: 11/25/2022]
|
23
|
Shih LY, Wei CK, Lin CW, Tseng CE. Postoperative retroperitoneal desmoid tumor mimics recurrent gastrointestinal stromal tumor: A case report. World J Gastroenterol 2012; 18:6172-6. [PMID: 23155350 PMCID: PMC3496898 DOI: 10.3748/wjg.v18.i42.6172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/23/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a locally invasive, myofibroblastic, nonmetastatic tumor. Its pathogenesis remains unclear and it may involve genetic abnormalities, sex hormones and traumatic injury, including surgery. Postoperative intra-abdominal desmoid tumor is rare, especially in the retroperitoneum. We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor. Sporadic trauma-related intra-abdominal desmoid tumors reported in the English literature are also reviewed. Despite an extremely low incidence, postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation. However, it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors, and surgical resection is the treatment option depending on the anatomic location.
Collapse
|
24
|
[Huge retrovesical tumor as an incidental finding: desmoid-type fibromatosis: a case report]. Urologe A 2012; 52:74-8. [PMID: 22992890 DOI: 10.1007/s00120-012-2990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 57-year-old patient with a huge, retrovesical, aggressive desmoid fibromatosis detected incidentally during preoperative staging for radical prostatectomy. The tumor was locally invasive consisting of monoclonal and fibroblastic proliferations. The etiology of such tumors is not well known but they are mostly sporadic and aggressive fibromatosis is sometimes associated with familial adenomatous polyposis (FAP) or Gardner's syndrome. Such desmoid tumors are slow growing and locally invasive but lack metastatic potential. Complete resection with wide margins is the therapy of choice and the tendency to recur is high. Radiotherapy following surgery is controversial. We discuss the pathogenesis, clinical manifestations and therapy of such rare tumors.
Collapse
|
25
|
Peng PD, Hyder O, Mavros MN, Turley R, Groeschl R, Firoozmand A, Lidsky M, Herman JM, Choti M, Ahuja N, Anders R, Blazer DG, Gamblin TC, Pawlik TM. Management and recurrence patterns of desmoids tumors: a multi-institutional analysis of 211 patients. Ann Surg Oncol 2012; 19:4036-42. [PMID: 22972507 DOI: 10.1245/s10434-012-2634-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Desmoid tumors are rare soft-tissue neoplasms with limited data on their management. We sought to determine the rates of recurrence following surgery for desmoid tumors and identify factors predictive of disease-free survival. METHODS Between January 1983 and December 2011, 211 patients with desmoid tumors were identified from three major surgical centers. Clinicopathologic and treatment characteristics were analyzed to identify predictors of recurrence. RESULTS Median age was 36 years; patients were predominantly female (68 %). Desmoid tumors most commonly arose in extremities (32 %), abdominal cavity (23 %) or wall (21 %), and thorax (15 %); median size was 7.5 cm. Most patients had an R0 surgical margin (60 %). The 1- and 5-year recurrence-free survival was 81.3 and 52.8 %, respectively. Factors associated with worse recurrence-free survival were: younger age (for each 5-year increase in age, hazard ratio [HR] = 0.90, 95 % confidence interval [95 % CI] 0.82-0.98) and extra-abdominal tumor location (abdominal wall referent: extra-abdominal site, HR = 3.28, 95 % CI, 1.46-7.36) (both P < 0.05). CONCLUSIONS Recurrence remains a problem following resection of desmoid tumors with as many as 50 % of patients experiencing a recurrence within 5 years. Factors associated with recurrence included age, tumor location, and margin status. While surgical resection remains central to the management of patients with desmoid tumors, the high rate of recurrence highlights the need for more effective adjuvant therapies.
