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Mejbel HA, Morris J, Bahrami A. Aggressive fibromatosis-like tumour with ANGPTL2::USP6 fusion. Histopathology 2024; 84:1243-1245. [PMID: 38379048 DOI: 10.1111/his.15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Haider A Mejbel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Morris
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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2
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Raad RA, Akers R, Al-Khudari S, Stenson K, Bhayani MK. A Nationwide Analysis of Head and Neck Fibromatoses. Laryngoscope 2024; 134:2228-2235. [PMID: 37933795 DOI: 10.1002/lary.31153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Head and neck fibromatoses (HNFs) are a rare, diverse group of soft tissue tumors characterized by an abnormal proliferation of fibroblasts. Available literature on these tumors is limited to case reports and small single-institutional studies. OBJECTIVE We aim to provide demographic, socioeconomic, tumor-related, and treatment characteristics of HNFs. DESIGN Retrospective cohort analysis using the National Cancer Database (NCDB). METHODS The NCDB was queried for fibromatosis-related histologic codes located within the head and neck region. Various factors were analyzed. Univariate and multivariate survival analyses were performed. RESULTS Between 2004 and 2016, 130 patients were included in the analyses. Average age was 57.4 years old with a predominance of White (83.6%) males (61.5%). Non-desmoid HNFs accounted for 60%-70% of the tumors. The salivary gland was the most common location (38.5%) and more than half of the tumors were high grade. The majority were treated surgically (90.8%) and 25% had positive margins. Mean and median overall survival (OS) were 98.9 and 135.4 months, respectively. Surgery is associated with better OS than nonsurgical alternatives. Addition of adjuvant treatments was not associated with differences in survival. CONCLUSION In the largest study to date, we describe demographic, socioeconomic, tumor-related, and treatment patterns of patients with this rare disease. These tumors are most frequently present in middle-aged males with high-grade histology. Most are treated surgically and positive surgical margins are common. Surgery has better OS than nonsurgical alternatives. While adjuvant radiation has become more common, we found no difference in survival compared to surgery alone. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2228-2235, 2024.
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Affiliation(s)
- Richard A Raad
- Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel Akers
- Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Samer Al-Khudari
- Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kerstin Stenson
- Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mihir K Bhayani
- Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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3
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Sommovilla J, Shepard D, Liska D. Management of Desmoid Disease in Familial Adenomatous Polyposis. Clin Colon Rectal Surg 2024; 37:185-190. [PMID: 38606047 PMCID: PMC11006445 DOI: 10.1055/s-0043-1770731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Desmoid disease, though technically a benign condition, is nevertheless a leading cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP). Desmoid disease impacts approximately 30% of FAP patients, with several known risk factors. It runs the gamut in terms of severity-ranging from small, slow-growing asymptomatic lesions to large, focally destructive, life-threatening masses. Desmoids usually occur following surgery, and several patient risk factors have been established, including female sex, family history of desmoid disease, 3' APC mutation, and extraintestinal manifestations of FAP. Desmoid disease-directed therapy is individualized and impacted by desmoid stage, severity, postsurgical anatomy, and consequences of disease. Medical therapy consists of options in multiple classes of drugs: nonsteroidal anti-inflammatory drugs, hormonal therapy, tyrosine kinase inhibitors, and cytotoxic agents. Surgical excision is sometimes an option, but can be limited by common location of disease at the root of the small bowel mesentery. Palliative surgical treatments are often considered in management of desmoid disease. Intestinal transplantation for severe desmoid disease is an emerging and promising option, though long-term data on efficacy and survival is limited.
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Affiliation(s)
- Joshua Sommovilla
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dale Shepard
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Liska
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
- Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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4
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Skubitz KM, Murugan P. RAD51C and MYST3 Mutations in a Case of Desmoid-Type Fibromatosis With No Mutation in CTNNB1 or APC. Cureus 2024; 16:e55496. [PMID: 38571839 PMCID: PMC10990071 DOI: 10.7759/cureus.55496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Most cases of desmoid-type fibromatosis (DTF) exhibit a mutation in APC or CTNNB1. We report a case of mesenteric DTF in which no mutation in APC or CTNNB1 was found, but a germline variant of uncertain significance (VUS) in RAD51C and a subclonal mutation in MYST3 were identified. Whether these genetic changes are important in DTF in this case, or whether genetically conventional DTF cells were present at a density below detection is unknown; it will be of interest to see results in further studies of wild-type APC/CTNNB1 cases.
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Affiliation(s)
| | - Paari Murugan
- Laboratory Medicine and Pathology, University of Minnesota, MInneapolis, USA
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5
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Bakde AM, Gunasekaran V, Anand A, Meshram N. Large Multicentric Synchronous Extra-Abdominal Fibromatosis of the Leg and Foot: A Case Report. Indian J Radiol Imaging 2024; 34:167-171. [PMID: 38106877 PMCID: PMC10723971 DOI: 10.1055/s-0043-1772849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Extra-abdominal fibromatosis is an uncommon, benign locally aggressive fibrous soft-tissue tumor that usually occurs in the shoulders, chest wall, back, thigh, and head and neck affecting the young adult population. It is commonly located in the subcutaneous tissue and may infiltrate the adjacent skeletal muscles. We hereby report a rare case of a large extra-abdominal fibromatosis of the leg and foot in a 38-year-old woman. The patient presented with a large voluminous lesion clinically and on imaging, which was difficult to diagnose. Magnetic resonance imaging (MRI) was very helpful in diagnosing the lesion. It revealed a large relatively well-defined, lobulated hypointense mass in the posterior compartment of the leg with extension into the lower thigh and foot with local infiltration into the gastrocnemius and soleus muscles. An incisional biopsy was performed, and the mass was diagnosed on pathological examination as a spindle-shaped fibroblast proliferation suggesting extra-abdominal fibromatosis.
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Affiliation(s)
- Ashwini M. Bakde
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vignesh Gunasekaran
- Department of Radiodiagnosis, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
| | - Aarti Anand
- Department of Radiodiagnosis, Govt. Medical College and Hospital, Nagpur, Maharashtra, India
| | - Nisha Meshram
- Department of Pathology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
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6
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Rabai NA, Alrababah A, Batayha SA, Ba-Shammakh SA, Sayaheen MO. A Sporadic Giant Mesenteric Desmoid-Type Fibromatosis in a Teenage Female: A Report of a Rare Case. Cureus 2023; 15:e46087. [PMID: 37900485 PMCID: PMC10611482 DOI: 10.7759/cureus.46087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Mesenteric desmoid-type fibromatosis (DTF) is a rare benign yet aggressive neoplasm that has an unpredictable biological behavior ranging from spontaneous regression to extensive local infiltration and has a high tendency for recurrence. The presenting symptoms are usually nonspecific and mostly related to the large size of the tumor compressing adjacent organs. Imaging studies can be suggestive of the diagnosis, but confirmation is based on histopathological and immunohistochemical examination. The lack of knowledge on the etiology and pathogenetic behavior of this tumor leads to therapeutic and prognostic challenges. Future genetic studies may help in advancing our understanding of this neoplasm and in formulating the proper management and follow-up plan. Here we present a case of a 14-year-old female who presented to the emergency room complaining of diffuse abdominal pain and distention. A computed tomography (CT) scan showed a large mass occupying most of the abdominal cavity and compressing adjacent organs. Exploratory laparotomy with resection and anastomosis was performed, and the histopathological and immunohistochemical examination of the resected mass was consistent with mesenteric DTF.
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Affiliation(s)
- Nimah A Rabai
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Arqam Alrababah
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Shaima A Batayha
- Department of Pathology, Jordan University of Science and Technology, Irbid, JOR
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7
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Maldonado AA, Broski SM, Carter JM, Spinner RJ. Unrecognized neuromuscular choristoma with recurrent desmoid-type fibromatosis and Marjolin ulcer: expanding the spectrum of neuromuscular choristoma sequelae within the nerve territory? Illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22554. [PMID: 36748757 PMCID: PMC10550558 DOI: 10.3171/case22554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neuromuscular choristoma (NMC) is a rare congenital lesion in which muscle tissue is admixed with nerve fascicles within a peripheral nerve. Patients commonly present in early childhood with neuropathy, plexopathy, or chronic undergrowth in the distribution of the affected nerve. OBSERVATIONS The authors present the case of a 35-year-old man with unrecognized neuromuscular NMC of the sciatic nerve, which resulted in recurrent, multicentric NMC-associated desmoid-type fibromatosis (NMC-DTF) within the nerve territory in association with a Marjolin ulcer, a cutaneous malignancy. LESSONS Based on anatomical and pathophysiological findings described in this case report, the authors support the association between NMC-DTF and Marjolin ulcer.
