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Tuan NHN, Hai TD, Minh LN, Than TLH, Tu PD, Bao NVT, Van Khoa L, Dang TN, Van Phuoc L. Transarterial doxorubicin-eluting beads embolization for the treatment of desmoid fibromatosis in the pubic region. Radiol Case Rep 2024; 19:4335-4340. [PMID: 39170777 PMCID: PMC11338108 DOI: 10.1016/j.radcr.2024.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/18/2024] [Accepted: 06/30/2024] [Indexed: 08/23/2024] Open
Abstract
Desmoid fibromatosis (DFs) is rare, low-grade neoplasm. Although it poses no risk of metastasis, DFs exhibits a range of clinical manifestations characterized by local infiltrative growth tendencies and a propensity for recurrence. Despite its nonmalignant nature, DFs can be highly debilitating and occasionally life-threatening, causing severe pain and functional limitations. Traditionally, surgery served as the conventional primary treatment approach; nevertheless, a recent shift in paradigm towards a more conservative management has emerged, accompanied by efforts to standardize the strategy among clinicians. Systemic doxorubicin has been demonstrated to be effective in treating DFs; however, it carries potential risks of adverse effects on the cardiovascular, digestive, and hematologic systems. The novel intravascular intervention employing drug-eluting beads loaded with doxorubicin represents an effective treatment for DFs, optimizing drug delivery to the target lesion and reducing systemic toxicity. In this article, we present a rare case of DFs in the right pubic region treated with transarterial doxorubicin-eluting beads embolization.
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Affiliation(s)
| | - Tran Duc Hai
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Le Nhat Minh
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | | | - Pham Dang Tu
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | | | - Le Van Khoa
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Thai Ngoc Dang
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Le Van Phuoc
- Department of radiology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
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Denwood H, Gonzalez MR, Sodhi A, Werenski J, Clunk M, Newman ET, Lozano-Calderón SA. Risk factors for local recurrence of upper extremity desmoid tumors. J Surg Oncol 2024; 129:813-819. [PMID: 38073165 DOI: 10.1002/jso.27559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Upper extremity (UE) desmoid tumors are locally aggressive neoplasms with high recurrence rates. Our study sought to analyze the demographics and treatment strategies of UE desmoid tumors and identify risk factors for recurrence. MATERIALS AND METHODS A retrospective review of 52 patients with histologically confirmed UE desmoid tumors treated at our institution between 1990 and 2015 was conducted. Survival was assessed using the Kaplan-Meier method and the Cox proportional hazards model was used for risk factor analysis. RESULTS For the entire cohort, median age was 40 (29-47) years, 75% were female, and 48% had local recurrence. The median tumor size was 45 (15-111) cm3 on imaging. Twenty-two patients had a previous resection. The most common treatments were surgery alone (50%) and surgery with adjuvant radiotherapy (21%). Tumor size ≥5 cm and tumor volume ≥40 cm3 on imaging were associated with increased recurrence (p = 0.006 and p = 0.005, respectively). Age and sex were not associated with local recurrence. Patients with a tumor size ≥5 cm were 2.6 times more likely to present with recurrence. At the 10-year mark, a lower local recurrence-free survival was seen in patients with tumors ≥5 cm (72.2% vs. 36.3%, p = 0.042) or ≥40 cm3 (67.2% vs. 32.7%, p = 0.034). CONCLUSION In our study, only tumor dimensions appeared to modify recurrence risk.
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Affiliation(s)
- Hayley Denwood
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alisha Sodhi
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Werenski
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilee Clunk
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- University of Toledo College of Medicine and Life Sciences Toledo, Toledo, Ohio, USA
| | - Erik T Newman
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Meade A, Wisecarver I, Cho MJ, Davis JJ, Duque S, Farewell JT, Zhang AY. The Role of Reconstruction on Desmoid Tumor Recurrence: A Systematic Review and Technical Considerations. Ann Plast Surg 2023; 90:S195-S202. [PMID: 36729103 DOI: 10.1097/sap.0000000000003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Desmoid tumors occur throughout the body, presenting as aggressive, locally invasive lesions that can impede quality of life. Many controversies remain regarding the optimal surgical treatment of desmoid. This article presents a systematic review and meta-analysis on surgical management, focusing on risk of recurrence and the utility of reconstruction within this unique patient population. METHODS A systematic review was conducted to search for articles. The clinical course of patients diagnosed with desmoid tumors and treated by our institution's multidisciplinary team was retrospectively reviewed over a 13-year period. Meta-analysis study findings were compared with our cohort. RESULTS From the systematic review, 10 studies with level of evidence III were found, which resulted in 981 patients. Twenty patients from our institution met the inclusion criteria for our study. In both our study cohort and the pooled results, recurrence was significantly higher in patients with positive microscopic margin after resection. In our study cohort, patients with recurrence had higher rates of positive margins compared with those without recurrence (83.3% vs 7.1%, P = 0.004), whereas the pooled study showed a difference of margin positivity of 50% vs 40% ( P = 0.01). No patients who underwent reconstruction in our study cohort had a recurrence during the study period. CONCLUSION In both our cohort and pooled results, recurrence was significantly higher in patients with positive margins after initial resection. Reconstruction was not found to be a risk factor for recurrence. Reconstruction following desmoid tumor resection should be considered a viable option if a large and aggressive resection is required to obtain negative margins.
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Affiliation(s)
- Anna Meade
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian Wisecarver
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Justin J Davis
- Institute for Plastic Surgery, Southern Illinois University, Springfield, IL
| | - Sofia Duque
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jordyn T Farewell
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew Y Zhang
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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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.
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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
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Albino L, Guo Y, Bacani J, Mather C, Nilsson JE, Dieleman LA. Case report: Desmoid fibromatosis diagnosed in a 27-year-old male after being mistaken for a gastrointestinal stromal tumour. Front Med (Lausanne) 2022; 9:998473. [PMID: 36438058 PMCID: PMC9684322 DOI: 10.3389/fmed.2022.998473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/25/2022] [Indexed: 11/04/2023] Open
Abstract
Despite being distinct lesions, gastrointestinal stromal tumours (GISTs) and desmoid fibromatosis may appear similar on imaging when they involve the stomach wall or bowel. As a result, they may be confused with one another when initially diagnosed. This report aims to present a case where a desmoid tumour was mistaken for a gastric GIST in a 27-year-old gentleman despite extensive investigation prior to exploratory laparotomy, and why differentiation through pathology, with a focus on the immunohistochemistry profile, is key for proper prognostication and appropriate management, including timely investigation for associated diseases such as Familial Adenomatous Polyposis in patients with desmoid tumours.
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Affiliation(s)
- Larissa Albino
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yimeng Guo
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Julinor Bacani
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Cheryl Mather
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Jan-Erick Nilsson
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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Riedel RF, Agulnik M. Evolving strategies for management of desmoid tumor. Cancer 2022; 128:3027-3040. [PMID: 35670122 PMCID: PMC9546183 DOI: 10.1002/cncr.34332] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
Abstract
Desmoid tumors (DTs) are rare soft tissue mesenchymal neoplasms that may be associated with impairments, disfigurement, morbidity, and (rarely) mortality. DT disease course can be unpredictable. Most DTs are sporadic, harboring somatic mutations in the gene that encodes for β-catenin, whereas DTs occurring in patients with familial adenomatous polyposis have germline mutations in the APC gene, which encodes for a protein regulator of β-catenin. Pathology review by an expert soft tissue pathologist is critical in making a diagnosis. Magnetic resonance imaging is preferred for most anatomic locations. Surgery, once the standard of care for initial treatment of DT, is associated with a significant risk of recurrence as well as avoidable morbidity because spontaneous regressions are known to occur without treatment. Consequently, active surveillance in conjunction with pain management is now recommended for most patients. Systemic medical treatment of DT has evolved beyond the use of hormone therapy, which is no longer routinely recommended. Current options for medical management include tyrosine kinase inhibitors as well as more conventional cytotoxic chemotherapy (e.g., anthracycline-based or methotrexate-based regimens). A newer class of agents, γ-secretase inhibitors, appears promising, including in patients who fail other therapies, but confirmation in Phase 3 trials is needed. In summary, DTs present challenges to physicians in diagnosis and prognosis, as well as in determining treatment initiation, type, duration, and sequence. Accordingly, evaluation by a multidisciplinary team with expertise in DT and patient-tailored management are essential. As management strategies continue to evolve, further studies will help clarify these issues and optimize outcomes for patients.