Collapse
Affiliation(s)
- Peter D Peng
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ibrahimi OA, Jim On SC, Fung MA, Eisen DB. A longstanding deep-seated nuchal tumor. Int J Dermatol 2012; 51:910-2. [PMID: 22788805 DOI: 10.1111/j.1365-4632.2011.05364.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Omar A Ibrahimi
- Department of Dermatology, University of Connecticut, Farmington, CT 06032, USA.
| | | | | | | |
Collapse
|
27
|
Vallabha T, Sindgikar V, Baloorkar R, Dhamangoankar M, Karjol U. Desmoid infilterating ileum, a rare complication. Indian J Surg 2012; 75:192-4. [PMID: 24426561 DOI: 10.1007/s12262-012-0564-y] [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: 09/06/2010] [Accepted: 06/04/2012] [Indexed: 10/28/2022] Open
Abstract
The desmoid tumor is an uncommon neoplasm that occurs sporadically or as a part of inherited syndrome. Desmoid tumors are benign, but may infiltrate adjacent structures. Rarely severe and fatal, clinical problems are seen if mesenteric vessels or abdominal organs are involved. Ileum is one of the rare sites and literature search regarding this yielded scant results. Hence, we decided to report this case of aggressive desmoid tumors of the abdominal wall infiltrating ileum.
Collapse
Affiliation(s)
- Tejaswini Vallabha
- Aniketan Nursing Home, KK Nagar Bagewadi Road, Bijapur, Karnataka 586109 India
| | - Vikram Sindgikar
- Department of General Surgery, BLDEU'SShri B.M. Patil Medical College, Bijapur, Karnataka India
| | - Ramakant Baloorkar
- Department of General Surgery, BLDEU'SShri B.M. Patil Medical College, Bijapur, Karnataka India
| | - Mandar Dhamangoankar
- Department of General Surgery, BLDEU'SShri B.M. Patil Medical College, Bijapur, Karnataka India
| | - Uday Karjol
- Department of General Surgery, BLDEU'SShri B.M. Patil Medical College, Bijapur, Karnataka India
| |
Collapse
|
28
|
Federici S, Mordenti M, Domenichelli V, Pelusi G, Straziuso S, Pericoli R. Successful combined treatment for giant mesenteric desmoid tumor: case report and review of the literature. J Pediatr Surg 2012; 47:e25-30. [PMID: 22703821 DOI: 10.1016/j.jpedsurg.2012.01.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 12/02/2011] [Accepted: 01/19/2012] [Indexed: 11/26/2022]
Abstract
Mesenteric aggressive fibromatosis, also known as abdominal desmoid tumor (DT), is a rare monoclonal neoplasm arising from muscoloaponeurotic structures, caused by a generalized defect in growth regulation of the connective tissue. Childhood abdominal DT is very rare (1), and the mesenteric localization is one of the rarest forms (approximately 5% of total cases). Despite its benign microscopic appearance and nonmetastasizing behavior, abdominal DT shows a high risk of recurrence (30%-80%) (2) and local aggressive growth. We report a case of a 7-year-old girl with a giant mesenteric fibromatosis, with multiple recurrence after surgical resections, successfully treated with low-dose of vinblastine (3-6 mg/m(2) per week) and methotrexate (20-30 mg/m(2) per week) for 24 months (every 7 days for 11 months and every 2 weeks for the last 13 months). After a follow-up of 47 months from the end of treatment, the child is in good health and in complete remission. Prolonged therapy with low-dose methotrexate and vinblastine appears to control abdominal DT and is associated with stable disease in patients with tumor unresponsive to surgery.
Collapse
|
29
|
Gari MKM, Guraya SY, Hussein AM, Hego MMN. Giant mesenteric fibromatosis: Report of a case and review of the literature. World J Gastrointest Surg 2012; 4:79-82. [PMID: 22530082 PMCID: PMC3332225 DOI: 10.4240/wjgs.v4.i3.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/11/2012] [Accepted: 02/20/2011] [Indexed: 02/06/2023] Open
Abstract
Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. This paper presents a 35-year-old female complaining of vague abdominal pain of 2 mo duration. Her computed tomography scan and magnetic resonance imaging revealed a pelvi-abdominal heterogenous mass with significant displacement of the small bowel and urinary bladder. She underwent surgical excision of the mass with resection and anastomosis of the involved loop of the small intestine. Histological examination confirmed mesenteric fibromatosis without infiltration of the bowel. The patient remained well during the 6 mo follow-up.