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Affiliation(s)
| | | | - Jodi M. Carter
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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8
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Qureshi A, Andrade R, Saavedra J, Xiao P, Asarian A. Incidental discovery of desmoid-type fibromatosis encapsulating granular cell tumor in a neck mass. J Surg Case Rep 2022; 2022:rjac439. [PMID: 36226135 PMCID: PMC9541280 DOI: 10.1093/jscr/rjac439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022] Open
Abstract
Multiple primary cancers are defined as primary malignant tumors of different histological origins in one person. Desmoid-type fibromatosis (DF) is an extremely rare, locally aggressive, connective tissue malignancy that can be rooted anywhere in the body with the most common sites being thoracic wall and extremities. In contrast, granular cell tumors are rare neoplasms derived from Schwann cells commonly found in the oral cavity, skin and gastrointestinal tract. Moreover, diagnosing a patient with two primary cell tumors has become more common and the challenge of treatment becomes the focus in clinical situations. However, findings of a mass containing DF encapsulated by a granular cell tumor. Currently, there are no established guidelines for this rare condition. This case report serves to raise awareness of these two uncommon primary tumors emerging in an idiosyncratic nature.
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Affiliation(s)
- Abid Qureshi
- Correspondence address. Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA. Tel: +1 917-519-1749; E-mail:
| | - Roberto Andrade
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Jonathan Saavedra
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
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9
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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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10
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Novotný R, Mendl J, Kocík M, Kristek J, Froněk J, Janousek L. Giant aggressive intra-abdominal desmoid-type fibromatosis - case report. Rozhl Chir 2022; 101:337-341. [PMID: 36075697 DOI: 10.33699/pis.2022.101.7.337-341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Aggressive fibromatosis, also known as desmoid tumour (DT), is a locally invasive soft tissue malignancy originating from fascial planes, connective tissue, and musculoaponeurotic structures of the muscles. The symptoms greatly depend on the location and size of the tumour. CASE REPORT A 68-year-old male patient without any comorbidities with a large, palpable mass in the abdomen underwent computed tomography (CT) of the abdomen during diagnostic examination in September 2017 in another centre. The CT scan revealed a giant intraperitoneal 30×40cm tumour without signs of infiltrating the surrounding organs and large vessels. The tumour biopsy revealed an aggressive DT. The patient was scheduled for tumour resection. Midline laparotomy was performed in the supine position under general anaesthesia. After gaining access to the abdominal cavity, 8 litres of clear ascites were evacuated. The tumour was not attached to the abdominal wall. Large omentum was freed from the DT. The perioperative finding confirmed the CT images of DT encapsulation of the medial colic artery, part of the small intestine, and transverse colon. The tumour was resected with part of the mesenteric radix, 30 cm of small intestine, and 2/3 of the transverse colon. After the DT was removed entirely, the small intestine was re-anastomosed end to end. The abdominal cavity and the liver were carefully checked for bleeding. The abdominal cavity was closed in a standard manner. RESULTS The postoperative hospital stay was uneventful. The patient was discharged on the 7th postoperative day with prophylactic low weight molecular heparin for one month. Currently, we have five months of follow-up with no signs of DT recurrence based on CT examination. The histology of the resected tumour confirmed the diagnosis of a desmoid tumour (aggressive abdominal fibromatosis). CONCLUSION Desmoid tumours are benign neoplasms with no metastatic potential. However, their treatment is challenging due to their aggressive growth, infiltrative behaviour, and a high tendency to recur.
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11
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Kim YR, Yoon YS, Park H. Extra-Abdominal Desmoid-Type Fibromatosis Mimicking Myxofibrosarcoma. J Belg Soc Radiol 2022; 106:81. [PMID: 36213374 PMCID: PMC9504096 DOI: 10.5334/jbsr.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023] Open
Abstract
A 27-year-old woman was confirmed to have extraabdominal desmoid-type fibromatosis. Desmoid-type fibromatosis is a very rare connective tissue neoplasm with the extraabdominal type even more rare. It is most commonly found in proximal structures such as shoulders, neck, chest, and extremities. There are few case reports for desmoid-type fibromatosis located in paraspinal soft tissue. We report a case of desmoid-type fibromatosis mimicking a myxofibrosarcoma. Teaching Point: Even if there are suggestive findings for malignant soft tissue tumor on radiologic evaluation, histological confirmation is necessary before surgical treatment.
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Affiliation(s)
- Ye Rin Kim
- From the Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon 14584, Bucheon, Republic of Korea, KR
| | - Yu Sung Yoon
- From the Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon 14584, Bucheon, Republic of Korea, KR
| | - Hyerim Park
- From the Department of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Republic of Korea, KR
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12
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Arima K, Komohara Y, Uchihara T, Yamashita K, Uemura S, Hanada N, Baba H. A Case of Mesenteric Desmoid Tumor Causing Bowel Obstruction After Laparoscopic Surgery. Anticancer Res 2022; 42:381-384. [PMID: 34969748 DOI: 10.21873/anticanres.15496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A desmoid tumor is a rare neoplasm that is derived from soft tissues. Although it shows benign characteristics pathologically, local recurrence can occur. CASE REPORT We herein report the case of a patient with an intraabdominal desmoid tumor that developed 3 years after laparoscopic appendectomy for acute appendicitis. A 59-year-old male visited our emergency room with complaints of abdominal pain and fullness. Abdominal computed tomography revealed distention of the small intestine with a point of obstruction by an intraabdominal tumor-like region. Pathological findings showed that the tumor was compatible with desmoid fibromatosis. CONCLUSION In cases with an intraabdominal tumor after laparoscopic surgery, it is important to consider the possibility of a desmoid tumor, since it is difficult to diagnose it accurately before surgery.
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Affiliation(s)
- Kota Arima
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan .,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyuki Uchihara
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kohei Yamashita
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichiro Uemura
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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13
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Gupta A, Batta NS, Batra V. Postoperative Recurrent Paraspinal Fibromatosis after Resection of Cervical Meningioma and Review of Literature. Indian J Radiol Imaging 2021; 31:514-518. [PMID: 34556942 PMCID: PMC8448242 DOI: 10.1055/s-0041-1734357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The extra-abdominal deep fibromatoses also called as desmoid tumor (DT) are rare musculoaponeurotic, histologically benign tumoral soft tissue lesions which are locally aggressive with high rate of recurrence and no metastatic potential. Here, we describe a rare case of postoperative paraspinal fibromatosis in female child after aciurgy of intraspinal cervical meningioma. The lesion was incidentally detected in routine follow-up study and showed significant interval growth over a period of 1 year. Surgical resection was performed after histopathological confirmation; however, recurrence was observed. Hitherto only seven cases of postoperative paraspinal fibromatosis have been reported in the literature. To the best of authors' knowledge, this report is the first case of postoperative fibromatosis in cervical spine after resection of meningioma. The aim of the case report is to emphasize the clinical scenario for suspicion of fibromatosis, magnetic resonance imaging clues, and multidisciplinary treatment strategy which has shifted toward initial active surveillance.
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Affiliation(s)
- Ankur Gupta
- Department of Radiology, Mahajan Imaging, Sports Injury Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India
| | - Nafisa S Batta
- Department of Radiology, Mahajan Imaging, Sports Injury Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India
| | - Vikas Batra
- Department of Radiology, Mahajan Imaging, Sports Injury Centre, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India
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Abstract
Fibromatosis of the breast is a rare, benign locally infiltrative tumor without metastatic potential. Patients typically present with a painless, palpable, firm breast mass, which may be mobile or fixed to the pectoralis muscle. While some cases are related to familial mutations in the adenomatous polyposis coli (APC) gene, the majority are sporadic due to somatic mutations or prior injury to the breast tissue. On mammography, fibromatosis is typically seen as an irregular, dense, spiculated mass. US demonstrates a hypoechoic, irregular mass with indistinct margins. Fibromatosis is indistinguishable from breast cancer on imaging, and core biopsy is required for definitive diagnosis. Wide local excision is the historical standard for treatment; however, recurrence rates are high, and other emerging therapies are being explored. This article reviews the clinical features, imaging and histopathologic findings, along with brief overview of management.