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Affiliation(s)
- Richard F Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark Agulnik
- Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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Michaelides A, Ang A, ChinAleong J, Kocher HM. Large desmoid tumour of the small bowel mesentery. BMJ Case Rep 2022; 15:e247935. [PMID: 35236693 PMCID: PMC8895928 DOI: 10.1136/bcr-2021-247935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
A 74-year-old man was being investigated for a pancreatic insulinoma when an incidental mesenteric mass measuring 2.6 cm x 2.5 cm was noticed on CT imaging. A wait-and-see approach was decided on. Thirty-nine months later, the patient presented with symptoms of abdominal obstruction. CT images revealed the mesenteric mass filled majority of the abdominal cavity and measured 29 cm x 26 cm x 16 cm. The patient underwent an open bypass gastrojejunostomy which stopped working a few weeks later due to further compression by the tumour. A debulking surgery was performed: a right hemicolectomy and small bowel resection with excision of the desmoid tumour and bypass gastrojejunostomy. The tumour measured 12.6 kg and was macroscopically visualised to have a white cut surface with a focal translucent area. Microscopic analysis revealed bland spindle cells with pale eosinophilic cytoplasm showing no cytological atypia, in keeping with a mesenteric desmoid tumour. Currently, two and a half years from the debulking surgery, the patient remains well and in remission with planned surveillance.
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Affiliation(s)
- Athena Michaelides
- HPB Surgery, Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Andrew Ang
- HPB Surgery, Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Joanne ChinAleong
- Department of Pathology, Centre for Tumour Biology, Barts Health NHS Trust, London, London, UK
| | - Hemant M Kocher
- HPB Surgery, Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, London, UK
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Mundada A, Tote D, Zade A. Desmoid tumor of Meckel's diverticulum presenting as intestinal obstruction: A rare case report with literature review. J Cancer Res Ther 2022; 18:880-884. [DOI: 10.4103/jcrt.jcrt_582_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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9
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Xu Y, Duan Z, Hu W, Zhu K, You J, Abe M, Chen P, Zhang Q, Zong L. Huge mesenteric fibromatosis presenting with intestinal perforation and acute diffuse peritonitis: a case report. Transl Cancer Res 2020; 9:5674-5678. [PMID: 35117931 PMCID: PMC8797417 DOI: 10.21037/tcr-19-1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
Abstract
Mesenteric fibromatosis is a locally invasive myofibroblastic proliferation and rarely metastasize to other organs. Hollow organ perforation and acute diffuse peritonitis caused by mesenteric fibromatosis rarely occurred. Here we report a case of huge mesenteric fibromatosis who complained a paroxysmal epigastric pain, and CT scan showed a huge mass, pneumoperitoneum and ascites. An urgent laparotomy showed an intro-abdominal mass and perforation locating at the jejunum. Postoperative histology confirmed it to be mesenteric fibromatosis. With one-year follow-up, the patient had no recurrence. We wish to share our treating experience of this interesting case because it did not belong to a typical type but presenting with acute diffuse peritonitis, and total resection and R0 margin is a key to treat acute case. This atypical one has not been reported in the literature till now.
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Affiliation(s)
- Yingying Xu
- Department of General Surgery, Yizhen People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Zongkui Duan
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Wenqing Hu
- Department of General Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, China
| | - Kaixuan Zhu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jun You
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo Hospital, Tokyo, Japan
| | - Ping Chen
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qinyuan Zhang
- Department of Gastrointestinal Surgery, The First People's Hospital of Dali City, Dali, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of General Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, China.,Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Goto A, Matsuhashi N, Takahashi T, Tanahashi T, Matsui S, Imai H, Tanaka Y, Yamaguchi K, Yoshida K. Feasibility of the Reconstruction with Fascia Lata Patch on the Abdominal Wall Defect After Resection of the Abdominal Desmoid Tumor. Clin Exp Gastroenterol 2020; 13:249-254. [PMID: 32753929 PMCID: PMC7351623 DOI: 10.2147/ceg.s249870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The abdominal desmoid tumor shows invasive development and high local recurrence rate. The primary treatment method is complete removal of the tumor because of the high recurrence rate; however, the problem for the surgeon is the reconstruction of the abdominal wall after resection of the abdominal desmoid tumor. Case Presentation A 63-year-old man underwent open drainage and ileostomy for the perforation of ileocecal tumor. After 3 months, he underwent right hemicolectomy and ileostomy closure. Pathological examination revealed no malignancy, and the ileocecal tumor showed the presence of abscess. He noticed a palpable mass in the left abdomen. Enhanced abdominal computed tomography (CT) revealed a large abdominal incisional hernia and an enhanced mass of 40 mm in the left rectus muscle. Needle biopsy was performed and the diagnosis was desmoid tumor. He underwent resection of the desmoid tumor and repair of hernia. We performed wide local resection, with a 2-cm surgical margin. The hernia was repaired by simple closure, and the defect in the left abdomen was repaired with reconstruction using the fascia lata patch through plastic surgery. Conclusion We encountered a case of abdominal wall desmoid tumor combined with a large abdominal incisional hernia. We selected the use of autologous fascia based on the risk of recurrence. The patient has not shown recurrence of incisional hernia or desmoid tumor 22 months after surgery. The use of fascia lata patch can be considered as a satisfactory alternative for such reconstruction cases.
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Affiliation(s)
- Ayana Goto
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Toshiyuki Tanahashi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Satoshi Matsui
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Hisashi Imai
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Kazuya Yamaguchi
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu City 501-1194, Japan
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Association of MRI T2 Signal Intensity With Desmoid Tumor Progression During Active Observation: A Retrospective Cohort Study. Ann Surg 2020; 271:748-755. [PMID: 30418203 DOI: 10.1097/sla.0000000000003073] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictors of desmoid progression during observation. SUMMARY OF BACKGROUND DATA Untreated desmoids can grow, remain stable, or regress, but reliable predictors of behavior have not been identified. METHODS Primary or recurrent desmoid patients were identified retrospectively from an institutional database. In those managed with active observation who underwent serial magnetic resonance imaging (MRIs) with T2-weighted sequences, baseline tumor size was recorded, and 2 radiologists independently estimated the percentage of tumor volume showing hyperintense T2 signal at baseline. Associations of clinical or radiographic characteristics with progression-free survival (PFS; by RECIST) were evaluated by Cox regression and Kaplan-Meier statistics. RESULTS Among 160 patients with desmoids, 72 were managed with observation, and 37 of these had serial MRI available for review. Among these 37 patients, median age was 35 years and median tumor size was 4.7 cm; all tumors were extra-abdominal (41% in abdominal wall). Although PFS was not associated with size, site, or age, it was strongly associated with hyperintense T2 signal in ≥90% versus <90% of baseline tumor volume (as defined by the "test" radiologist; hazard ratio = 11.3, P = 0.003). For patients in the ≥90% group (n = 20), 1-year PFS was 55%, compared with 94% in the <90% group (n = 17). The percentage of baseline tumor volume with hyperintense T2 signal defined by a validation radiologist correlated with results of the test radiologist (ρ = 0.75). CONCLUSION The percent tumor volume characterized by hyperintense T2 signal is associated with desmoid progression during observation and may help distinguish patients who would benefit from early intervention from those who may be reliably observed.
