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Sachs JP, Dardano AN. Nuchal-type Fibroma Induced by Repetitive Trauma from Weightlifting: Case Report and Comprehensive Review of Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5517. [PMID: 38204868 PMCID: PMC10781125 DOI: 10.1097/gox.0000000000005517] [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: 07/20/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
A nuchal-type fibroma (NTF) is a rare, benign, subcutaneous nodule that most frequently occurs in the posterior neck along the midline. It is characterized histologically by bundles of thick collagen fibers confined to the dermis and subcutaneous tissue of the posterior neck. Few trauma-related NTF cases have been published. We present a biopsy-proven case of NTF that is likely to have developed as a result of weightlifting activity in the gym, including repetitive trauma to the area of the lesion during the exercise known as the "barbell back squat." During this exercise, a heavy barbell was repeatedly rested on the patient's vertebral prominence at the level of C7/T1, the location where the NTF developed. Our 25-year old patient reported that he had been doing this exercise on a weekly basis for about 10 years. We believe that repetitive trauma at this location from specific weightlifting exercises may attribute to the incidence of NTF. A description of key magnetic resonance imaging characteristics and the surgical pathology of this case are provided, along with a review of current literature on trauma-related NTFs.
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Affiliation(s)
- Jared P. Sachs
- From New York Medical College School of Medicine, Valhalla, N.Y
| | - Anthony N. Dardano
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Fla
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Jiang S, Shen LP, Tang M, Jiang HT. A giant extra-nuchal type fibroma on the thigh. Asian J Surg 2023; 46:3985-3987. [PMID: 37080809 DOI: 10.1016/j.asjsur.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Shan Jiang
- Department of Radiology, Jining No. 1 People's Hospital, Jining, Shandong, 272011, PR China
| | - Li-Ping Shen
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 318000, PR China
| | - Meng Tang
- Department of Ultrasonography, Jining No. 1 People's Hospital, Jining, Shandong, 272011, PR China
| | - Han-Tao Jiang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 318000, PR China.
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Abstract
A nuchal-type fibroma is a rare, benign fibrous tumour that typically occurs in the posterior neck along the midline, but can occur in extra-nuchal locations, most commonly in the back, shoulder and face. We present a biopsy-proven case that arose as a result of heavy gym-related activities. In particular, a heavy barbell was rested on his vertebral prominence at the level of C7/T1 during leg squatting. Repetitive trauma as a cause for extra-nuchal-type fibromas has been sparsely reported, but we suggest that sustained high pressure is an additional required feature. Although this lesion was in the posterior neck, it was contained entirely within the subcutaneous tissues without involvement of the nuchal ligament. Hence, it was considered an extra-nuchal fibroma. A description of key ultrasound and MRI imaging characteristics are provided to assist in making the diagnosis, along with a review of the current literature and a discussion of differential diagnoses.