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Affiliation(s)
- Nicole Winkler
- University of Utah Health/Huntsman Cancer Institute, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Michael Peterson
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
| | - Rachel Factor
- University of Utah Health/Huntsman Cancer Institute, Department of Pathology, Salt Lake City, UT, USA
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15
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Baroud S, Alawadhi A. A Severe Case of Infantile Systemic Hyalinosis in an Asian Child: A Product of Consanguinity. Cureus 2021; 13:e16433. [PMID: 34414050 PMCID: PMC8365122 DOI: 10.7759/cureus.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Infantile systemic hyalinosis (ISH) is a rare, autosomal recessive disorder characterized by widespread abnormal growth of hyalinized fibrous tissue in skin and mucosae. The typical clinical picture consists of the development of joint contractures, skin lesions, and severe, chronic pain. We report the case of a 2-year-old Pakistani girl, who presented to our clinic with papulonodular lesions, gingival hyperplasia, hypotonia, and joint contractures. Skin biopsy revealed hyaline deposits, and genetic testing revealed a mutation in the protein Anthrax toxin receptor 2 (ANTXR2).
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Affiliation(s)
- Sumer Baroud
- Department of Dermatology, Medical University of Sharjah, Sharjah, ARE
| | - Ameen Alawadhi
- Department of Dermatology, Salmaniya Medical Complex, Manama, BHR
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Bhati M, Balakrishna G, Joshi K, Bhattacharya K, Bal M, Ghosh Laskar S, Sinha S, Joshi A, Joshi P, Nair S, Chaturvedi P. Fibromatoses of Head and Neck: Case Series and Literature Review. Rambam Maimonides Med J 2021; 12:RMMJ.10444. [PMID: 34270403 PMCID: PMC8284993 DOI: 10.5041/rmmj.10444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study was to retrospectively review clinical data, management protocols, and clinical outcomes of patients with fibromatoses of head and neck region treated at our tertiary care center. METHODS We retrospectively reviewed the medical records of 11 patients with confirmed histopathological diagnosis of fibromatosis registered in the Department of Head and Neck Surgery at Tata Memorial Centre, India, between 2009 and 2019. Various clinical and pathological features and treatment modalities were evaluated. RESULTS Age at diagnosis ranged between 18 and 74 years, with a median age of 36 years. The female-to-male ratio was 5:6. Supraclavicular fossa (n=4) was the most common subsite of origin in the neck (n=8). The lateral (n=2) and posterior cervical regions (n=2) were other common neck subsites. Less commonly involved sites were the mandible (n=1), maxilla (n=1), and thyroid (n=1). A total of eight patients underwent surgery at other centers before being referred to us for further management. Out of a total 11 patients, nine patients had unresectable disease at presentation. Six of the patients with unresectable disease received a combination of weekly doses of vinblastine 6 mg/m2 and methotrexate 30 mg/m2 for a median duration of 6 months (range 6-18 months) followed by hormonal therapy with tamoxifen. Three patients received metronomic chemotherapy followed by hormonal therapy. One treatment-naive patient with fibromatosis of posterior cervical (suboccipital) region underwent R2 resection (excision of bulk of the tumor with preservation of critical structures) at our center along with adjuvant radiotherapy. One pregnant patient reported to us after undergoing surgery outside and defaulting radiotherapy. During median follow-up of 29 months (range 1-77 months), six patients had stable disease, and four patients had disease reduction. Disease progression was seen in one patient. The two-year progression-free survival (PFS) was 90% (95% CI 70%-100%). CONCLUSION Gross residual resection (R2) was the mainstay of surgical treatment in our series, as obtaining clear surgical margins is seldom possible in these locally aggressive tumors. Radiotherapy, chemotherapy, and hormonal therapy are the other preferred and more conservative treatment modalities. The goal of surgery should be preserving function with minimal or no morbidity. As fibromatoses in the head and neck region are extremely rare, their treatment awaits the development of standard treatment protocols.
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Affiliation(s)
- Muddasir Bhati
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gurukeerthi Balakrishna
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kamaldeep Joshi
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kajari Bhattacharya
- Department of Radiodiagnosis and Imaging, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiotherapy, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shwetabh Sinha
- Department of Radiotherapy, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Poonam Joshi
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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17
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Abstract
Desmoid fibromatosis is a locally aggressive tumor with an unpredictable clinical course. Surgery was once the mainstay of treatment, but the treatment protocol has been constantly evolving and currently active surveillance is the front-line approach. There have been significant insights into the molecular biology with the addition of mutational analysis of CTNNB1 adding to prognostic information. We present a review of the literature with current practice guidelines, also including novel therapeutic targets and ongoing clinical trials, to unravel the next step in the management of sporadic desmoid fibromatosis.
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Affiliation(s)
- Saneya Pandrowala
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
| | - Robin L Jones
- Department of Medicine, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sanjay Gupta
- Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, Scotland, UK
| | - Ashish Gulia
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
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18
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Aghighi M, Cloutier JM, Hoover WD, Roy K, Lo AA, Brown RA. Cutaneous desmoid-type fibromatosis: A rare case with molecular profiling. J Cutan Pathol 2021; 48:1185-1188. [PMID: 33978242 DOI: 10.1111/cup.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
Fibromatoses encompass a broad group of histopathologically similar fibroblastic/myofibroblastic proliferations with divergent clinical manifestations and behavior. Deep (desmoid-type) fibromatoses are typically large, rapidly growing, and locally aggressive tumors that occur in the abdominal wall, mesentery, and extra-abdominal soft tissue, principally the musculature of the trunk and extremities. Most sporadic cases of desmoid fibromatosis harbor inactivating mutations in CTNNB1, the gene encoding beta-catenin. Tumors occurring in the context of familial adenomatous polyposis and Gardner syndrome bear inactivating mutations in APC. By contrast, mutations in CTNNB1 or APC have not been identified in cases of superficial fibromatosis. Cutaneous involvement by desmoid fibromatosis is exceedingly rare. Here we present a 78-year-old male with desmoid-type fibromatosis arising in the dermis of the right medial calf with a pathogenic mutation in CTNNB1 and a variant of unknown significance in APC.
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Affiliation(s)
- Maryam Aghighi
- Department of Pathology, Rutgers Health-St. Barnabas Medical Center, Livingston, New Jersey, USA
| | | | - William D Hoover
- Dermatology Group of the Carolinas, Concord, North Carolina, USA
| | - Katherine Roy
- Dermatology Group of the Carolinas, Concord, North Carolina, USA
| | - Amy A Lo
- Department of Pathology, Stanford Medicine, Stanford, California, USA
| | - Ryanne A Brown
- Department of Pathology, Stanford Medicine, Stanford, California, USA.,Department of Dermatology, Stanford University, Stanford, California, USA.,Pathology and Laboratory Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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19
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Abstract
OBJECTIVES Fibromatosis is a rare tumor with a prevalence of 2-4 per million per year. Its occur-rence in the thyroid is very rare and to the best of our knowledge only five cases have been reported in the literature.Subject and Results. In this case report, we present a thirty-seven-year-old man without any significant past medical history, who presented with an anterior neck swelling and occasional cough for four months before admission. Sonographic-guided fine needle aspiration cytology studies reported a follicular neoplasm. Microscopic and immunohistochemical evaluation of the thyroidectomy specimen showed thyroid fibromatosis. The patient had no symptoms after surgery and no signs of recurrence after 2 years of follow-up.
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20
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Agnihotri MA, Sathe PA. Inclusion body fibromatosis - A report of four cases and review of literature. J Postgrad Med 2021; 67:24-26. [PMID: 33565473 PMCID: PMC8098864 DOI: 10.4103/jpgm.jpgm_774_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Inclusion body fibromatosis (IBF) also called the “Reye tumor” is a rare spindle cell proliferation with distinct clinicopathological features. This is a report of four cases of IBF from a single institute. Typical location, age, size of the lesion, bland histology, and paranuclear inclusions are the distinguishing features of this entity. Medical literature search reveals very few series of cases of IBF, the remaining cases being in the form of case reports. The aim of this report is to highlight the typical features of this rare entity.
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Affiliation(s)
- M A Agnihotri
- Department of Pathology, Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - P A Sathe
- Department of Pathology, Seth G. S. Medical College, Mumbai, Maharashtra, India
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21
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Ng WL, Teoh SY, See MH, Rahmat K, Jayalakshmi P, Ramli MT, Teh MS, Vijayananthan A. Desmoid Type Fibromatosis of the Breast Masquerading as Breast Carcinoma: Value of Dynamic Magnetic Resonance Imaging and Its Correlation. Eur J Breast Health 2021; 17:197-199. [PMID: 33870121 DOI: 10.4274/ejbh.galenos.2020.5482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/14/2020] [Indexed: 12/29/2022]
Abstract
Desmoid type fibromatosis of the breast is a rare stromal tumor that accounts for <0.2% of all breast tumors. Bilateral and multicentric lesions are extremely rare, with only less than ten cases reported in the literature. Although benign, it is locally aggressive with frequent recurrence in up to almost one-third of the cases. We experienced our first case of bilateral multicentric breast fibromatosis in a 19-year-old woman, with a paternal aunt diagnosed with breast cancer at age 30, who presented to our institution with the chief complaint of retracted nipples for 1 year. The patient denied any history of trauma to her chest. Sonography showed suspicious bilateral hypoechoic masses. Magnetic resonance imaging (MRI) was performed for further evaluation because of the extensive involvement of both the breasts. This report aimed to illustrate the main clinical, radiological, and histopathological characteristics of this rare disease to increase awareness of this entity and discuss the role of MRI.
