Nuchal fibroma presenting as two posterior neck masses

Nuchal-type Fibroma Induced by Repetitive Trauma from Weightlifting: Case Report and Comprehensive Review of Literature

A nuchal-type fibroma (NTF) is a rare, benign, subcutaneous nodule that most frequently occurs in the posterior neck along the midline. It is characterized histologically by bundles of thick collagen fibers confined to the dermis and subcutaneous tissue of the posterior neck. Few trauma-related NTF cases have been published. We present a biopsy-proven case of NTF that is likely to have developed as a result of weightlifting activity in the gym, including repetitive trauma to the area of the lesion during the exercise known as the "barbell back squat." During this exercise, a heavy barbell was repeatedly rested on the patient's vertebral prominence at the level of C7/T1, the location where the NTF developed. Our 25-year old patient reported that he had been doing this exercise on a weekly basis for about 10 years. We believe that repetitive trauma at this location from specific weightlifting exercises may attribute to the incidence of NTF. A description of key magnetic resonance imaging characteristics and the surgical pathology of this case are provided, along with a review of current literature on trauma-related NTFs.

Repetitive trauma-induced extra-nuchal-type fibroma

A nuchal-type fibroma is a rare, benign fibrous tumour that typically occurs in the posterior neck along the midline, but can occur in extra-nuchal locations, most commonly in the back, shoulder and face. We present a biopsy-proven case that arose as a result of heavy gym-related activities. In particular, a heavy barbell was rested on his vertebral prominence at the level of C7/T1 during leg squatting. Repetitive trauma as a cause for extra-nuchal-type fibromas has been sparsely reported, but we suggest that sustained high pressure is an additional required feature. Although this lesion was in the posterior neck, it was contained entirely within the subcutaneous tissues without involvement of the nuchal ligament. Hence, it was considered an extra-nuchal fibroma. A description of key ultrasound and MRI imaging characteristics are provided to assist in making the diagnosis, along with a review of the current literature and a discussion of differential diagnoses.

Nuchal-type Fibroma: Single-Center Experience and Systematic Literature Review

BACKGROUND

Nuchal-type fibroma is a rare benign tumor arising from the connective tissue. Our aim was to present our experience via two cases of this tumor and a comprehensive review of the literature.

PATIENTS AND METHODS

We report a case of a 23-year-old female with a mass located in the posterior neck and the upper back and a case of a 50-year-old male with a mass located in the posterior neck, which were proved to be nuchal-type fibromas in the histopathological examination. We also searched the PubMed/Medline database for published cases of nuchal-type fibromas.

RESULTS AND DISCUSSION

Nuchal-type fibroma is a rare benign tumor arising from the connective tissue, usually in the posterior neck, which affects different ages, with most patients being male. It is a poorly circumscribed tumor consisting of hypocellular, thick, dense and haphazardly arranged collagen bundles with entrapped adipocytes, nerve fibers and muscle fascicles and a few scattered spindle cells, which are CD34 positive. Its excision is curative, and the recurrence risk is generally low. However, patients with Gardner's syndrome may experience recurrence more frequently.

CONCLUSION

Nuchal-type fibroma should be included in the differential diagnosis of subcutaneous, soft-tissue masses, especially when these involve the posterior neck.

Nuchal-type fibroma of the shoulder: A case report and review of the literature

Nuchal-type fibroma, initially described in 1988 by Enzinger and Weiss, is a rare clinical entity associated with distinct subcutaneous and dermal fibrous tissue proliferation. The etiology of nuchal-type fibroma largely remains to be elucidated. Typical characteristics of this entity include hypocellular, haphazardly arranged collagen with entrapped adipose tissue, paucity of elastin and entrapped small nerves, on which the pathological diagnosis is based. Magnetic resonance imaging (MRI) is the preferred imaging modality for the detection of nuchal-type fibroma, due to its superior soft tissue resolution and multi-planar capabilities. The present study presents the unique findings of a nuchal-type fibroma arising in the shoulder of a 48-year-old man. Distinct features of the nuchal-type fibroma in the present case included hyperintensity on T1- and T2-weighted MRI. Microscopic examination revealed marked mucoid tissue degeneration. To the best of our knowledge, this is the first case report of nuchal-type fibroma presenting with these distinct features. The present findings may therefore assist with the general and differential diagnosis of nuchal-type fibroma.

Multiple nuchal-type fibromas on the scalp: a case report

Nuchal-type fibroma is a rare, benign, fibrous, tumor-like proliferation characterized by dense hypocellular bundles of collagen, with sparsely scattered fibroblasts, interspersed fat tissue, and entrapped nerve fibers. It usually develops in the posterior neck as a solitary, firm, poorly circumscribed, subcutaneous mass. Herein, we report about a 32-year-old man who presented with a 6-year history of multiple nodules on the scalp. Histopathological features were consistent with those of nuchal-type fibroma. The tumors were surgically excised.

Multiple nuchal fibromas in a 2-year-old without Gardner syndrome

Nuchal fibromas, uncommon benign soft tissue tumors typically arising along the posterior neck, are often associated with Gardner syndrome (GS). These tumors have rarely been reported in association with scleroderma or as secondary to trauma and diabetes. Nuchal fibromas not associated with GS have been described predominantly in men aged 30 to 50. We report a 2-year-old African American girl with multiple nuchal fibromas along the posterior aspect of her neck and upper back. Retinal examination showed no signs of congenital hypertrophy of the retinal pigment epithelium, and genetic testing for the adenomatous polyposis coli gene mutation seen in GS was negative.