Collapse
Affiliation(s)
- Mohammed Khalid Mirza Gari
- Mohammed Khalid Mirza Gari, Amir Mounir Hussein, Moustafa Mahmoud Nafady Hego, Department of Surgery, Imam Abdulrehman Bin Faisal Hospital, National Guard Health Affairs, Dammam 31412, Saudi Arabia
| | | | | | | |
Collapse
|
30
|
Bocale D, Rotelli MT, Cavallini A, Altomare DF. Anti-oestrogen therapy in the treatment of desmoid tumours: a systematic review. Colorectal Dis 2011; 13:e388-95. [PMID: 21831172 DOI: 10.1111/j.1463-1318.2011.02758.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The treatment of desmoid tumours (DTs) is controversial. Anti-oestrogen therapy has frequently been used, but clear information of its efficacy is lacking. In this systematic review we have undertaken a comprehensive analysis to assess the effectiveness of anti-oestrogen therapy in terms of ability to induce partial or complete regression of DTs. METHOD A systematic review of articles published in English between January 1983 and December 2009 was carried out according to the RECIST criteria. A literature search was performed on electronic databases including: United States National Library of Medicine (MEDLINE-PubMed), Excerpta Medica (EMBASE), Cochrane Library and Google search engine. Two-hundred articles dealing with DTs were identified but only fourty-one were were selected as appropriate for the study. The chi-square test was used for statistical analysis. RESULTS Data on 168 DTs treated with anti-oestrogen agents, alone or in combination with nonsteroidal anti-inflammatory drugs, were identified with an overall response rate of 51%. There was no difference in response according to the type of DTs or between different anti-oestrogen therapies. Combination with anti-inflammatory drugs did not improve the outcome. Toremifene was sometimes effective in cases resistant to tamoxifen. Response did not seem to be related to oestrogen receptor status. CONCLUSIONS Despite potential inaccuracies in the methodology, the results of the review indicate that anti-oestrogen therapy produces some effect in about one half of patients with DTs. Its indication compared with other treatments is discussed.
Collapse
Affiliation(s)
- D Bocale
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University Aldo Moro of Bari, Bari, Italy
| | | | | | | |
Collapse
|
31
|
Righetti AEM, Jacomini C, Parra RS, de Almeida ALNR, Rocha JJR, Féres O. Familial adenomatous polyposis and desmoid tumors. Clinics (Sao Paulo) 2011; 66:1839-42. [PMID: 22012061 PMCID: PMC3180149 DOI: 10.1590/s1807-59322011001000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ana Elisa Moraes Righetti
- Division of Coloproctology, Department of Surgery and Anatomy, School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | | | | |
Collapse
|
32
|
Huang K, Fu H, Shi YQ, Zhou Y, Du CY. Prognostic factors for extra-abdominal and abdominal wall desmoids: a 20-year experience at a single institution. J Surg Oncol 2009; 100:563-9. [PMID: 19722232 DOI: 10.1002/jso.21384] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Previous reports even large studies discussing the prognosis of desmoids have included tumors from intra- and extra-abdominal sites as well as incomplete resection. The purpose of this study was to explore prognostic factors associated with the recurrence free survival (RFS) rate in surgically treated extra-abdominal and abdominal wall desmoids. PATIENTS AND METHODS A total of 198 consecutive desmoid patients were treated with surgery over a 20-year period at a single institution. Of these, 151 patients with extra-abdominal and abdominal wall tumors were retrospectively reviewed. One hundred thirteen patients were referred for the primary tumor and the other 38 for recurrent disease initially treated elsewhere. All patients underwent a macroscopically complete resection. RESULTS The median follow-up interval was 102 months. Thirty-one patients (20.5%) had a local recurrence (LR). No patients died of the disease. The 5- and 10-year RFS was 79.7% and 78.5%, respectively. Admission status, gender, tumor size, margin status, location, and number, were predictors of LR in univariate analysis. Tumor size and margin status were independent prognostic factors in multivariate analysis. Positive margins were predictive of recurrence of primary disease, and also showed a trend for recurrent disease, which was not statistically significant. The selective use of adjuvant radiation did not show significant benefit over local control. CONCLUSIONS Regardless of primary or recurrent disease, microscopically negative margins should always be the goal for extra-abdominal desmoids surgery, if no cosmetic defects or function demolition is encountered. Extra-abdominal desmoids deserve more attention and should be treated more aggressively, especially when leaving positive margins.