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Affiliation(s)
- Wei Lin Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Yong Teoh
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
| | - Mee Hoong See
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
| | - Pailoor Jayalakshmi
- Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia (formerly)
| | | | - Mei Sze Teh
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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22
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Genco IS, Hackman K, Morrar D, Jin C, Santagada E, Hajiyeva S. The significance of enhancer of zeste homolog 2 (EZH2) expression in spindle cell lesions of the breast. Pathol Int 2021; 71:415-419. [PMID: 33730427 DOI: 10.1111/pin.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
Spindle cell lesions of the breast are rare entities and pose a diagnostic challenge for pathologists due to overlapping morphologic and immunohistochemical features. We evaluated EZH2 expression in various benign (fibromatosis (n = 8), myofibroblastoma (n = 7), neurofibroma (n = 1), nodular fasciitis (n = 5), benign phyllodes tumor (n = 18)) and malignant (malignant phyllodes tumor (n = 8), metaplastic breast carcinoma (n = 16) and angiosarcoma (n = 8)) spindle cell lesions as a potential diagnostic and therapeutic marker. The EZH2 expression was evaluated semi-quantitatively to categorize the cases as 'low' and 'high' expression. All benign lesions showed low EZH2 expression, whereas high EZH2 expression was observed in the majority (28/32; 88%) of malignant lesions. The study results suggest that EZH2 may be used both as an additional diagnostic tool to reach an accurate diagnosis of the spindle cell lesions of the breast and as a therapeutic target for the malignant lesions.
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Affiliation(s)
- Iskender Sinan Genco
- Department of Pathology, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Kayla Hackman
- Department of Pathology, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Doaa Morrar
- Department of Pathology, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Cao Jin
- Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eugene Santagada
- Department of Pathology, Northwell Health Lenox Hill Hospital, New York, NY, USA
| | - Sabina Hajiyeva
- Department of Pathology, Northwell Health Lenox Hill Hospital, New York, NY, USA
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23
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Kumar JN, Indirani M, Sampathirao N, Shelley S. Fibromatosis with aggressive demeanor: Benign impersonator of malignancy. World J Nucl Med 2020; 20:121-124. [PMID: 33850503 PMCID: PMC8034791 DOI: 10.4103/wjnm.wjnm_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/06/2022] Open
Abstract
Fibromatosis or desmoid fibromatosis is a rare benign neoplasm and develops commonly in the abdominal wall, abdominal cavity, or extra-abdominal sites. The mainstay of treatment is surgery. Chemotherapy and radiotherapy are preferred in cases of inoperable/relapse or a multifocal disease. Hereby, we report a case of fibromatosis arising in the left popliteal fossa, proven by histopathology and immunohistochemistry. Local excision of the mass was performed. The patient was asymptomatic for 6 months, after which she complained of difficulty in walking. Clinical evaluation elicited recurrence in the surgical bed. In spite of the surgical excision with tumor-free margins, recurrence was seen within a span of 6 months. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) was done to rule out multifocal disease and to define the extent of relapse. Although magnetic resonance imaging provides an excellent soft-tissue resolution to delineate the disease, 18F-FDG PET/CT is an important and supplementary tool which aids in the management of fibromatosis.
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Affiliation(s)
- J Naveen Kumar
- Department of Nuclear Medicine and PET CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - M Indirani
- Department of Nuclear Medicine and PET CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Nikita Sampathirao
- Department of Nuclear Medicine and PET CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - S Shelley
- Department of Nuclear Medicine and PET CT, Apollo Hospitals, Chennai, Tamil Nadu, India
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24
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Abstract
Desmoid-type fibromatosis (DF), also known as deep fibromatosis or desmoid tumor, is an extremely rare neoplasm that develops from fascia and musculoaponeurotic tissue. These tumors are characterized by slow progressive growth, local invasion, and local recurrence after surgical excision, but they lack metastatic potential. DF accounts for 3.5% of all fibrous tumors, with an annual incidence of approximately 2–4/million. Until now, only a small number of cases have been found in the chest wall. Herein, we present a rare case of chest wall DF in a 43-year-old female, which was discovered accidentally due to a thoracic wall mass that extended outward from the sternum. Computed tomography scans revealed a subcutaneous soft tissue mass anterior to the sternum, which was considered to be a mesenchymal tumor or an inflammatory lesion. The patient underwent surgical excision of the mass. The mass was completely removed and all margins were negative. According to the pathological results, the patient was finally diagnosed as DF. Postoperative radiotherapy was suggested subsequently, especially considering the locally aggressive and infiltrative nature of the tumor. However, this was rejected by the patient, and biannual re-examination was recommended instead. Despite the absence of postoperative radiotherapy, there was no evidence of local recurrence 2 years later. We consider regular postoperative follow-up may be able to replace postoperative radiotherapy, and if there exist an opportunity to completely resect the mass, surgical is a worthwhile choice.
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Affiliation(s)
- Yi Xiao
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinyuan He
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chulian Gong
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Libao Liu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaohong Huang
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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25
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Crombé A, Kind M, Ray-Coquard I, Isambert N, Chevreau C, André T, Lebbe C, Cesne AL, Bompas E, Piperno-Neumann S, Saada E, Bouhamama A, Blay JY, Italiano A; French Sarcoma Group. Progressive Desmoid Tumor: Radiomics Compared With Conventional Response Criteria for Predicting Progression During Systemic Therapy-A Multicenter Study by the French Sarcoma Group. AJR Am J Roentgenol 2020; 215:1539-48. [PMID: 32991215 DOI: 10.2214/AJR.19.22635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The response of desmoid tumors (DTs) to chemotherapy is evaluated with Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) in daily practice and clinical trials. MRI shows early change in heterogeneity in responding tumors due to a decrease in cellular area and an increase in fibronecrotic content before dimensional response. Heterogeneity can be quantified with radiomics. Our aim was to develop radiomics-based response criteria and to compare their performances with clinical and radiologic response criteria. MATERIALS AND METHODS. Forty-two patients (median age, 38.2 years) were included in this retrospective multicenter study because they presented with progressive DT and had an MRI examination at baseline, which we refer to as "MRI-0," and an early MRI evaluation performed after the first chemotherapy cycle (mean time after first chemotherapy cycle, 3 months [SD, 28 days]), which we refer to as "MRI-1." After signal intensity normalization, voxel size standardization, discretization, and segmentation of DT volume on fat-suppressed contrast-enhanced T1-weighted imaging, 90 baseline and delta 3D radiomics features were extracted. Using cross-validation and least absolute shrinkage and selection operator-penalized Cox regression, a radiomics score was generated. The performances of models based on the radiomics score, modified Response Evaluation Criteria in Solid Tumors, European Association for the Study of the Liver criteria, Cheson criteria, Choi criteria, and revised Choi criteria from MRI-0 to MRI-1 to predict progression-free survival (PFS, as defined by RECIST 1.1) were assessed with the concordance index. The results were adjusted for performance status, tumor volume, prior chemotherapy, current chemotherapy, and β-catenin mutation. RESULTS. There were 10 cases of progression. The radiomics score included four variables. A high score indicated a poor prognosis. The radiomics score independently correlated with PFS (adjusted hazard ratio = 5.60, p = 0.003), and none of the usual response criteria independently correlated with PFS. The prognostic model based on the radiomics score had the highest concordance index (0.84; 95% CI, 0.71-0.96). CONCLUSION. Quantifying early changes in heterogeneity through a dedicated radiomics score could improve response evaluation for patients with DT undergoing chemotherapy.
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26
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Singhal P, Namdev R, Sarangal H, Narang S. A Rare Case of non Syndromic Congenital Idiopathic Gingival Fibromatosis: Electrosurgical Management. J Clin Pediatr Dent 2020; 44:352-5. [PMID: 33181851 DOI: 10.17796/1053-4625-44.5.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Idiopathic gingival fibromatosis (IGF) is a rare, genetically heterogeneous condition that is usually a part of syndrome or, rarely, an isolated disorder. It is characterized by a slowly progressive, non hemorrhagic, fibrous enlargement of keratinized gingiva which usually begins at the time of eruption of permanent dentition, however very few cases involving the primary teeth have been described in literature. Congenital gingival fibromatosis is very rare condition in which the gingival tissues become thickened and erupting teeth remain submerged beneath hyperplastic tissue masses. This case report discusses the rare case of congenital non syndromic idiopathic gingival fibromatosis in a two year old boy who reported with absence of teeth and incompetent lips. Gingivectomy was done using modified microdissection electrocautery needle to remove the excess gingival tissues. Excised tissue has been examined histologically. The patient was followed up for a period of one year and no recurrence was observed.