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Yogesh Kumar B, Vidyadhara S, Vadhiraja BM. Pediatric recurrent aggressive spinal fibromatosis with progressive kyphosis and neurological deficits. J Orthop Surg (Hong Kong) 2020; 27:2309499019846618. [PMID: 31079576 DOI: 10.1177/2309499019846618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aggressive fibromatosis is a benign, locally invasive fibroblastic proliferation that can cause compressive effects on adjacent structures. The primary cure of this disease rests in wide excision of the tumor. Unfortunately even when surgical margins are clear of tumor, recurrence rates are high. Postoperative radiotherapy is indicated following surgical excision. We present a 13-year-old girl who had been operated for the intraspinal mass in upper thoracic spine and paraparesis with thoracic limited laminectomy and excision of the tumor mass elsewhere. The histopathological examination was reported to be aggressive fibromatosis. After 2 years, she presented again with 1-year duration of progressive deformity in the upper thoracic spine and weakness of both lower limbs. Focal kyphosis at T4-T5 was measuring 68°. Magnetic resonance imaging (MRI) showed recurrent tumor involvement of posterior elements of T2-T5 and paravertebral soft tissues with signal changes in the cord at T2-T5 vertebral levels with focal kyphosis and internal gibbus. She underwent posterior spinal revision decompression with internal gibbectomy and instrumented fusion. The histopathology showed features suggestive of aggressive fibromatosis. After wound healing at 2 weeks, she underwent 3-D conformal radiotherapy, based on the preoperative tumor extent on MRI (dose of 45 Gy in 25 fractions over 5 weeks). She had normal neurology at 2-year follow-up and was tumor free on MRI. Hence, aggressive fibromatosis can recur following successful surgical wide excision. Multilevel thoracic laminectomy in growing children can cause progressive spinal deformity and neurological deficits. Operative treatment of recurrent tumor involves en bloc excision with instrumented fusion followed by local radiotherapy. This is the first pediatric recurrent spinal fibromatosis reported with successful treatment as per author's knowledge.
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Affiliation(s)
| | - S Vidyadhara
- 2 Manipal Spine Care Center, Manipal Hospital, Bangalore, India
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Local Control and Analgesic Efficacy of Percutaneous Cryoablation for Desmoid Tumors. Cardiovasc Intervent Radiol 2019; 43:110-119. [PMID: 31471720 DOI: 10.1007/s00270-019-02323-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cryoablation is being more and more often used to treat desmoid tumors. We report our experience of cryoablation as a local and analgesic treatment for inoperable or recurring desmoid tumors. METHODS This study includes 34 patients who underwent percutaneous cryoablation of 41 desmoid tumors between July 2012 and September 2016. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. All cryoablation procedures were performed using the same cryoablation system. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 31 December 2018. Disease-free survival at 3 years was also recorded. Radiological tumor response was determined by tumor measurements using RECIST 1.1. RESULTS Twelve patients benefitted from curative treatment on 100% of the tumor volume, but 22 patients received debulking treatment because of the risk of neighboring structures. Two patients had a postoperative hematoma grade 2 of the CIRSE classification system for complications, and two patients had grade 4 complications involving palsy of the common fibular nerve. Disease-free survival at 3 years was 42.2%. The mean VAS pain scores were 5.7 and 2.4 at pretreatment and 6 months, respectively, showing a mean reduction of 3.3 (p < 0.001). At 6 months, all measured tumor dimensions were significantly lower than pretreatment. CONCLUSION Cryoablation is an effective therapeutic option for the local treatment and for the analgesic management of desmoid tumors.
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14
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Panagiotopoulou IG, Shah N, Rowaiye B, Chandrakumaran K, Carr NJ, Moran B. Not all abdominal masses after colorectal cancer surgery are malignant: intra-abdominal fibromatosis masquerading as recurrence. Colorectal Dis 2019; 21:886-893. [PMID: 30927550 DOI: 10.1111/codi.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
AIM Intra-abdominal fibromatosis is an unusual mesenchymal tumour that can be locally aggressive without any metastatic potential. Fibromatosis may simulate cancer recurrence on imaging surveillance for colorectal cancer follow-up. The optimal treatment of recurrent peritoneal malignancy is cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Confirmatory biopsy of lesions suspicious for colorectal cancer recurrence may not be feasible, thereby rendering surgery the safest option. Our aim was to determine the incidence of fibromatosis in a cohort of patients undergoing CRS and HIPEC for suspected colorectal cancer recurrence. METHODS One hundred and seventy-one CRS and HIPEC cases were performed at our Peritoneal Malignancy Institute between February 2007 and October 2018 for colorectal peritoneal metastases and were included in a prospectively maintained database. RESULTS A total of 49 (29%) of 171 cases were performed for primary colorectal cancer with peritoneal metastases, whereas 122 (71%) of 171 cases were performed for suspected colorectal cancer recurrence detected on surveillance imaging after primary colorectal cancer resection. On histological analysis of the resected specimen, five (4.1%) of 122 cases undergoing CRS and HIPEC for colorectal recurrence had fibromatosis. CONCLUSION Fibromatosis can masquerade as colorectal cancer recurrence. In this series it occurred with an incidence of 4.1% among a cohort of patients undergoing CRS and HIPEC for probable recurrence. Surgical resection may be the only option to confirm the diagnosis and rule out malignancy.
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Affiliation(s)
- I G Panagiotopoulou
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N Shah
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Rowaiye
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - K Chandrakumaran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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15
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The Challenge in the Management of Extremity Fibromatoses: Our Experience. Indian J Surg Oncol 2019; 10:329-334. [PMID: 31168258 DOI: 10.1007/s13193-018-0857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
Desmoid tumours are known for their varied clinical behaviour. Hence, choosing an ideal treatment protocol remains challenging. This is further complicated by the rarity of these neoplasms and high recurrence rates following treatment. In our study, we tried to answer these questions in the background of Indian scenario. This is a retrospective study of 41 patients with extremity fibromatoses who were operated between June 2002 and November 2012. The mean age for all patients was 29.2 years with 30 females and 11 males. The mean duration of follow-up was 4.37 years. Eight patients were margin-positive on final histopathology. Seventeen developed recurrences (41.4%). Ten of these 17 patients underwent repeat surgery. The remaining 7 patients with inoperable recurrence were put on metronomic chemotherapy. The DFS for patients treated with surgical management was 62.6% at 3 years, 54.4% at 5 years and 44% at 10 years. The enigmacy on the tumour biology, natural history and optimal management of fibromatoses continue. Surgery remains the standard treatment and should be attempted only if R0 resection is possible without much morbidity to the patient. Non-surgical modalities also have their role to play in the management of these neoplasms.
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16
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Abraham N, Nabawi AS. The challenging case of a primigravid Bedouin woman with a dormant neck nodule that grew explosively during her pregnancy. J Surg Case Rep 2019; 2019:rjz061. [PMID: 30906520 PMCID: PMC6425158 DOI: 10.1093/jscr/rjz061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/09/2019] [Indexed: 11/18/2022] Open
Abstract
A Desmoid tumor in the neck is a rare tumor in an even more unusual site. Our patient was an 18-year-old primigravid Bedouin woman from northwest Egypt. She presented with a dormant neck nodule that grew explosively during her first pregnancy and stopped abruptly after delivery. The presentation was confusing at first, as the fixation of the tumor to the underlying tissues implied a malignancy, while a 1-year history of non-metastasis alluded to a benign process. Pre-operative tissue diagnosis revealed an Estrogen receptor-expressing desmoid tumor. Desmoid tumors are indeed locally invasive with no metastatic potential, but they tend to recur and grow during high-estrogen states. This report aims to increase awareness of peripartum Desmoid tumors, as well as discuss the surgical-site, psychological and socioeconomic challenges in the peculiar case of this Bedouin woman, and our recommendations after this experience and literature review.