Collapse
Affiliation(s)
- Kai Huang
- Department of Abdominal Surgery, Fudan University Shanghai Cancer Centre, Shanghai, China
| | | | | | | | | |
Collapse
|
33
|
Yu YH, Son BK, Jun DW, Kim SH, Jo YJ, Park YS, Hong BW, Joo JE. [A case of desmoid tumor presenting as intra-abdominal abscess]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 53:315-9. [PMID: 19458469 DOI: 10.4166/kjg.2009.53.5.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Desmoid tumor is a rare benign tumor derived from fibrous sheath or musculoaponeurotic structure. The tumor is benign histologically but considered as malignant clinically because it has high propensity on infiltrative growth with local invasion and tendency to recurrence after local excision. Especially, when this tumor happens to be in the intra-abdomen, the prognosis is worse because it can cause intestinal obstruction, ureter obstruction and, fistula formation. It also can invade major vessels in abdomen. This tumor occurs more frequently in patients with familial adenomatous polyposis (FAP), in post-partume women, and at old surgical incision site. However, in this case, the patient had neither previous surgery nor a FAP history. We report a rare case of the young male patient who presented with an acute abdomen and underwent laparotomy and was found to have an intra-abdominal desmoid tumor with abscess formation.
Collapse
Affiliation(s)
- Yeon Hwa Yu
- Departments of Internal Medicine, Surgery, Eulji University School of Medicine, Nowon-gu, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Rampone B, Pedrazzani C, Marrelli D, Pinto E, Roviello F. Updates on abdominal desmoid tumors. World J Gastroenterol 2008. [PMID: 18023087 DOI: 10.3748/wjg.13.5985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.
Collapse
Affiliation(s)
- Bernardino Rampone
- Department of General Surgery and Surgical Oncology, Unit of Surgical Oncology, University of Siena, Policlinico Le Scotte, viale Bracci, 1, 53100, Siena, Italy.
| | | | | | | | | |
Collapse
|
35
|
Rampone B, Pedrazzani C, Marrelli D, Pinto E, Roviello F. Updates on abdominal desmoid tumors. World J Gastroenterol 2008; 13:5985-8. [PMID: 18023087 PMCID: PMC4250878 DOI: 10.3748/wjg.v13.45.5985] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.
Collapse
Affiliation(s)
- Bernardino Rampone
- Department of General Surgery and Surgical Oncology, Unit of Surgical Oncology, University of Siena, Policlinico Le Scotte, viale Bracci, 1, 53100, Siena, Italy.