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27
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Abstract
Benign myofibroblastic lesions can clinically and histologically be mistaken for sarcoma. Excessive and potentially disfiguring surgical treatment can be avoided by ruling out malignancy. We present the case of a low-grade, myofibroblastic lesion of the lip, which shows how detailed clinical examination rather than reliance on histopathological information alone helped to achieve this. Differential diagnoses of myofibroblastic lesions are also discussed.
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Affiliation(s)
- Veena Abigale Patel
- Oral Surgery Department, The Royal National ENT & Eastman Dental Hospitals, London, UK.,Oral Medicine Department, Leeds Dental Institute, Worsley Building, Leeds, UK
| | - Ambareen Naqvi
- Oral Surgery Department, The Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Sonita Koshal
- Oral Surgery Department, The Royal National ENT & Eastman Dental Hospitals, London, UK
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28
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Mahnashi Y, Alotaibi AS, Aldakhail M, Alshahrani A. Desmoid tumor at the gastrointestinal anastomosis after a one-anastomosis gastric bypass (mini-gastric bypass): a case report. J Surg Case Rep 2020; 2020:rjz411. [PMID: 32015825 PMCID: PMC6990101 DOI: 10.1093/jscr/rjz411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/30/2019] [Indexed: 12/28/2022] Open
Abstract
Desmoid tumors of the small bowel wall are rare tumors of the gastrointestinal tract. The signs and symptoms ranging from non-specific to severe abdominal pain to the sensation of a mass and abdominal fullness. We present the case of a 48-year-old man who presented 3 years post-one-anastomosis gastric bypass (mini-gastric bypass) with vague abdominal pain and early satiety of one-month duration. A CT scan of the abdomen revealed a well-defined compressive mass in the left hypochondrium. A laparoscopic exploration was performed, but it was converted into a laparotomy due to the huge size of the mass. The desmoid tumor at the gastrojejunal anastomosis was resected, followed by a Roux-en-Y reconstruction. The patient’s postoperative course was uneventful, and he was discharged on the seventh day post-operation. He did not show any signs or symptoms suggestive of complications or recurrence during his follow-up.
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Affiliation(s)
- Yasir Mahnashi
- General Surgery Department, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
| | - Atheer S Alotaibi
- General Surgery Department, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
| | - Mohammad Aldakhail
- General Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 3615, Saudi Arabia
| | - Amer Alshahrani
- General Surgery Department, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
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29
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Samejima J, Ito H, Yokose T, Nagashima T. Desmoid-type fibromatosis arising from thoracotomy incision. Clin Case Rep 2020; 8:389-390. [PMID: 32128196 PMCID: PMC7044401 DOI: 10.1002/ccr3.2634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Desmoid-type fibromatosis following thoracotomy is rare and has been previously reported only in <20 cases; however, it might mimic chest wall recurrence of previous cancer and needs differential diagnosis. When the tumor location corresponded to the thoracotomy incision, we should consider desmoid-type fibromatosis as a differential diagnosis.
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Affiliation(s)
- Joji Samejima
- Departments of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Ito
- Departments of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | | | - Takuya Nagashima
- Departments of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
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30
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Bauer BM, Williams NL, Zuckerman LM. Development of multifocal extra-abdominal desmoid fibromatosis after surgical resection. Clin Case Rep 2019; 7:2515-2519. [PMID: 31893092 PMCID: PMC6935608 DOI: 10.1002/ccr3.2551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023] Open
Abstract
Multifocal fibromatosis is a rare entity. We report on two cases where multifocal disease developed after surgical resection. Chronic inflammation and repetitive trauma may be considered a risk factor for developing multifocal disease.
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Affiliation(s)
- Brendon M. Bauer
- Department of Orthopaedic SurgeryLoma Linda University Medical CenterLoma LindaCAUSA
| | - Nadine L. Williams
- Department of Orthopaedic SurgeryLoma Linda University Medical CenterLoma LindaCAUSA
| | - Lee M. Zuckerman
- Division of Orthopaedic SurgeryCity of Hope National Medical CenterDuarteCAUSA
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31
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Ahmed AA, Vundamati D, Farooqi M, Repnikova E, Zinkus T, Hetherington M, Paulson L. Next-Generation Sequencing in the Diagnosis of Rare Pediatric Sinonasal Tumors. Ear Nose Throat J 2019; 100:NP263-NP268. [PMID: 31550935 DOI: 10.1177/0145561319863371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of desmoid fibromatosis or other spindle cell tumors in the sinonasal region is very rare in children and needs to be thoroughly confirmed with immunohistochemical and/or molecular tests. We report 2 patients with such rare tumors and describe the use of next-generation sequencing in their evaluation. A 3-year-old female had a 4.4-cm midline nasal cavity mass involving the bony septum and extending into the base of the skull bilaterally. The moderate cellular fibroblastic proliferation revealed areas of thick keloid-like collagen bands and other areas with myxoid edematous stroma. Deep targeted sequencing identified a novel G34V mutation in the CTNNB1 gene consistent with desmoid fibromatosis. An 11-month-old male infant presented with a right nasal mass that extended through the cribriform plate into the anterior cranial fossa and involved the right ethmoid sinus and adjacent right orbit. Histology revealed an infiltrative atypical fibrous proliferation with focal calcifications that was negative for CTNNB1 and GNAS mutations. A novel RET E511K variant was identified in the tumor and later was also found in the germline and hence rendered of unknown significance. Both cases highlight the utility of next-generation sequencing in the evaluation of pediatric sinonasal spindle cell tumors that may have overlapping pathologic features. Reporting of rare or novel variants in tumor-only sequencing should be cautiously evaluated in children and pairing with germline sequencing may be needed to avoid the pitfall of assigning uncommon variants.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Divya Vundamati
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Midhat Farooqi
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Elena Repnikova
- Department of Pathology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Timothy Zinkus
- Department of Radiology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Maxine Hetherington
- Department of Pediatrics Hematology-Oncology, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
| | - Lorien Paulson
- Department of Surgery, 4204Children's Mercy Hospital/University of Missouri, Kansas City, MO, USA
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Stone JJ, Prasad NK, Laumonerie P, Howe BM, Amrami KK, Carter JM, Jentoft ME, Spinner RJ. Recurrent desmoid-type fibromatosis associated with underlying neuromuscular choristoma. J Neurosurg 2019; 131:175-183. [PMID: 30168738 DOI: 10.3171/2018.3.jns152935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Desmoid-type fibromatosis (DTF) presents a therapeutic dilemma. While lacking metastatic potential, it is a locally aggressive tumor with a strong propensity for occurrence near nerve(s) and recurrence following resection. In this study, the authors introduce the association of an occult neuromuscular choristoma (NMC) identified in patients with DTF. METHODS After experiencing a case of DTF found to have an occult NMC, the authors performed a retrospective database review of all other cases of biopsy-proven DTF involving the extremities or limb girdles in patients with available MRI data. Two musculoskeletal radiologists with expertise in peripheral nerve imaging reviewed the MRI studies of the eligible cases for evidence of previously unrecognized NMC. RESULTS The initial case of a patient with an occult sciatic NMC is described. The database review yielded 40 patients with DTF-18 (45%) in the upper limb and 22 (55%) in the lower limb. Two cases (5%) had MRI findings of NMC associated with the DTF, one in the proximal sciatic nerve and the other in the proximal tibial and sural nerves. CONCLUSIONS The coexistence of NMC may be under-recognized in a subset of patients with extremity DTF. This finding poses implications for DTF treatment and the likelihood of recurrence after resection or biopsy. Further study may reveal crucial links between the pathogenesis of NMC and DTF and offer novel therapeutic strategies.