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Affiliation(s)
- Nader Abraham
- Department of Surgery, Alexandria University School of Medicine, Alexandria, Egypt
| | - Ayman S Nabawi
- Department of Surgery, Alexandria University School of Medicine, Alexandria, Egypt
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17
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Burke E, Saeed M, Anant P, Sami B, Salama M, Ahmed I. Large intra-abdominal desmoid tumour posing diagnostic and therapeutic challenges, a case report. J Surg Case Rep 2018; 2018:rjy304. [PMID: 30443319 PMCID: PMC6232280 DOI: 10.1093/jscr/rjy304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/08/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022] Open
Abstract
We present the case of a 46-year-old gentleman originally from China who presented to the acute surgical assessment unit complaining of upper abdominal discomfort, dyspepsia and early satiety ongoing for the previous 6 months. On exam he had a palpable mass in the left upper quadrant. He underwent an esophagogastroduodenoscopy which was normal and later received a CT abdomen which identified a well-circumscribed soft tissue mass in the mesenteric fat and lying adjacent to the transverse colon with no obvious cleavage plane between them. Colonoscopy was then performed which was normal. After discussion at MDT he was taken for laparotomy. At laparotomy the mass was found to be adherent to major vessels, small bowel and large bowel necessitating an extended right hemicolectomy and small bowel resection. The mass itself could not be completely excised. Histology from the resected specimen confirmed desmoid tumour.
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Affiliation(s)
- Eoghan Burke
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Munir Saeed
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Paul Anant
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Babur Sami
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Mohamed Salama
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Ibrahim Ahmed
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
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18
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Sporadic Abdominal Wall Desmoid type Fibromatosis: treatment paradigm after thirty two years. BMC Surg 2018; 18:37. [PMID: 29879959 PMCID: PMC5992671 DOI: 10.1186/s12893-018-0367-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/24/2018] [Indexed: 01/01/2023] Open
Abstract
Background Desmoid-type fibromatosis is a benign mesenchymal neoplastic process. It exhibits an uncertain growth pattern and high recurrence rate. Previously radical surgical resection was the mainstay of treatment, but recently more surgeons are opting for conservative management with observation (“wait and see” policy). The authors intend to evaluate different therapeutic modalities and oncological outcomes for abdominal wall desmoid tumors. Methods We performed a retrospective study of patients who underwent surgical, hormonal or chemotherapy treatment for abdominal wall desmoid tumors between 1982 to 2014 at two institutions affiliated with the University of São Paulo, Brazil. Results In the study period, 32 patients were included. Twenty-seven patients had surgery upfront. Of those, 89% were women with a median age of 33 years. Mean tumor size was 10 cm. Pathology confirmed free margins in 92% of resections. Tumor recurrence rate was 11%, with median relapse-free survival being 24 months. Multivariate analysis showed that positive final margins (p < 0.001) and positive frozen section (p = 0.001) were independent predictors of recurrence. For the 5 patients who underwent pharmacological therapy, median age was 33 years and median tumor diameter before treatment was 13 cm. Four patients exhibited partial response by Response Evaluation Criteria in Solid Tumors (RECIST). The single patient who did not respond to RECIST underwent radiotherapy. Conclusion Desmoid tumor treatment has been evolving over the past decade towards a more conservative approach. Pharmacological treatment may result in tumor size regression. When surgical excision is indicated, positive margins represent an important prognostic factor for local tumor recurrence.
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19
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Jambhekar A, Robinson S, Zafarani P, Rucinski J, Gudavalli P. Intestinal obstruction caused by desmoid tumours: a review of the literature. JRSM Open 2018; 9:2054270418763340. [PMID: 29760935 PMCID: PMC5946608 DOI: 10.1177/2054270418763340] [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] [Indexed: 01/10/2023] Open
Abstract
Intraabdominal desmoid tumours are rare and can cause intestinal obstruction. Based on the review of the literature, surgical resection with negative margins and adjuvant chemotherapy is the optimal strategy for treatment of this pathology.
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Affiliation(s)
- Amani Jambhekar
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Shawn Robinson
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Parvin Zafarani
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - James Rucinski
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Prasad Gudavalli
- Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
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20
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Tonelli F, Ficari F, Valanzano R, Brandi ML. Treatment of Desmoids and Mesenteric Fibromatosis in Familial Adenomatous Polyposis with Raloxifene. TUMORI JOURNAL 2018; 89:391-6. [PMID: 14606641 DOI: 10.1177/030089160308900408] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Among the great variety of extracolonic manifestations of familial adenomatous polyposis, the most serious are desmoids and fibromatosis of the abdominal cavity. These may be a danger to the patient and a concern to the clinician. Pharmacological management of this relentless problem is favored by surgical intervention. At present, however, beneficial actions of medical therapy are not separable from undesirable side effects. Methods We studied the effects of 120 mg daily of raloxifene, a non-steroidal benzothiophene, on progressive desmoid tumors and mesenteric fibromatosis by evaluation of lesion size and symptoms in 13 patients with familial adenomatous polyposis, selected on the basis of intra-abdominal localization of the lesion, on refractoriness to other medical treatments, and on estrogen receptor-α expression. Results The patients had a significant response to raloxifene therapy, with complete remission in 8 cases and partial response in 5 cases, evaluated by regression of symptoms and tumor size. Serum biochemical parameters did not show any significant changes. Side effects were never observed. Conclusions Although the number of patients included in the study is limited and in spite of some limitations, the available results support that, in the evaluation of response, daily therapy with raloxifene decreases desmoid tumor and mesenteric fibromatosis size and symptoms and does not cause side effects. These findings offer a novel option in the pharmacological treatment of desmoids, leading to medical therapy of these neoplastic lesions in familial adenomatous polyposis patients.
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Affiliation(s)
- Francesco Tonelli
- Department of Clinical Physiopathology, University of Florence, Italy
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21
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Macagno N, Fina F, Penel N, Bouvier C, Nanni I, Duffaud F, Rouah R, Lacarelle B, Ouafik L, Bonvalot S, Salas S. Proof of concept: prognostic value of the plasmatic concentration of circulating cell free DNA in desmoid tumors using ddPCR. Oncotarget 2018; 9:18296-18308. [PMID: 29719606 PMCID: PMC5915073 DOI: 10.18632/oncotarget.24817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Abstract
Since desmoid tumors (DT) exhibit an unpredictable clinical course, with stabilization and/or spontaneous regression, an initial "wait-and-see" policy is the new standard of care-thus, the actual challenge is to identify early factors of progression. We present a method of detection of CTNNB1 mutations using a targeted digital droplet PCR (ddPCR) on cell-free DNA (cfDNA) extracted from blood samples of 31 DT patients. Furthermore, we analyzed the correlation between DT evolution and plasmatic concentration of total and mutated cfDNA at the time of diagnosis. Circulating copies of CTNNB1 mutants (ctDNA) were detected in the plasma of 6 patients (33%) but their concentration was not correlated with evolution of the tumor. Concentration of total cfDNA was higher in the plasma of patients with progressive desmoids (p = 0,0009). Using a threshold <900 copies/mL of plasma to detect indolent desmoid and a threshold >1375, it was possible to predict desmoid evolution for 65% of patients by measuring the quantity of circulating DNA in their plasma as early as the time of diagnosis. Albeit showing that the detection of CTNNB1 mutants is possible in the plasma of patients harboring a desmoid tumor, the results of this preliminary study raise the hypothesis that most of the circulating DNA detected in their plasma is derived from non-neoplastic cells, most likely normal neighboring tissues being actively invaded. Our results open the perspective of using cfDNA as a biomarker to predict prognosis at the time of diagnosis and assess tumor dynamics to optimize the treatment strategy.