| | | | | | | | | |
Collapse
|
36
|
Cohen S, Ad-El D, Benjaminov O, Gutman H. Post-traumatic soft tissue tumors: case report and review of the literature a propos a post-traumatic paraspinal desmoid tumor. World J Surg Oncol 2008; 6:28. [PMID: 18312655 PMCID: PMC2270823 DOI: 10.1186/1477-7819-6-28] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 02/29/2008] [Indexed: 12/28/2022] Open
Abstract
Background Antecedent trauma has been implicated in the causation of soft tissue tumors. Several criteria have been established to define a cause-and-effect relationship. We postulate possible mechanisms in the genesis of soft tissue tumors following antecedent traumatic injury. Case presentation We present a 27-year-old woman with a paraspinal desmoid tumor, diagnosed 3-years following a motor vehicle accident. Literature is reviewed. Conclusion Soft tissue tumors arising at the site of previous trauma may be desmoids, pseudolipomas or rarely, other soft tissue growths. The cause-and-effect issue of desmoid or other soft tissue tumors goes beyond their diagnosis and treatment. Surgeons should be acquainted with this diagnostic entity as it may also involve questions of longer follow-up and compensation and disability privileges.
Collapse
Affiliation(s)
- Sarit Cohen
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa,
| | | | | | | |
Collapse
|
37
|
|
38
|
Tolan S, Shanks JH, Loh MY, Taylor B, Wylie JP. Fibromatosis: benign by name but not necessarily by nature. Clin Oncol (R Coll Radiol) 2007; 19:319-26. [PMID: 17419039 DOI: 10.1016/j.clon.2007.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 02/12/2007] [Accepted: 02/15/2007] [Indexed: 12/15/2022]
Abstract
Aggressive fibromatoses, also known as desmoid tumours, are rare fibrous tissue proliferations with a tendency for slow, local infiltrative growth. There is an association with Gardner's syndrome and familial adenomatous polyposis. Histologically they are fairly bland with no abnormal mitoses or necrosis. They do not metastasize, but can cause significant morbidity through their locally destructive effects. Magnetic resonance imaging is the method of choice for diagnosis, pre-treatment planning and post-treatment follow-up. Surgical excision with a wide margin is the treatment of choice. However, there is a tendency for local recurrence and repeated excision may result in a poor functional or cosmetic outcome. Radiotherapy is used to reduce local recurrence rates after excision and is also used to treat inoperable tumours. Long-lasting remissions can be obtained. Treatment is now planned using modern three-dimensional conformal techniques, similar to those used in soft tissue sarcoma management. There is no definite dose-response relationship, but doses of 50-60 Gy in 1.8-2 Gy fractions are recommended. Systemic therapy has been used for lesions not controlled by surgery or radiotherapy, or less commonly, as a primary treatment. Tamoxifen and non-steroidal anti-inflammatory agents are used most often as they are relatively non-toxic, but there is limited experience with cytotoxic chemotherapy and biological agents. There are no randomised trials to help guide the management of this locally aggressive 'benign' tumour and treatment decisions are best made by the local soft tissue sarcoma multidisciplinary team.
Collapse
Affiliation(s)
- S Tolan
- Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
39
|
Rakha EA, Kandil MA, El-Santawe MG. Gigantic recurrent abdominal desmoid tumour: a case report. Hernia 2006; 11:193-7. [PMID: 17149531 DOI: 10.1007/s10029-006-0165-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 10/23/2006] [Indexed: 12/15/2022]
Abstract
Deeply seated fibromatosis or desmoid tumour (DT) is a rare entity characterized by benign proliferation of fibroblasts. Although non-malignant, this tumour can be life-threatening due to its invasive property and high recurrence rate. We report a unique case of a huge recurrent abdominal DT (36 cm in diameter, 25 kg in weight) that caused pressure necrosis and sloughing of the overlying anterior abdominal wall, and produced a large fungating mass protruding outside the abdomen. Although preoperative neoadjuvant therapies were all ineffective, radical surgical removal of the tumour was successful. The procedure was followed by an excellent clinical recovery and the patient is still alive with no evidence of recurrent disease after a 6-year follow-up. We recommend surgical removal of DT regardless of its size and in particular in cases where there is no or inadequate response to neoadjuvant therapy.