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Affiliation(s)
- Jonathan J Stone
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nikhil K Prasad
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pierre Laumonerie
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,2Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - B Matthew Howe
- 3Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
| | | | - Jodi M Carter
- 4Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mark E Jentoft
- 4Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
PURPOSE Desmoids are locally infiltrative, nonmalignant soft tissue tumors. Surgery, radiation therapy, and chemotherapy have been the mainstay of treatment, but relapse is common and side effects can result in significant morbidity. MR-HIFU is increasingly recognized as an alternative treatment modality. We assessed the success rate of MR-HIFU for the treatment of extra-abdominal desmoids at our institute. MATERIALS AND METHODS Five patients with relapsing desmoid tumors (three males, two females; age range 40-79 years) were treated using the Sonalleve system in an outpatient setting without general anesthesia. Changes in total tumor volumes were measured with a tumor tracking software. Adverse events were documented. RESULTS MR-HIFU was successful in all patients without severe side effects. Follow up ranged from 13 to 60 months. Three patients required more than one treatment session. In 3 patients with small lesions (mean = 9.7 mL), complete ablation was achieved with no evidence of viable tumor on follow up MRI at an average of 35.7 months, while in two patients with larger lesions (mean = 46 mL) the targeted tumor volumes decreased by 73% at 14 months. Skin injuries comprised first- and second-degree burns and were observed with short distance to skin (mean = 0.9 cm) and proximity to bone (i.e. ribs). Skin burns healed within weeks with topical treatment. CONCLUSION MR-HIFU shows good mid-term result for extra-abdominal desmoids with complete response for small lesions and stabilization of larger lesions. MR-HIFU for desmoids can be performed under regional anesthesia/sedation as outpatients.
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Affiliation(s)
- Arash Najafi
- a Department of Radiology and Nuclear Medicine , Canton Hospital Winterthur , Winterthur , Switzerland
| | - Bruno Fuchs
- b Department of Orthopedics and Trauma Surgery , Canton Hospital Winterthur , Winterthur , Switzerland
| | - Christoph A Binkert
- a Department of Radiology and Nuclear Medicine , Canton Hospital Winterthur , Winterthur , Switzerland
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Lacka DE, Nasierowska-Guttmejer A. Fibromatosis - immunohistochemical evaluation, differential diagnosis from gastrointestinal tumors, and other mesenchymal tumours. Prz Gastroenterol 2019; 14:79-85. [PMID: 30944681 DOI: 10.5114/pg.2019.83429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
Introduction Fibromatosis is a histologically benign growth of fibroblastic and myofibroblastic cells, with a potential to recur and invade local organs. It can occur as a superficial or deep form. Visceral fibromatosis and superficial fibromatosis are histologically similar. They both have alterations in the WNT signalling pathway, but mutations in the APC or β-catenin gene do not occur in superficial fibromatoses. Aim To present four cases of deep fibromatosis and one case of Peyronie’s disease, along with immunohistochemical staining analysis and the criteria for differential diagnosis. Material and methods All patients were hospitalised in the Central Clinical Hospital of the MSWiA in Warsaw during the period of 2012–2015. Surgical specimens were examined, and tissue samples were embedded in paraffin blocks. Results As the result of the study we present a short algorithm of immunostainings that can be useful in differential diagnosis. When a spindle cell tumour is encountered in the abdomen a gastrointestinal stromal tumor (GIST) should always be excluded; therefore, a CD117 staining is recommended as the first step. When the staining is negative, fibromatosis can be taken into consideration. β-Catenin staining should be done in order to confirm that diagnosis. Conclusions The diagnosis of fibromatosis is not always simple; GISTs can easily be mistaken for it. Immunohistochemical staining with CD34 and CD117 antibodies are useful in differential diagnosis. DTF should present negative stainings for S100, CD34, CD99, and bcl-2, which can help to distinguish it from other mesenchymal tumours.
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Morris G, Jacobson JA, Kalume Brigido M, Gaetke-Udager K, Yablon CM, Dong Q. Ultrasound Features of Palmar Fibromatosis or Dupuytren Contracture. J Ultrasound Med 2019; 38:387-392. [PMID: 30027660 DOI: 10.1002/jum.14699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To retrospectively characterize the ultrasound appearance of palmar fibromatosis in patients with a surgical or clinical diagnosis of palmar fibromatosis. METHODS A search of ultrasound reports from 2005 to 2015 and a subsequent search of medical records were performed to identify patients with a surgical or clinical diagnosis of palmar fibromatosis. The ultrasound images were retrospectively reviewed to record the lesion location, size, echogenicity, compressibility, hyperemia, and calcification. RESULTS A total of 36 patients were identified (average age, 60 years; 61% male), yielding a total of 55 palmar fibromatosis lesions, of which 2%, 7%, 29%, 36%, 20%, and 5% were located at the first, second, third, fourth, and fifth digits and between the fourth and fifth digits, respectively. The lesions were located directly superficial to the flexor tendons in 93% with their epicenters at the distal metacarpal in 89%. Average lesion dimensions were 13.1 mm in length, 6.8 mm in width, and 2.5 mm in depth. On ultrasound images, the lesions were characteristically hypoechoic (98%) and noncompressible (95%). Atypical features included calcification (2%), compressibility (5%), hyperemia on color Doppler images (6%), epicenters at the metacarpophalangeal joint (7%) or proximal phalanx (4%), and location superficial but lateral to the flexor tendons (7%). CONCLUSIONS Palmar fibromatosis most commonly appears hypoechoic and is located directly superficial to the flexor tendons with an epicenter at the distal metacarpal, most commonly the fourth digit. However, the epicenter location may be at the distal metacarpal and proximal phalanx of other digits, adjacent to the flexor tendons, with possible hyperemia and calcification.
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Affiliation(s)
- Gregory Morris
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | | | - Kara Gaetke-Udager
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Qian Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
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Cohen BE, Murthy NS, McKenzie GA. Ultrasonography of Plantar Fibromatosis: Updated Case Series, Review of the Literature, and a Novel Descriptive Appearance Termed the "Comb Sign". J Ultrasound Med 2018; 37:2725-2731. [PMID: 29603334 DOI: 10.1002/jum.14615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this series is to review the appearance of plantar fibromatosis with high-resolution ultrasonography (US) and highlight a new imaging sign termed the "comb sign." A retrospective study was performed for patients with a clinical diagnosis of plantar fibromatosis. Charts of 43 patients (age range, 26-77 years; mean age, 54 years) were reviewed to gather patient demographics and symptoms. Several US characteristics were evaluated with emphasis on any new imaging features. A total of 57 plantar fibromas in 43 patients were examined. Plantar fibromatosis was seen as a lobular marginated oval nodule along the superficial plantar fascia involving the central or medial cord, often at the middle third (84%) of the plantar fascia, showing posterior acoustic enhancement (65%), mixed echogenicity (82%), and intralesional vascularity (53%). Slightly more than half (51%) of the lesions showed a previously unrecognized appearance, designated the comb sign. This sign was more commonly seen in the setting of larger fibromas (P < .05). Plantar fibromatosis is usually a clinical diagnosis that can be aided by a typical US appearance. Although the imaging characteristics are largely similar to prior literature, this series suggests that most show mixed echogenicity and posterior acoustic enhancement, and approximately half show internal vascularity. A new US sign, termed the comb sign, shows alternating bands of hypoechogenicity and isoechogenicity, particularly in larger plantar fibromas, and can help in further characterization.
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Affiliation(s)
- Blake E Cohen
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA. Revision requested
| | - Naveen S Murthy
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA. Revision requested
| | - Gavin A McKenzie
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota, USA. Revision requested
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Silva S, Lage P, Cabral F, Alves R, Catarino A, Félix A, André S. Bilateral breast fibromatosis after silicone prosthetics in a patient with classic familial adenomatous polyposis: A case report. Oncol Lett 2018; 16:1449-1454. [PMID: 30008823 PMCID: PMC6036415 DOI: 10.3892/ol.2018.8853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/16/2018] [Indexed: 11/07/2022] Open
Abstract
Breast fibromatosis is a benign fibroblastic proliferation accounting for less than 0.2% of breast tumors. It presents sporadically or as a manifestation of familial adenomatous polyposis (FAP). Fibromatosis in FAP may develop in patients with adenomatous polyposis coli (APC) gene mutations at any location through the gene. Notably, there is an increased risk if mutation is downstream codon 1400. The present case report described a 33-year-old woman with recurrent bilateral breast fibromatosis after breast implants in a context of classic FAP. APC mutation (codon-935) was detected at the age of 16. In the same year, a thyroidectomy for a cribriform-morular papillary thyroid carcinoma (pT1) was performed. Seven years later, a prophylactic total colectomy with >100 adenomas without invasive carcinoma was performed and the patient was kept under surveillance. At the age of 30 years old, she underwent breast silicone implantation for cosmetic reasons. One year later, bilateral breast tumors were diagnosed in core biopsy as fibromatosis (nuclear β-catenin+, estrogen receptors-). After no success with medical treatment with tamoxifen, bilateral mastectomy was performed. The patient relapsed one year later and a fibromatosis lesion in the right thoracic wall was excised again. The patient demonstrated no signs of relapse 24 months after the surgery. This rare case illustrates that the increased risk of developing fibromatosis in patients with FAP, even in the classic form, should be considered before deciding to place breast implants.