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Affiliation(s)
- Nicolas Macagno
- Department of Pathology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.,Aix-Marseille University, Medical Faculty, CRO2, UMR 911 (Equipe IV), Marseille, France
| | - Frédéric Fina
- Department of Pathology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.,ID-Solutions, Grabels, France
| | - Nicolas Penel
- Department of General Oncology, Oscar Lambret Center, Lille, France
| | - Corinne Bouvier
- Department of Pathology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.,Aix-Marseille University, Medical Faculty, CRO2, UMR 911 (Equipe IV), Marseille, France
| | - Isabelle Nanni
- Department of Molecular Oncology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Florence Duffaud
- Department of Oncology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.,Aix-Marseille University, Medical Faculty, Marseille, France
| | - Raquel Rouah
- Department of Molecular Oncology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Bruno Lacarelle
- Department of Medical Biology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France
| | - L'houcine Ouafik
- Department of Molecular Oncology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, PSL Univeristy, Paris, France
| | - Sébastien Salas
- Department of Oncology, Assistance Publique Hôpitaux de Marseille Timone Hospital, Marseille, France.,Aix-Marseille University, Medical Faculty, Marseille, France
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22
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Muccino E, Gentile G, Mantero S, Marchesi M, Rancati A, Zoja R. The medico-legal observation of an aggressive urogenital fibromatosis with isolated development not related to any traumatic event. Forensic Sci Int 2016; 260:e1-e6. [PMID: 26786144 DOI: 10.1016/j.forsciint.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/26/2015] [Accepted: 01/02/2016] [Indexed: 11/29/2022]
Abstract
Desmoid tumor is a fibroproliferative neoplasm with an intermediate malignancy and it can be localized in every bodily district: some locations are considered exceptional, like the urogenital localization. The Author point out a rare case of giant idiopathic scrotal fibromatosis that was found during an autopsy. A widower, that lived alone in poor hygienic conditions, was found dead in his house. The Judicial Authority ordered the autopsy, that was performed two days later at the Medico-Legal Section of Milan University. External examinations revealed only the considerable dimension of the scrotum (cm 24 × 41). The cause of death was fixed in a cardiac tamponade due to a natural heart laceration localized in correspondence of a transmural infarction. The toxicological exam resulted negative, while the histopathological and immunohistochemical analysis qualify the scrotal mass as a desmoids tumor. Due to the absence of predisposing conditions and of fibroproliferative infiltration in bladder and retroperitoneal space, the neoplasm was configured as an idiopathic desmoid tumor. The presented case gives the reason for the discussion concerning medico-legal aspects that are typical of rare neoplasms.
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Affiliation(s)
- Enrico Muccino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Guendalina Gentile
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Stefano Mantero
- Centro Nazionale delle Ricerche-Istituto di Ricerca Genetica e Biomedica (IRGB)- Istituto Clinico Humanitas, Via Manzoni 113, 20089 Rozzano MI, Italy
| | - Matteo Marchesi
- Azienda Ospedaliera Papa Giovanni XXIII-Piazza OMS 1, 24127 Bergamo
| | - Alessandra Rancati
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy.
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23
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Lee JH, Jeong JS, Kim SR, Jin GY, Chung MJ, Kuh JH, Lee YC. Mediastinal Desmoid Tumor With Remarkably Rapid Growth: A Case Report. Medicine (Baltimore) 2015; 94:e2370. [PMID: 26717381 PMCID: PMC5291622 DOI: 10.1097/md.0000000000002370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Desmoid tumors (DTs) are a group of rare and benign soft tissue tumors that result from monoclonal proliferation of well-differentiated fibroblasts. Since DTs tend to infiltrate and compress adjacent structures, the location of DTs is one of the most crucial factors for determining the severity of the disease. Furthermore, DTs can further complicate the clinical course of patients when the growth is remarkably rapid, especially for DTs occurring in anatomically critical compartments, including the thoracic cavity.The authors report a case of a 71-year-old man with a known mediastinal mass incidentally detected 4 months ago, presenting dyspnea with right-sided atelectasis and massive pleural effusion. Imaging studies revealed a 16.4 × 9.4-cm fibrous mass with high glucose metabolism in the anterior mediastinum. The mass infiltrated into the chest wall and also displaced the mediastinum contralaterally. Interestingly, the tumor had an extremely rapid doubling time of 31.3 days.En bloc resection of the tumor was performed as a curative as well as a diagnostic measure. Histopathologic examination showed spindle cells with low cellularity and high collagen deposition in the stroma. Immunohistochemical staining was positive for nuclear β-catenin. Based on these pathologic findings, the mass was diagnosed as DT. After surgery, there has been no evidence of recurrence of disease in the patient.This patient presents a mediastinal DT with extremely rapid growth. Notably, the doubling time of DT in our case was the shortest among reported cases of DT. Our experience also highlights the benefits of early interventional strategy, especially for rapidly growing DTs in the thoracic cavity.
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Affiliation(s)
- Joon Hyung Lee
- From the Department of Internal Medicine and Research Center for Pulmonary Disorders (JHL, JSJ, SRK, YCL); Department of Radiology (GYJ); Department of Pathology (MJC); and Department of Thoracic & Cardiovascular Surgery (JHK), Chonbuk National University Medical School, Jeonju, South Korea
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24
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Crago AM, Chmielecki J, Rosenberg M, O'Connor R, Byrne C, Wilder FG, Thorn K, Agius P, Kuk D, Socci ND, Qin LX, Meyerson M, Hameed M, Singer S. Near universal detection of alterations in CTNNB1 and Wnt pathway regulators in desmoid-type fibromatosis by whole-exome sequencing and genomic analysis. Genes Chromosomes Cancer 2015; 54:606-15. [PMID: 26171757 DOI: 10.1002/gcc.22272] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022] Open
Abstract
CTNNB1 mutations or APC abnormalities have been observed in ∼85% of desmoids examined by Sanger sequencing and are associated with Wnt/β-catenin activation. We sought to identify molecular aberrations in "wild-type" tumors (those without CTNNB1 or APC alteration) and to determine their prognostic relevance. CTNNB1 was examined by Sanger sequencing in 117 desmoids; a mutation was observed in 101 (86%) and 16 were wild type. Wild-type status did not associate with tumor recurrence. Moreover, in unsupervised clustering based on U133A-derived gene expression profiles, wild-type and mutated tumors clustered together. Whole-exome sequencing of eight of the wild-type desmoids revealed that three had a CTNNB1 mutation that had been undetected by Sanger sequencing. The mutation was found in a mean 16% of reads (vs. 37% for mutations identified by Sanger). Of the other five wild-type tumors sequenced, two had APC loss, two had chromosome 6 loss, and one had mutation of BMI1. The finding of low-frequency CTNNB1 mutation or APC loss in wild-type desmoids was validated in the remaining eight wild-type desmoids; directed miSeq identified low-frequency CTNNB1 mutation in four and comparative genomic hybridization identified APC loss in one. These results demonstrate that mutations affecting CTNNB1 or APC occur more frequently in desmoids than previously recognized (111 of 117; 95%), and designation of wild-type genotype is largely determined by sensitivity of detection methods. Even true CTNNB1 wild-type tumors (determined by next-generation sequencing) may have genomic alterations associated with Wnt activation (chromosome 6 loss/BMI1 mutation), supporting Wnt/β-catenin activation as the common pathway governing desmoid initiation.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Juliann Chmielecki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA
| | - Mara Rosenberg
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA
| | - Rachael O'Connor
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Caitlin Byrne
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fatima G Wilder
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine Thorn
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Phaedra Agius
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah Kuk
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicholas D Socci
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Li-Xuan Qin
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA.,Department of Pathology, Harvard Medical School, Boston, MA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Surgery, Weill Cornell Medical College, New York, NY
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25
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Togral G, Yildizgoren MT, Arikan M, Gungor S. Destructive invasion of the clavicle by desmoid tumor: a case report. Pan Afr Med J 2014; 19:383. [PMID: 25995779 PMCID: PMC4430038 DOI: 10.11604/pamj.2014.19.383.5693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Abstract
Desmoid tumors are rare, soft-tissue neoplasms that do not metastasize, but exhibit aggressive growth and local invasion. They originate most frequently from abdominal fascial structures, although they can also appear at extra-abdominal sites. The most common extra-abdominal locations include the shoulder, chest wall, back, thigh, and head and neck. In children, desmoid tumors are more infiltrative, having a tendency towards osseous involvement more frequently than in adult patients. We report acase of a supraspinatus muscle desmoid tumor in a female patient with clavicle destruction.
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Affiliation(s)
- Guray Togral
- Oncology Training and Research Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Mustafa Turgut Yildizgoren
- Mustafa Kemal University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Hatay, Turkey
| | - Murat Arikan
- Oncology Training and Research Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Safak Gungor
- Oncology Training and Research Hospital, Department of Orthopaedics and Traumatology, Ankara, Turkey
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Wilder F, D'Angelo S, Crago AM. Soft tissue tumors of the trunk: management of local disease in the breast and chest and abdominal walls. J Surg Oncol 2014; 111:546-52. [PMID: 25418423 DOI: 10.1002/jso.23843] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/16/2014] [Indexed: 01/01/2023]
Abstract
Soft tissue sarcomas of the trunk are rare lesions, generally managed using an algorithm similar to that employed for extremity sarcomas. This review summarizes the standard treatment of truncal sarcomas and considers how these recommendations differ for each of the various common histologic subtypes observed on the trunk: desmoid, dermatofibrosarcoma protuberans (DFSP), and angiosarcoma.