Collapse
Affiliation(s)
- E A Rakha
- Department of Histopathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.
| | | | | |
Collapse
|
40
|
Liegl B, Leithner A, Bauernhofer T, Windhager R, Guelly C, Regauer S, Beham A. Immunohistochemical and mutational analysis of PDGF and PDGFR in desmoid tumours: is there a role for tyrosine kinase inhibitors in c-kit-negative desmoid tumours? Histopathology 2006; 49:576-81. [PMID: 17163842 DOI: 10.1111/j.1365-2559.2006.02562.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To determine the platelet-derived growth factor (PDGF) alpha and beta status of desmoid tumours. Desmoid tumours are rare monoclonal neoplasms that appear to have no metastatic potential. Surgical resection and radiotherapy in the event of a positive surgical margin is the first-line treatment. Recurrences are frequent. Treatment results using non-steroidal anti-inflammatory agents, anti-oestrogen compounds and other agents such as Imatinib mesylate have been published. Therapy with Imatinib has been proposed as a therapeutic option, although in most reports desmoid tumours are reported to be c-kit-. METHODS AND RESULTS We performed immunohistochemical analysis on 124 archived samples (85 patients) of desmoid tumours using antibodies to PDGFalpha, PDGFbeta, PDGFRalpha and PDGFRbeta. All desmoid tumours showed immunoreactivity with antibodies to PDGFalpha and PDGFRalpha, whereas with antibodies to PDGFbeta and PDGFRbeta no specific reaction could be detected. Mutational analysis of PDGFRalpha (exons 11, 12, 17 and 18) and PDGFRbeta (exon 12) on frozen material from 14 patients was performed, but no mutations leading to amino acid changes in the mature protein were identified. CONCLUSION The absence of an activating mutation in a protooncogene does not exclude the efficacy of tyrosine kinase inhibitors through other possible mechanisms, and these might be a therapeutic option for patients with desmoid tumours in whom established local and systemic approaches fail to control the disease.
Collapse
Affiliation(s)
- B Liegl
- Institute of Pathology, Medical University of Graz, Graz, Austria.
| | | | | | | | | | | | | |
Collapse
|
41
|
Oguz M, Bedirli A, Gultekin A, Dursun A, Mentes BB. Desmoid tumor arising at the colostomy site after abdominoperineal resection for rectal carcinoma: report of a case. Dis Colon Rectum 2006; 49:1445-8. [PMID: 16897327 DOI: 10.1007/s10350-006-0648-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 69-year-old male who developed a desmoid tumor at the site of his end colostomy after abdominoperineal resection for rectal carcinoma is reported. The tumor was resected with wide margins. Histopathology revealed desmoid tumor of the anterior abdominal wall with no malignant features. The patient had an uneventful postoperative course. To our knowledge, this is the first case of solitary desmoid tumor of anterior abdominal wall at the colostomy site reported in the literature.
Collapse
Affiliation(s)
- Mehmet Oguz
- Department of Surgery, Gazi University Medical School, Cayyolu, Ankara 06810, Turkey
| | | | | | | | | |
Collapse
|
42
|
Komatsu S, Ichikawa D, Kurioka H, Koide K, Ueshima Y, Shioaki Y, Lee CJ, Mutoh F, Hosokawa Y, Oka T, Yamagishi H. Intra-abdominal desmoid tumor mimicking lymph node recurrence after gastrectomy for gastric cancer. J Gastroenterol Hepatol 2006; 21:1224-6. [PMID: 16824087 DOI: 10.1111/j.1440-1746.2006.04210.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
43
|
Rajesh A, Sandrasegaran K. Mesenteric desmoid mimicking recurrent testicular cancer. ACTA ACUST UNITED AC 2005; 30:777-9. [PMID: 16096867 DOI: 10.1007/s00261-005-0321-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 12/29/2004] [Indexed: 11/27/2022]
Abstract
The detection of a solid abdominal mass after surgery for testicular cancer most frequently represents metastatic disease. We report an unusual case of mesenteric desmoid tumor presenting after retroperitoneal lymph node dissection for metastatic testicular cancer. To our knowledge, there are no similar reports in the radiology literature.