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Kostakis ID, Feretis T, Damaskos C, Garmpis N, Liapis G, Pateras I, Garmpi A, Georgakopoulou VE, Antoniou EA. Nuchal-type Fibroma: Single-Center Experience and Systematic Literature Review. In Vivo 2021; 34:2217-2223. [PMID: 32871744 DOI: 10.21873/invivo.12032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nuchal-type fibroma is a rare benign tumor arising from the connective tissue. Our aim was to present our experience via two cases of this tumor and a comprehensive review of the literature. PATIENTS AND METHODS We report a case of a 23-year-old female with a mass located in the posterior neck and the upper back and a case of a 50-year-old male with a mass located in the posterior neck, which were proved to be nuchal-type fibromas in the histopathological examination. We also searched the PubMed/Medline database for published cases of nuchal-type fibromas. RESULTS AND DISCUSSION Nuchal-type fibroma is a rare benign tumor arising from the connective tissue, usually in the posterior neck, which affects different ages, with most patients being male. It is a poorly circumscribed tumor consisting of hypocellular, thick, dense and haphazardly arranged collagen bundles with entrapped adipocytes, nerve fibers and muscle fascicles and a few scattered spindle cells, which are CD34 positive. Its excision is curative, and the recurrence risk is generally low. However, patients with Gardner's syndrome may experience recurrence more frequently. CONCLUSION Nuchal-type fibroma should be included in the differential diagnosis of subcutaneous, soft-tissue masses, especially when these involve the posterior neck.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - Themistoklis Feretis
- First Department of Endoscopic Surgery, Metropolitan General Hospital, Athens, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Liapis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pateras
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki E Georgakopoulou
- Department of Pulmonology, Laiko General Hospital, Athens, Greece.,First Department of Pulmonology, Sismanogleio Hospital, Athens, Greece
| | - Efstathios A Antoniou
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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GARCÍA-CURDI F, BENÍTEZ-ALONSO PE, LOIS-ORTEGA Y, MOROS-GARCÍA M, SEBASTIÁN-CORTÉS JM, VALLÉS-VARELA H. Fibroma tipo nucal laterocervical. Descripción de un caso. REVISTA ORL 2018. [DOI: 10.14201/orl.18394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lee CC, Lai CS, Lin CH, Lin YN, Chu SC, Chai CY, Lee CH. Extra nuchal-type fibroma associated with repetitive blunt trauma during religious activities. Trauma Case Rep 2016; 4:16-20. [PMID: 29942846 PMCID: PMC6011863 DOI: 10.1016/j.tcr.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2016] [Indexed: 11/25/2022] Open
Abstract
Nuchal-type fibroma (NTF) is a rare, benign subcutaneous tumor that usually arises from the posterior neck. NTF is histologically characterised by dense collagen bundles and sparse fibroblasts. Only four trauma-related cases have been previously published. Herein, we present a case of extra NTF with histopathology, and six palanquin porters by using snowball sampling technique in ethnographic field research. A palanquin is a type of human-powered transport carried upon the shoulders mostly seen in religious processions. All individuals (mean age, 26.8 years) displayed similar shoulder masses measuring up to 12 cm in the greatest dimensions. They averaged approximately 8.1 years of palanquin-carrying work each. We believe that long-term, heavy shoulder weight bearing of palanquins in religious dance performances may attribute to the incidence of extra NTF. This study reviews all literature of trauma-associated NTF through PubMed database, and highlights the association between repetitive blunt trauma and the development of NTF.
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Affiliation(s)
- Chia-Chen Lee
- School of Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Sheng Lai
- School of Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lin
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yun-Nan Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shao-Chi Chu
- School of Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Hui Lee
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Gong Y, Zhao X, Wu DI, Liu J. Nuchal-type fibroma of the shoulder: A case report and review of the literature. Oncol Lett 2016; 11:4152-4154. [PMID: 27313758 DOI: 10.3892/ol.2016.4530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/18/2016] [Indexed: 11/06/2022] Open
Abstract
Nuchal-type fibroma, initially described in 1988 by Enzinger and Weiss, is a rare clinical entity associated with distinct subcutaneous and dermal fibrous tissue proliferation. The etiology of nuchal-type fibroma largely remains to be elucidated. Typical characteristics of this entity include hypocellular, haphazardly arranged collagen with entrapped adipose tissue, paucity of elastin and entrapped small nerves, on which the pathological diagnosis is based. Magnetic resonance imaging (MRI) is the preferred imaging modality for the detection of nuchal-type fibroma, due to its superior soft tissue resolution and multi-planar capabilities. The present study presents the unique findings of a nuchal-type fibroma arising in the shoulder of a 48-year-old man. Distinct features of the nuchal-type fibroma in the present case included hyperintensity on T1- and T2-weighted MRI. Microscopic examination revealed marked mucoid tissue degeneration. To the best of our knowledge, this is the first case report of nuchal-type fibroma presenting with these distinct features. The present findings may therefore assist with the general and differential diagnosis of nuchal-type fibroma.