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Affiliation(s)
- Sara Silva
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Francisco Cabral
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Rui Alves
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Ana Catarino
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Serviço de Anatomia Patológica do Hospital da Luz, 1500-650 Lisbon, Portugal
| | - Ana Félix
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Saudade André
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
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Hong AM, Jones D, Boyle R, Stalley P. Radiation Therapy as an Alternative Treatment for Desmoid Fibromatosis. Clin Oncol (R Coll Radiol) 2018; 30:589-592. [PMID: 29803344 DOI: 10.1016/j.clon.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
AIM To determine the outcome after radiation therapy for desmoid fibromatosis. MATERIALS AND METHODS A retrospective review of 50 patients treated between 1988 and 2016 in a specialised bone and soft tissue tumour clinic. RESULTS The median age at the time of radiation therapy was 36.8 years (range 15.1-69.0) and the median follow-up time was 51 months. Forty-three patients underwent radiation therapy as the definitive treatment with a median dose of 56 Gy (range 30-58.8 Gy). The median dose for the seven patients treated with postoperative radiation therapy was 50.4 Gy (range 48-56 Gy). Eleven patients (22%) developed progressive disease after radiation therapy at a median time of 41 months (range 12-113 months). The recurrences were within the radiation therapy field in four patients and outside the field in seven patients. One patient developed a radiation-induced malignancy 20 years after treatment. CONCLUSIONS Radiation therapy is an alternative treatment in the management of desmoid fibromatosis. It should be considered in patients for whom surgical resection is not feasible, or as adjuvant therapy after surgery with involved margins where any further recurrences would cause significant morbidity.
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Affiliation(s)
- A M Hong
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Australia.
| | - D Jones
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - R Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - P Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
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Eypper E, Lee J, Tarasen A, Weinberg M, Adetayo O. An Algorithmic Approach to the Management of Infantile Digital Fibromatosis: Review of Literature and a Case Report. Eplasty 2018; 18:e19. [PMID: 29780440 PMCID: PMC5950536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Objective: Infantile digital fibromatosis is a rare benign childhood tumor, infrequently cited in the literature. Hallmarks include nodular growths exclusive to fingers and toes and the presence of eosinophilic cytoplasmic inclusions on histology. This article aims to exemplify diagnoses of infantile digital fibromatosis and possible treatment options. Methods: A computerized English literature search was performed in the PubMed/MEDLINE database using MeSH headings "infantile," "juvenile," "digital," and "fibromatosis." Twenty electronic publications were selected and their clinical and histological data recorded and used to compile a treatment algorithm. Results: A 9-month-old male child was referred for a persistent, symptomatic nodule on the third left toe. A direct excision with Brunner-type incisions was performed under general anesthesia. The procedure was successful without complications. The patient has no recurrence at 2 years postsurgery and continues to be followed. Histological examination revealed a proliferation of bland, uniformly plump spindle cells with elongated nuclei and small central nucleoli without paranuclear inclusions consistent with fibromatosis. Conclusions: Asymptomatic nodules should be observed for spontaneous regression or treated with nonsurgical techniques such as chemotherapeutic or steroid injection. Surgical removal should be reserved for cases with structural or functional compromise.
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Samardzic T, Lømo J, Skaane P. Screening-detected desmoid tumor of the breast: findings at conventional imaging and digital breast tomosynthesis. Acta Radiol Open 2018; 7:2058460117752034. [PMID: 29375894 PMCID: PMC5777554 DOI: 10.1177/2058460117752034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 01/27/2023] Open
Abstract
Desmoid tumor of the breast is a rare benign entity that usually is mistaken for carcinoma clinically and radiologically. We report two cases of desmoid tumor of the breast detected by mammography screening using digital breast tomosynthesis (DBT). The larger tumor was detected at both full-field digital mammography (FFDM) and DBT. The smaller desmoid tumor, however, was identified only at tomosynthesis. Mammographic and ultrasonographic findings at diagnostic work-up were consistent with carcinoma of the breast. Preoperative needle biopsies could not conclusively diagnose the lesions. Both patients underwent excisional biopsy and histopathology revealed fibromatosis of the desmoid type.
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Affiliation(s)
| | - Jon Lømo
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Per Skaane
- Department of Radiology, Oslo University Hospital, University of Oslo, Oslo, Norway
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Chi Z, Mangus RS, Kubal CA, Chen S, Lin J. Multivisceral transplant is a viable treatment option for patients with non-resectable intra-abdominal fibromatosis. Clin Transplant 2017; 32:e13186. [PMID: 29288580 DOI: 10.1111/ctr.13186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intra-abdominal fibromatosis often involves the mesentery root which is non-resectable by conventional surgery. Multivisceral transplant (MVT), as a potential cure to non-resectable fibromatosis, has rarely been reported and the prognosis is unknown. METHODS Six patients who underwent MVT for intra-abdominal fibromatosis were reviewed. Clinicopathological features, immunohistochemistry for β-catenin, p53, and Ki67, and outcomes were evaluated. Appropriate data for comparative analysis were obtained from a cohort of 24 patients who underwent conventional resection for intra-abdominal fibromatosis. RESULTS Among six MVT patients, four had familial adenomatous polyposis (FAP). Two patients had an initial intestinal transplantation, three had multiple prior surgeries, and two had adjuvant therapy. One patient died of hemorrhagic stroke shortly after MVT, and five patients (83%) survived with a median follow-up of 64 months. The 1-year and 5-year survival rates were 67% for all five patients. Two patients had recurrences after MVT and one of them had FAP. In comparison, six of 24 patients who underwent conventional surgery had FAP; six (25%) had recurrences and three had FAP. For FAP patients; the mean recurrence time was 13 months for MVT versus 6 months for conventional surgery. Ki67 proliferative index, β-catenin, and p53 expression did not significantly correlate to recurrence. CONCLUSIONS Multivisceral transplant (MVT) is a viable option for patients who have non-resectable intra-abdominal fibromatosis with promising surviving rates, although recurrence still occurs. Surgical margin, Ki67 proliferative index, β-catenin, and p53 expression are not predicative for recurrence of fibromatosis.
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Affiliation(s)
- Zhikai Chi
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Mangus
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Zaragoza MV, Nguyen CHH, Widyastuti HP, McCarthy LA, Grosberg A. Dupuytren's and Ledderhose Diseases in a Family with LMNA-Related Cardiomyopathy and a Novel Variant in the ASTE1 Gene. Cells 2017; 6:E40. [PMID: 29104234 PMCID: PMC5753070 DOI: 10.3390/cells6040040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/07/2017] [Accepted: 10/27/2017] [Indexed: 12/23/2022] Open
Abstract
Dupuytren's disease (palmar fibromatosis) involves nodules in fascia of the hand that leads to flexion contractures. Ledderhose disease (plantar fibromatosis) is similar with nodules of the foot. While clinical aspects are well-described, genetic mechanisms are unknown. We report a family with cardiac disease due to a heterozygous LMNA mutation (c.736C>T, p.Gln246Stop) with palmar/plantar fibromatosis and investigate the hypothesis that a second rare DNA variant increases the risk for fibrotic disease in LMNA mutation carriers. The proband and six family members were evaluated for the cardiac and hand/feet phenotypes and tested for the LMNA mutation. Fibroblast RNA studies revealed monoallelic expression of the normal LMNA allele and reduced lamin A/C mRNAs consistent with LMNA haploinsufficiency. A novel, heterozygous missense variant (c.230T>C, p.Val77Ala) in the Asteroid Homolog 1 (ASTE1) gene was identified as a potential risk factor in fibrotic disease using exome sequencing and family studies of five family members: four LMNA mutation carriers with fibromatosis and one individual without the LMNA mutation and no fibromatosis. With a possible role in epidermal growth factor receptor signaling, ASTE1 may contribute to the increased risk for palmar/plantar fibromatosis in patients with Lamin A/C haploinsufficiency.
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Affiliation(s)
- Michael V Zaragoza
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
- Department of Biological Sciences, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Cecilia H H Nguyen
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Halida P Widyastuti
- UCI Cardiogenomics Program, Department of Pediatrics, Division of Genetics & Genomics, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
- Department of Biological Sciences, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Linda A McCarthy
- Department of Biomedical Engineering and The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, CA 92697, USA.
| | - Anna Grosberg
- Department of Biomedical Engineering and The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, CA 92697, USA.