Collapse
Affiliation(s)
- A Rajesh
- Department of Radiology, Indiana University Medical Center, Indianapolis, 46202, USA
| | | |
Collapse
|
44
|
Affiliation(s)
- Anders Merg
- Roswell Park Cancer Center, Buffalo, New York, USA
| | | | | | | |
Collapse
|
45
|
Micke O, Seegenschmiedt MH. Radiation therapy for aggressive fibromatosis (desmoid tumors): results of a national Patterns of Care Study. Int J Radiat Oncol Biol Phys 2005; 61:882-91. [PMID: 15708271 DOI: 10.1016/j.ijrobp.2004.07.705] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 07/07/2004] [Accepted: 07/12/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE After a general Patterns of Care Study (PCS) the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) initiated a multicenter cohort study to analyze the radiation therapy practice for aggressive fibromatosis. METHODS AND MATERIALS In 2002 a PCS was conducted in all German radiotherapy (RT) institutions by mailing a standardized structured questionnaire, to assess patients accrual, number, pretreatment, treatment indications, RT, and target volume concepts for irradiation in aggressive fibromatosis. In addition, the treatment outcome of individual patients was evaluated. The PCS was structured and analyzed according to the model for quality assessment by Donabedian in three major components: structure, process, and outcome evaluation. RESULTS A total of 101 institutions returned the questionnaire: 52.7% reported satisfactory clinical data and experience for inclusion in this analysis. A total accrual rate of 278 patients per year was reported with median number of 2 cases (1-7 cases) per institution. Satisfactory data for a long-term clinical evaluation was reported for 345 patients from 19 different institutions. The applied total doses ranged between 36 and 65 Gy (median, 60 Gy). The local control rate was 81.4% in primary RT for unresectable tumors and 79.6% in postoperative RT. No acute or late radiation toxicities > Grade 2 (RTOG) were observed. No clear dose-response relationship could be established, but there was a tendency toward a lower local control rate in patients with a higher number of operative procedures before RT and patients treated for recurrent aggressive fibromatosis. CONCLUSIONS This study comprises the largest database of cases reported for RT in aggressive fibromatosis. Radiotherapy provides a high local control rate in the postoperative setting and in unresectable tumors. This PCS may serve as a starting point for a national or international prospective multicenter study or registry, or both.
Collapse
Affiliation(s)
- Oliver Micke
- Department of Radiotherapy, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
| | | |
Collapse
|
46
|
Durkin AJ, Korkolis DP, Al-Saif O, Zervos EE. Full-term gestation and transvaginal delivery after wide resection of an abdominal desmoid tumor during pregnancy. J Surg Oncol 2005; 89:86-90. [PMID: 15660370 DOI: 10.1002/jso.20189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 29-year-old female was diagnosed with a symptomatic, extra-abdominal desmoid tumor during the first trimester of pregnancy. Computerized tomography (CT) and transabdominal ultrasound (US) noted a mass within the left rectus sheath measuring up to 15 cm in greatest diameter, with mild compression of the uterus. Preoperative diagnosis was confirmed by core-needle biopsy of the lesion. At 20-weeks gestation, wide local resection of the tumor with disease-free margins, as well as abdominal wall reconstruction with polytetrafluoroethylene (PTFE) mesh was successfully undertaken. Histological examination of the tumor ex vivo confirmed that the lesion was a desmoid tumor consisting of spindle cells with dense infiltrating collagenous fibers. Subsequent to her resection, the patient completed a full-term pregnancy without complication, and proceeded with a complication-free transvaginal delivery at 39 weeks. This case illustrates the probable contribution of estrogens towards desmoid tumor development, the durability of abdominal wall reconstruction when subjected to the extraordinary strain of both a gravid uterus and labor, as well as the safety and efficacy of aggressive surgical therapy during pregnancy.