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Affiliation(s)
- Yubao Gong
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xingyu Zhao
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - D I Wu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jianguo Liu
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Kim DH, Kim TH, Sung NH, Shin H, Lee AY, Lee SH. Multiple nuchal-type fibromas on the scalp: a case report. Ann Dermatol 2015; 27:194-6. [PMID: 25834360 PMCID: PMC4377410 DOI: 10.5021/ad.2015.27.2.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 11/08/2022] Open
Abstract
Nuchal-type fibroma is a rare, benign, fibrous, tumor-like proliferation characterized by dense hypocellular bundles of collagen, with sparsely scattered fibroblasts, interspersed fat tissue, and entrapped nerve fibers. It usually develops in the posterior neck as a solitary, firm, poorly circumscribed, subcutaneous mass. Herein, we report about a 32-year-old man who presented with a 6-year history of multiple nodules on the scalp. Histopathological features were consistent with those of nuchal-type fibroma. The tumors were surgically excised.
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Affiliation(s)
- Do Hun Kim
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Han Kim
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Nam Hee Sung
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - HyoSeung Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Ai Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Seung Ho Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Linos K, Sedivcová M, Cerna K, Sima R, Kazakov DV, Nazeer T, Glazyrin A, Valerian BT, Carlson JA. Extra nuchal-type fibroma associated with elastosis, traumatic neuroma, a rare APC gene missense mutation, and a very rare MUTYH gene polymorphism: a case report and review of the literature*. J Cutan Pathol 2011; 38:911-8. [PMID: 21752055 DOI: 10.1111/j.1600-0560.2011.01745.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of an extra nuchal-type fibroma in a 51-year-old male suspected to have attenuated familial adenomatous polyposis (Gardner's syndrome), who presented with a longstanding buttock mass excised due to enlargement and pain. Histopathologically, lobules of haphazard, hypocellular, hyalinized collagen bundles replaced the dermis and subcutis and entrapped nerve bundles, mimicking Morton neuroma. Ramifying nerve twigs found around larger nerve fascicles showed the co-existence of traumatic neuroma. Elastic tissue stain revealed elastosis characterized by large, arborizing fibers lying between and within the hyalinized collagen bundles. Modified Masson's trichrome stain showed light blue staining of collagen bundles producing the hyalinized nodules with irregular, light red staining of collagen bundles at their periphery and within tumor collagen. Compression and/or degeneration of collagen and secondary elastosis with later entrapment by tumor collagen could explain this microscopic phenotype. By immunohistochemistry, tumor spindle cells expressed nuclear β-catenin and cyclin D1, mostly within regions of fibrosis implicating activation of the adenomatous polyposis coli (APC)-Wnt pathway. Genetic analysis showed a missense mutation in APC gene (c.7504G>A, p.G2502S in exon 15) and a functional homozygous polymorphism in the MUTYH gene (c.36+325G>C, (IVS1+5G/C)). Nuchal-type fibroma has been associated with Gardner's syndrome and trauma. In this patient, genetic predisposition coupled with repetitive, localized trauma and collagen degeneration may have provided the stimulus for the development of extra nuchal-type fibroma.
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Affiliation(s)
- Konstantinos Linos
- Department of Pathology, Albany Medical College MC-81, Albany, NY 12208, USA
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Nuchal-type fibroma of the buttock: magnetic resonance imaging findings. Jpn J Radiol 2010; 28:538-41. [PMID: 20799020 DOI: 10.1007/s11604-010-0459-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 04/25/2010] [Indexed: 10/19/2022]
Abstract
Nuchal-type fibroma, first described in 1988 by Enzinger and Weiss, is a rare fibrous growth occurring predominantly in the interscapular and paraspinous regions. It is typically located in the subcutaneous tissue of the posterior neck but may occur in extranuchal soft tissue sites such as the upper back, shoulder, and facial regions. In this article, we describe the magnetic resonance imaging findings of a nuchal-type fibroma that involved the buttock in a 45-year-old woman, and we review and discuss the literature on the subject.
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