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Harati K, Jaenisch A, Behr B, Goertz O, Harati A, Hirsch T, Stricker I, Lehnhardt M, Daigeler A. Effect of surgical margins on prognosis in aggressive fibromatosis: A single-institutional analysis of 90 patients. Oncol Lett 2017; 14:5129-5134. [PMID: 29113152 PMCID: PMC5661366 DOI: 10.3892/ol.2017.6864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/17/2016] [Indexed: 12/03/2022] Open
Abstract
The treatment of aggressive fibromatosis poses a therapeutic challenge in an interdisciplinary setting. The extent of surgical resection is still discussed controversially. The present retrospective analysis aimed to determine prognostic factors leading to recurrence. Between 2000 and 2014, 114 patients with aggressive fibromatosis were treated surgically at BG-University Hospital Bergmannsheil (Bochum, Germany). Univariate and multivariate analyses were restricted to 90 participants with information available on surgical margins at the initial procedure. The median follow-up time was 7.7 years. A total of 45 patients (50%) developed recurrence during follow-up. Primary tumors were resected with negative margins (R0) in 50 patients (68%) and with microscopically positive margins (R1) in 28 patients (25%). In addition, tumors in 12 patients (7%) were resected with macroscopically positive margins at the initial surgical procedure. The rates of recurrence-free survival (RFS) after 5 years were 68.8% [95% confidence interval (CI), 53.5–79.9%] in patients with R0-resected primary tumors and 34.1% (95% CI, 19.9–48.9%) in patients with R1/R2-status (P=0.001). Narrow and wide clear margins within the R0-group were not associated with significantly different outcomes. Adjuvant radiation, tumor site and patient age were not associated with a significant alteration of RFS. The current results suggest that the attainment of microscopically negative surgical margins at the initial surgical treatment is associated with a significantly improved prognosis. A conservative surgical approach involving the attainment of narrow negative margins while preserving function should be sought in patients in whom tumor resection is indicated. The decision for resection should be made interdisciplinary in each case based on tumor progression, available treatment alternatives and the decision of the informed patient.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Anais Jaenisch
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Ali Harati
- Department of Neurosurgery, Klinikum Dortmund, D-44145 Dortmund, Germany
| | - Tobias Hirsch
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, D-44789 Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany
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Abstract
RATIONALE Intraabdominal fibromatosis is a rare benign tumor that often affects the mesentery or retroperitoneum, and can infiltrate adjacent organs. However, it is rare for fibromatosis to arise from the small intestinal wall. PATIENT CONCERNS A 27-year-old female with a tangible abdominal tumor is described. DIAGNOSES The computed tomography (CT) scan revealed a 7.5 cm, small intestine-associated tumor in the right abdomen. INTERVENTIONS The patient received tumor resection and intestinal anastomosis. OUTCOMES Further pathological examination confirmed the tumor as a duodenal fibromatosis that infiltrated the intestinal wall. To the best of our knowledge, this is the first report of a duodenum-derived fibromatosis that invaded the muscular layer of the intestine. LESSONS Our study demonstrated that an unexplained abdominal mass should be noteworthy and properly treated.
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Affiliation(s)
- Jiannan Li
- Department of General Surgery, The Second Hospital of Jilin University
| | - Hanxiang Le
- Department of General Surgery, The Second Hospital of Jilin University
| | - Wei Chai
- Department of Gynecology and Obstetrics, The First Hospital of Jilin University
| | - Yan Zhou
- Department of General Surgery, The Second Hospital of Jilin University
| | - Lifang Jin
- Department of Hematology and Oncology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Tongjun Liu
- Department of General Surgery, The Second Hospital of Jilin University
| | - Kai Zhang
- Department of General Surgery, The Second Hospital of Jilin University
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Abstract
Desmoid-type fibromatosis of the breast (also referred to as desmoid tumor or aggressive fibromatosis) is exceedingly rare. Although it does not metastasize, desmoid-type fibromatosisis is frequently locally aggressive. Recurrence is common (up to 35%), even after presumed total excision of the primary tumor [1]. The breast is an unusual location for the development of this tumor, with relatively few cases reported in the literature. We report a case of desmoid-type fibromatosis in the breast in a 31-year-old female who presented with a four-month history of a palpable left breast mass. Her imaging was discordant, so she underwent surgical excision of the mass. Multiple positive margins were present. She underwent re-excision to the level of the sternum medially. Final pathology showed a focally positive posterior margin, without muscle or fascial involvement. The patient's case was discussed at the multidisciplinary tumor board conference and no further intervention was recommended. To our knowledge, this is the first case report in the literature in which negative margins were unable to be achieved for desmoid tumors of the breast operatively.
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Abstract
Desmoid tumors are fibroblastic connective tissue tumors that most commonly develop within the anterior abdominal wall. The etiology of desmoid tumors has not been well defined; however, hereditary, hormonal, traumatic, and surgery-related causes have been implicated. Desmoid tumors are believed to arise from musculoaponeurotic structures. Development in the breast is very rare. Several reports of desmoid tumors arising in the vicinity of the fibrous capsule of a breast implant have been described, but to date, the authors are not aware of any published cases following autologous breast reconstruction. This report describes a desmoid tumor developing after a muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction and subsequent surgical management.
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Affiliation(s)
- Christine Oh
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ziyad S Hammoudeh
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian T Carlsen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Abstract
Background: Pyrocarbon implants represent an increasingly popular method to treat proximal interphalangeal joint dysfunction. To this point, no association has been shown between pyrocarbon biomaterials and fibromatosis. We present a potentially serious and destructive complication associated with pyrocarbon arthroplasty. Methods: We demonstrate a clinical case involving pyrocarbon arthroplasty and subsequent fibromatosis development in an otherwise healthy 23-year-old female. To present this association, we illustrate the diagnostic workup involved in a rapidly expanding soft tissue mass of the hand and explain the appropriate treatment. Results: Pyrocarbon arthroplasty was associated with development of locally destructive fibromatosis confirmed by histopathological examination. Treatment involved wide resection with preservation of local structures. Conclusion: We describe the first association between fibromatosis and pyrocarbon biomaterial. Due to fibromatosis destructive effects, clinicians should be aware of potential complications associated with these materials and know how to accurately diagnose and treat these lesions.
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Affiliation(s)
- Jacob Rinkinen
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Kevin C. Chung
- University of Michigan Health System, Ann Arbor, MI, USA,Kevin C. Chung, Section of Plastic Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, USA.
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48
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Abstract
Although the role of the skin in the development and propagation of Dupuytren disease remains unclear, dermofasciectomy and full-thickness skin grafting (FTSG) appears to delay recurrence. In 2011, a 71-year-old, left-handed man presented with recurrent Dupuytren disease in the dominant hand. In 1991, he originally underwent a primary dermofasciectomy and FTSG for Dupuytren disease involving the palmar skin. Twenty years later, the left middle finger was drawn into flexion by a recurrent cord, and the old graft and adjacent palmar skin were clinically involved by fibromatosis. We performed a revision dermofasciectomy and FTSG. Microscopic analysis of the excised graft demonstrated dense infiltration of the entire skin graft by Dupuytren disease, with areas of active and burnt-out fibromatosis distinct from hypertrophic scarring. This report of Dupuytren fibromatosis infiltrating a skin graft raises questions about the pathophysiology of Dupuytren disease.
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Affiliation(s)
- Ryckie George Wade
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Laszlo Igali
- Department of Histopathology and Immunohistochemistry, The Cotman Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Andrea Figus
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Department of Medical Education, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.
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Parra C, Eisen C, Arleo EK. Unusual findings in the male breast patient: a case series. Breast Dis 2016; 35:133-8. [PMID: 25267371 DOI: 10.3233/bd-140391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this case series, we present the history and imaging of several male patients with breast complaints. Given the rise in men presenting with breast cancer, from 1 in 100,000 in the 1970s to 1.5 in 100,000 in 2012 [1,2], these cases presented here together provide the useful reminder that a comprehensive clinical history and focal physical examination is critical when assessing the symptomatic male (as well as female) patient with a breast complaint.
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Abstract
Desmoid tumors represent a nonmalignant proliferation of fibroblast-related cells. These rare tumors are difficult to treat and often persist as indolent, lifelong conditions. There are a number of treatments available for both anatomic and symptom regression. Some of these treatments, unfortunately, may not provide long-lasting results and may result in further complications. Pain is a distressing symptom that may be due to the tumor itself or the result of utilized treatments. Pharmacologic therapies represent a noninvasive alternative to surgical resection. Pain symptoms require therapeutic regimens that must be modified as the tumor evolves in expression. The individualized pain treatment program utilized may often reflect principles used in both nonmalignant and malignant pain management models. This review seeks to increase awareness of desmoid tumors through a review of the literature and discussion of its pharmacotherapeutic management.
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