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Affiliation(s)
- Fatima Wilder
- Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York
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27
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Yoon GW, Kim JD, Chung SH. The analysis of treatment of aggressive fibromatosis using oral methotrexate chemotherapy. Clin Orthop Surg 2014; 6:439-42. [PMID: 25436069 PMCID: PMC4233224 DOI: 10.4055/cios.2014.6.4.439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 12/19/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Aggressive fibromatosis is a rare but invasive tumor infiltrating widely between fascia and muscle fibers. It has a high tendency to be locally recurrent despite complete resection. Effectiveness of adjuvant treatment for aggressive fibromatosis including radiotherapy, pharmacological agents, hormonal treatments, and chemotherapy have been previously reported. The purpose of this article was to collect and analyze all information regarding the effectiveness and side effects of oral methotrexate in aggressive fibromatosis. METHODS From 2005 to 2011, eleven patients with aggressive fibromatosis treated with oral methotrexate at our institution were analyzed in this study. Oral methotrexate was administered once per week at 10 mg per week. Authors collected information about effectiveness concerning cases of local recurrence and metastasis. RESULTS Eleven patients had remission, two patients had local recurrence. Fatal complications or toxicity were not observed. CONCLUSIONS Oral methotrexate given at this dose and schedule was considered as a useful treatment in primary inoperable fibromatosis and recurrent fibromatosis.
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Affiliation(s)
- Gi Woon Yoon
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jae Do Kim
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - So Hak Chung
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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28
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Aggressive fibromatosis in children. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31829cbde9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE To construct a postoperative nomogram to estimate the risk of local recurrence for patients with desmoid tumors. BACKGROUND The standard management of desmoid tumors is resection, but many recur locally. Other options include observation or novel chemotherapeutics, but little guidance exists on selecting treatment. METHODS Patients undergoing resection during 1982-2011 for primary or locally recurrent desmoids were identified from a single-institution prospective database. Cox regression analysis was used to assess risk factors and to create a recurrence nomogram, which was validated using an international, multi-institutional data set. RESULTS Desmoids were treated surgically in 495 patients (median follow-up of 60 months). Of 439 patients undergoing complete gross resection, 100 (23%) had recurrence. Five-year local recurrence-free survival was 69%. Eight patients died of disease, all after R2 resection. Adjuvant radiation was not associated with improved local recurrence-free survival. In multivariate analysis, factors associated with recurrence were extremity location, young age, and large tumor size, but not margin. Abdominal wall tumors had the best outcome (5-year local recurrence-free survival rate of 91%). Age, site, and size were used to construct a nomogram with concordance index of 0.703 in internal validation and 0.659 in external validation. Integration of additional variables (R1 margin, sex, depth, and primary vs recurrent presentation) did not importantly improve concordance (internal concordance index of 0.707). CONCLUSIONS A postoperative nomogram including only size, site, and age predicts local recurrence and can aid in counseling patients. Systemic therapies may be appropriate for young patients with large, extremity desmoids, but surgery alone is curative for most abdominal wall lesions.
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30
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Garvey PB, Booth JH, Baumann DP, Calhoun KA, Liu J, Pollock RE, Butler CE. Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence. J Am Coll Surg 2013; 217:472-80. [PMID: 23816381 DOI: 10.1016/j.jamcollsurg.2013.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The propensity of desmoid tumors to develop in scars has led some surgeons to limit the complexity of desmoid defect reconstruction as a strategy for avoiding desmoid recurrence. We hypothesized that desmoid recurrence rates are similar despite the magnitude of reconstruction. STUDY DESIGN We retrospectively compared recurrence rates between patients who underwent reconstruction and patients who underwent primary closure without reconstruction after desmoid tumor resection in consecutive patients for 15 years. Univariate and multivariate regression analyzed associations between patient, tumor, and treatment characteristics and outcomes. RESULTS We included 164 consecutive patients (80 [49%] reconstructions vs 84 [51%] primary closures). Mean follow-up duration was 7.1 ± 4.5 years. Patients who underwent reconstruction had more desmoids in an area of earlier trauma or surgery (p < 0.001), greater defect volume (p < 0.01), longer operative time (p < 0.001) and hospital stay (p < 0.001), and more postoperative complications (p = 0.015) compared with the primary closure group. Despite these differences, desmoid recurrence rates were similar for the reconstruction and primary closure groups (30% and 29%, respectively; p = 0.7), as was mean time to tumor recurrence, and no tumors recurred within flap donor sites. Multivariate regression analysis demonstrated the 45F mutation to be the only independent predictor of recurrence (hazard ratio = 1.87; p = 0.04). CONCLUSIONS Rates of desmoid recurrence in resection defects are similar for primary closures and complex reconstructions. Therefore, surgeons should not limit the magnitude of reconstructions in an attempt to avoid tumor recurrence. However, given the propensity of desmoids to recur, reconstructions should allow for the possibility of future resections and reconstructions, particularly in tumors with 45F gene mutations.
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Affiliation(s)
- Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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31
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Shakur SF, Takagi I, Jacobsohn JA, Golden BM, Karahalios DG. Spinal fibromatosis: a report of two cases and review of the literature. Spine J 2013; 13:e1-6. [PMID: 23523438 DOI: 10.1016/j.spinee.2013.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 09/09/2012] [Accepted: 02/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal fibromatosis is a unique subset of fibromatosis that is only anecdotally described in the literature in sporadic case reports. According to our review of the literature, only 11 cases of spinal fibromatosis have been previously documented. This paucity of clinical data limits our understanding of its presentation and treatment. PURPOSE The authors present the first two cases of spinal fibromatosis encountered at their institution, and review the literature of reported cases to elucidate the presentation and outcomes of patients with this rare tumor. STUDY DESIGN A report of two cases and review of the literature. METHODS The two patients in our case report were women aged 45 and 38 years. Both of the patients presented to our clinic after previous excisional biopsy of a spinal mass, 17 years and 1 year later, respectively, with pain and paresthesias that recapitulated their former symptoms. Thirteen cases, including the two described in the current article, were culled from the literature. RESULTS Magnetic resonance imaging revealed an enhancing lesion in the posterior elements of the spinal column in the first case and a paraspinal soft tissue mass in the second case. The tumors were histologically defined by haphazardly arranged, elongated, and slender spindle cells separated by abundant collagen without mitoses or necrosis. Surgical management resulted in intralesional resection in the first case and en bloc resection in the second case. By 40 and 10 months after surgery, both patients remain without neurologic deficits. CONCLUSIONS Among 13 cases of spinal fibromatosis, pain with or without a mass is the most common symptom at presentation. Tumor etiology is evenly distributed between de novo origin and surgical trauma. Treatment outcomes, although, cannot be determined from the limited data currently available.
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Affiliation(s)
- Sophia F Shakur
- Section of Neurosurgery, University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL 60637, USA.
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32
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Wu Z, Chu X, Fan S, Meng X, Xu C. Papillary thyroid carcinoma with fibromatosis-like stroma: A case report and review of the literature. Oncol Lett 2012; 5:215-217. [PMID: 23255922 DOI: 10.3892/ol.2012.993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/17/2012] [Indexed: 12/22/2022] Open
Abstract
Papillary thyroid carcinoma with fibromatosis-like stroma (PTC-FLS) is a rare type of thyroid carcinoma that does not receive adequate follow-up. This study describes a case of PTC-FLS on the right side of the neck. The patient consented to a right hemithyroidectomy with a central compartment lymphadenectomy. Pathological examination revealed that the two initial lesions were consis tent with benign histological performance. Using immunohistology, the proliferated stromal cells were revealed to be positive for vimentin and smooth muscle actin (SMA), but negative for thyroglobulin, S-100 and CK. Post-operative follow-up was scheduled at 3-month intervals for 2 years and then at 6-month intervals for the next 3 years. There were no signs of tumor recurrence at the 5-year follow-up.