Collapse
Affiliation(s)
- Alan J Durkin
- Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Digestive Disorders Center, Tampa, Florida 33601, USA
| | | | | | | |
Collapse
|
47
|
March JA, Esclapez P, García-Granero E, Lledó S. Fibromatosis: abordaje de York-Mason modificado para la escisión de un tumor desmoide en la región sacra. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)78961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
48
|
Mace J, Sybil Biermann J, Sondak V, McGinn C, Hayes C, Thomas D, Baker L. Response of extraabdominal desmoid tumors to therapy with imatinib mesylate. Cancer 2002; 95:2373-9. [PMID: 12436445 DOI: 10.1002/cncr.11029] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Desmoid tumor represents a rare monoclonal neoplasm arising from deep musculoaponeurotic structures and may occur sporadically or in association with the familial adenomatous polyposis and Gardner syndromes. Desmoid tumors do not appear to demonstrate metastatic potential; however, local infiltrative growth results in significant morbidity and potential mortality. Although the delineation of optimal therapy for desmoid tumors has been confounded by several factors, surgical resection with adjuvant radiotherapy for a positive surgical margin remains the standard approach. Responses have been demonstrated to nonsteroidal antiinflammatory agents, antiestrogen compounds, and a variety of other agents in small series. Imatinib mesylate appears to demonstrate inhibitory activity against multiple class 3 receptor tyrosine kinases, including platelet-derived growth factor receptor (PDGFR)-alpha and PDGFR-beta, as well as c-kit. METHODS The authors performed immunohistochemical and qualitative real-time polymerase chain reaction analysis on nine desmoid tumor specimens that demonstrated consistent positivity for c-kit as well as PDGFR-alpha and PDGFR-beta. At the time of last follow-up, 2 patients had received therapy with imatinib mesylate at a dose of 400 mg twice daily. RESULTS Both patients demonstrated ongoing radiographic and clinical responses with a duration of 9 months and 11 months, respectively. CONCLUSIONS Imatinib mesylate has been reported to have activity against desmoid tumor, most likely because of c-kit and PDGFR receptor tyrosine kinase activity inhibition, and warrants further study. The relative novelty of this agent and the lack of long-term toxicity data should prompt its use only in the salvage setting in which established local and systemic approaches fail to control disease. In addition, the use of imatinib mesylate in the treatment of this neoplasm preferably should be in the context of a formal prospective clinical trial.
Collapse
Affiliation(s)
- Joseph Mace
- Division of Medical Oncology, Department of Internal Medicine, University of Michigan Medical Center, Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Desmoid tumours exhibit fibroblastic proliferation and arise from fascial or musculoaponeurotic structures. Despite their benign microscopic appearance, and their negligible metastatic potential, the propensity of desmoid tumours for local infiltration is potentially significant in terms of deformity, morbidity and mortality due to pressure effects and obstruction of vital structures and organs. The rarity of desmoid tumours, coupled with the variability in their clinical course, renders these lesions a vexing entity, and makes demonstration of the efficacy of any specific intervention difficult. Failure to recognize the potential for malignant behaviour in this tumour renders desmoids susceptible to inadequate treatment. This distinct pathological entity is reviewed with a specific focus on aetiology and treatment.
Collapse
Affiliation(s)
- C J Shields
- Department of Academic Surgery, National University of Ireland, Wilton, Cork, Ireland
| | | | | | | |
Collapse
|
50
|
Wang H, Recant W, Montag AG, Hart J. Pathologic quiz case. A large mesentric mass in 40-year-old man. Arch Pathol Lab Med 2001; 125:443-4. [PMID: 11231502 DOI: 10.5858/2001-125-0443-pqcalm] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- H Wang
- Department of Pathology, The University of Chicago Hospitals, Ill, USA
| | | | | | | |
Collapse
|