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33
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Role of tumor-associated macrophages and angiogenesis in desmoid-type fibromatosis. Virchows Arch 2012; 461:117-22. [DOI: 10.1007/s00428-012-1265-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/08/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
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34
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Recurrence patterns and management options in aggressive fibromatosis. Indian J Surg Oncol 2012; 3:222-7. [PMID: 23997510 DOI: 10.1007/s13193-012-0146-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022] Open
Abstract
Aggressive fibromatosis is a rare neoplasm arising from musculoaponeurotic structures. Our aim is to share our experience with this rare tumor in our institute and to discuss the more perplexing recurrence patterns and the management options. This is a retrospective study of the disease, treated in our institute for the past fourteen years. A total of 36 patients were analyzed. The demographic pattern of the disease, various treatment modalities offered and their outcome along with patterns of recurrence were studied. Our study showed a demographic pattern mostly similar to the rest of the world. But the pattern of recurrence and the multicentric and the non-random pattern of presentation observed in our study showed some difference from the other studies. We suggest surgery as the primary modality with radiation reserved for select patients with margin positivity, inoperable tumors, and multiple tumors. Since the disease has a long natural history a wait and watch policy can be observed for giving adjuvant RT. There is need for prospective multi-institutional RCTs to shed light on the unknown facts about this disease.
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35
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Makis W, Ciarallo A, Abikhzer G, Stern J, Laufer J. Desmoid tumour (aggressive fibromatosis) of the colon mimics malignancy on dual time-point 18F-FDG PET/CT imaging. Br J Radiol 2012; 85:e37-40. [PMID: 22308225 PMCID: PMC3473949 DOI: 10.1259/bjr/43870228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 03/10/2011] [Accepted: 04/04/2011] [Indexed: 12/16/2022] Open
Abstract
A 58-year-old female who presented with a lower gastrointestinal bleed was referred for an (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT after a colonoscopy revealed a submucosal mass in the ascending colon. The PET/CT confirmed the presence of an FDG-avid mass in the ascending colon with no other FDG-avid abnormalities. Dual time-point imaging was performed and showed a significant increase in FDG uptake in the mass, which raised strong suspicion of a colon malignancy. Although an initial biopsy of the mass did not show evidence of neoplasia, a decision was made to proceed with a right hemicolectomy based on high clinical and imaging suspicion of malignancy. Histological evaluation of the hemicolectomy revealed a benign colon desmoid tumour.
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Affiliation(s)
- W Makis
- Department of Nuclear Medicine, Brandon Regional Health Centre, Brandon, MB, Canada.
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36
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Stürmlin J, Banz V, Metzger J. Diagnosis and management of the intra-abdominal desmoid tumour. J Surg Case Rep 2012; 2012:2. [PMID: 24960778 PMCID: PMC3649496 DOI: 10.1093/jscr/2012.2.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Desmoid tumours are a rare entity and are usually detected with a certain delay, as they initially often grow without causing any specific clinical symptoms. Although these tumours grow slowly and do not metastasise, their growth pattern remains aggressive and local tissue displacement or even destruction is common. Surgery remains the only potentially curative treatment option. Here we report on the findings of a 43-year old female patient with a large intra-abdominal desmoid tumour, resulting in the displacement of most intra-abdominal organs to the right of the patient’s abdominal cavity. She successfully underwent surgical removal of the mass and recovered without complications.
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Affiliation(s)
- J Stürmlin
- Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - V Banz
- Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - J Metzger
- Cantonal Hospital Lucerne, Lucerne, Switzerland
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38
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Catania G, Ruggeri L, Iuppa G, Di Stefano C, Cardì F, Iuppa A. Abdominal wall reconstruction with intraperitoneal prosthesis in desmoid tumors surgery. Updates Surg 2011; 64:43-8. [DOI: 10.1007/s13304-011-0109-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/27/2011] [Indexed: 01/15/2023]
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39
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Verrill MW, Coley HM, Judson IR, Fisher C. Susceptibility of fibromatosis cells in short-term culture to Ifosfamide: a possible experimental treatment in clinically aggressive cases. Sarcoma 2011; 3:79-84. [PMID: 18521267 PMCID: PMC2395416 DOI: 10.1080/13577149977686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose. Deep fibromatoses are large, often rapidly growing
but benign soft tissue tumours. Although surgery is the mainstay of treatment, in
unremitting and aggressive cases the use of cytotoxic chemotherapy may produce
objective tumour responses. Fresh tumour samples from four patients with fibromatosis
were investigated as part of a study of drug resistance in soft tissue tumours. Methods. Following short-term culture of fibromatosis cells in vitro ,
chemosensitivity to 4-hydroperoxy-ifosfamide, the active form of ifosfamide and
doxorubicin was tested. Following 72-h continuous exposure to each drug,
surviving cell fraction was assessed using the lactate dehydrogenase assay. Results. Mean IC50
values for ifosfamide and doxorubicin were
6.2 and 0.35 µmol/l, respectively. In samples of soft tissue sarcoma (STS) from the
same study the mean IC50
values for ifosfamide and doxorubicin were 14.8 and
1.69 µmol. The difference in mean ifosfamide IC50
values for fibromatosis and
STS samples was statistically significant. Discussion. We are not aware of any other report suggesting
the use of ifosfamide in this condition. These observations suggest that, for patients
with inoperable or progressive lesions of fibromatosis causing significant morbidity,
it may be valuable to include ifosfamide in experimental treatment regimens.
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Affiliation(s)
- M W Verrill
- University of Newcastle Department of Medical Oncology Newcastle General Hospital Westgate Road Newcastle upon Tyne NE4 6B E UK
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40
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Abstract
Purpose. Aggressive fibromatosis (AF) is an uncommon locally infiltrating benign disease of soft tissue for which treatment comprises complete surgical resection. Radiotherapy can be given postoperatively if the margin is incompletely resected. If the tumour is inoperable radiotherapy provides an alternative treatment. Hormone therapy and cytotoxic chemotherapy have also been used for unresectable or recurrent disease. All treatment modalities carry an associated morbidity. We believe that the natural history of aggressive fibromatosis may include a period of stable disease without progression, during which time, treatment is not always necessary. Patients and methods. We present a retrospective review of 42 patients referred to the Royal Marsden Hospital between 1988 and 1995 with aggressive fibromatosis. Evidence of periods of stable disease and the relationship to delivered treatment was obtained from the case notes, including the natural history prior to referral to our institution. Stable disease was defined as a period of no objective progression for 6 months or longer. Results. Seventeen patients could be assessed for stable disease and all (100%) experienced at least one episode of stable disease, eight of whom whilst receiving hormonal or cytotoxic therapy. Of the 23 patients who could not be assessed for stable disease, as they underwent surgery at presentation or recurrence of disease, only 2 had persisting disease at last follow-up. Both of these patients had had positive surgical resection margins. Discussion. This study demonstrates the variable natural history of AF, which can include a substantial period of stable disease in a significant number of patients. A less aggressive approach to the management of AF may therefore be appropriate, particularly if a subgroup of patients who are likely to experience a period of stable disease can be identified.
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Affiliation(s)
- G Mitchell
- Sarcoma Unit Royal Marsden Hospital NHS Trust Fulham Road London SW3 6JJ UK
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Abstract
Desmoid tumors are soft-tissue neoplasms arising from fascial or musculo-aponeurotic structures. Most reported thoracic desmoid tumors originate from the chest wall. However, intrathoracic desmoid tumors are rare. We present a case of a 35-year-old male patient complaining of mild shortness of breath. The patient was diagnosed to have a huge intrathoracic desmoid tumor, which was successfully resected.
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Affiliation(s)
- Majdi Ibrahim
- Department of Thoracic Surgery, King Fahad Hospital, Almadinah Almunawarah, Saudi Arabia
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42
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Barbier O, Anract P, Pluot E, Larouserie F, Biau D, Dumaine V, Tomeno B. Traitement chirurgical dans les tumeurs desmoïdes extra-abdominales: analyse critique d’une série de 36 patients opérés. ONCOLOGIE 2011. [DOI: 10.1007/s10269-010-1949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Tan CH, Pua U, Liau KH, Lee HY. Mesenteric desmoid tumour masquerading as a fat-containing cystic mass. Br J Radiol 2011; 83:e200-3. [PMID: 20846976 DOI: 10.1259/bjr/68468861] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mesenteric desmoid tumour (MDT) is an uncommon neoplasm that typically presents as a solid soft-tissue mass on cross-sectional imaging. MDT manifesting as a fat-containing cystic mass on CT has not been described in the literature. We report such an unusual case with clinicopathological correlation.
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Affiliation(s)
- C H Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
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44
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Venkat D, Levine E, Wise WE. Abdominal pain and colonic obstruction from an intra-abdominal desmoid tumor. Gastroenterol Hepatol (N Y) 2010; 6:662-665. [PMID: 21103447 PMCID: PMC2978418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
| | | | - William E. Wise
- Department of Surgery, Division of Colon and Rectal Surgery, Riverside Methodist Hospital, Columbus, Ohio
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45
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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.
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Affiliation(s)
- Kai Huang
- Department of Abdominal Surgery, Fudan University Shanghai Cancer Centre, Shanghai, China
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46
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Lakranbi M, Smahi M, Maidi M, Bouchikh M, Msougar Y, Ouadnouni Y, Fenan H, Achir A, Caidi M, Alaziz A, Benosman A. [Desmoid tumors of the chest wall: report of 12 cases]. Pan Afr Med J 2009; 3:13. [PMID: 21532722 PMCID: PMC2984280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 11/08/2009] [Indexed: 11/19/2022] Open
Abstract
Introduction:
Les tumeurs desmoides sont des tumeurs rares des tissus mous qui peuvent être très agressives localement. A travers l’expérience de notre service, nous analyserons les résultats du traitement chirurgical de ces tumeurs.
Patients et méthodes:
De 1980 à 2008, 12 patients ont été opérés pour tumeur desmoide de la paroi thoracique. Le diagnostic a été suspecté sur la base des signes cliniques et radiologiques. Aucun patient n’avait un syndrome de Gardner. L’abord chirurgical a été souvent électif à l’aplomb de la tumeur.
Résultats:
La résection a été complète dans 11 cas. La confirmation diagnostique a été apportée par l’étude histologique de la pièce opératoire. La durée du suivi post opératoire variait entre 24 et 180 mois. Une patiente était décédée par insuffisance cardiaque et rénale. 7 cas avaient récidivé, et qui ont été traités par simple résection complète dans 5 cas, dont un avait nécessité une greffe myocutanée ; par ailleurs, deux cas ont été traités par résection incomplète associée à une radiothérapie adjuvante.
Conclusion:
La chirurgie des tumeurs desmoides de la paroi thoracique doit être aussi large que possible pour diminuer le risque de récidive.
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Affiliation(s)
- Marouane Lakranbi
- Service de chirurgie thoracique CHU Rabat, Maroc
,
Corresponding author: Lakranbi marouane, interne en chirurgie thoracique au CHU de Fès, Maroc, 250, rue al ward hay essalam BP: 11000 Salè Maroc, téléphone: 0021263660432.
| | | | - Mehdi Maidi
- Service de chirurgie thoracique CHU Rabat, Maroc
| | | | | | | | - Hicham Fenan
- Service de chirurgie thoracique CHU Rabat, Maroc
| | | | | | - Ahmed Alaziz
- Service de chirurgie thoracique CHU Rabat, Maroc
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47
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Desmoid tumor of the chest wall in an elderly woman. Gen Thorac Cardiovasc Surg 2009; 57:554-7. [PMID: 19830521 DOI: 10.1007/s11748-008-0404-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/22/2008] [Indexed: 10/20/2022]
Abstract
We report a case of desmoid tumor of the chest wall in a 79-year-old woman. The patient was referred to our hospital for management of a chest wall mass. Four months previously, the patient noted a small lump in the right lateral chest wall that had rapidly increased in size. Magnetic resonance imaging of the chest revealed a soft tissue tumor in the right lateral chest wall with unclear margins that extended into the intercostal muscles. Positron emission tomography with (18)F-fluorodeoxyglucose (FDG) showed slight FDG accumulation at the lesion. Because open biopsy suggested a desmoid tumor, full-thickness chest wall resection with reconstruction was performed. The final diagnosis was desmoid tumor of the chest wall. Wide surgical resection during the initial operation is an essential element in the treatment of this tumor.
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48
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Intraoperative electron radiotherapy for the management of aggressive fibromatosis. Int J Radiat Oncol Biol Phys 2009; 76:1154-60. [PMID: 19647952 DOI: 10.1016/j.ijrobp.2009.03.067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 03/08/2009] [Accepted: 03/09/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. METHODS AND MATERIALS Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). RESULTS After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. CONCLUSION Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.
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Melis M, Zager JS, Sondak VK. Multimodality management of desmoid tumors: how important is a negative surgical margin? J Surg Oncol 2009; 98:594-602. [PMID: 19072851 DOI: 10.1002/jso.21033] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Desmoid tumors are rare, locally invasive mesenchymal tumors without metastatic potential. Their clinical behavior is heterogeneous and characteristically unpredictable; outcomes are influenced by anatomic location, proximity to vital organs, association with familial adenomatous polyposis. Surgery is the main treatment modality, but the significance of positive resection margins remains controversial since they may not increase the risk of recurrence: in this setting re-resection, adjuvant radiation or close clinical follow-up could all be appropriate options. We reviewed the current evidence for multimodality therapy of desmoids, with a focus on the importance of resection margins, and present our own algorithm for treatment.
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Affiliation(s)
- Marcovalerio Melis
- Division of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Gouin F, Tesson A, Bertrand-Vasseur A, Cassagnau E, Rolland F. [Rating of tumoral growth in non-operated primary or recurrent extra-abdominal aggressive fibromatosis]. ACTA ACUST UNITED AC 2008; 93:546-54. [PMID: 18065863 DOI: 10.1016/s0035-1040(07)92676-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE STUDY Extra-abdominal aggressive fibromatosis (EAAF) is a benign desmoid tumor with a potentially aggressive behavior. Surgical treatment is compromised by a very high rate of recurrence, sometimes with significant morbidity. We conducted a prospective surveillance of our patients (clinical and MRI) with EAAF to search for prognostic factors. MATERIAL AND METHODS This cohort included 17 patients with EAAF. For nine patients, biopsy alone was performed. For eight, the tumor was a recurrence after surgical removal. Patients were seen for a clinical assessment and MRI every six months. RESULTS Median follow-up was 42 months (range 6-114). Three patients worsened clinically with pain or functional impairment. One patient required neurosurgery to control pain (good stable outcome). MRI showed progression for two tumors (12%) but with a short follow-up since diagnosis (9 and 14 months), in one case despite medical treatment. Three tumors regressed and twelve remained stable on successive MRI. On average the tumor growth lasted ten months. DISCUSSION Tumor growth was never noted beyond 36 months. This notion of an interruption in tumor growth is mentioned sporadically in reports on EAAF, which have generally included recurrent tumors. To our knowledge this is the first series reporting tumors left in place a followed with modern imaging techniques. The high rate of spontaneous interruption of tumor growth must be counterbalanced with the difficult task of local treatment: the risk of recurrence is particularly high after surgery and functional sequelae can be significant when wide resection is proposed in an anatomically difficult localization. The precise role for surgery, and combined radiotherapy, remain to be determined. There are only scarce reports on general treatments. Considering these facts, we propose that surgical resection should not be considered the only solution for the treatment of EAAF. Further work is needed to define the useful contribution of simple surveillance of these benign tumors.
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Affiliation(s)
- F Gouin
- Pôle ostéo-articulaire, Service d'Orthopédie Traumatologie, CHU Hôtel-Dieu, 44093 Nantes Cedex.
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