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Khozamah Z, Mdawr E, Rahme MN, Halakey W, Hamchou MH, Torbey A. Uncommon encounter: Nasopharyngeal desmoid tumor: A case report. Int J Surg Case Rep 2024; 123:110256. [PMID: 39288481 DOI: 10.1016/j.ijscr.2024.110256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/01/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Desmoid tumors, also known as aggressive fibromatosis, are rare benign tumors originating from the musculoaponeurotic stroma. While desmoid tumors in the head and neck region are documented, those located in the nasopharynx are exceptionally rare. CASE PRESENTATION A 26-year-old male presented with a three-year history of left nasal obstruction. A CT scan revealed a mass measuring 5.9 × 4.6 × 3.2 cm occupying the left nasal cavity and nasopharynx, with invasion into the maxillary sinus wall. A biopsy confirmed the presence of a nasopharyngeal desmoid tumor. The patient subsequently underwent endoscopic resection followed by radiotherapy. DISCUSSION Nasopharyngeal desmoid tumors pose a significant diagnostic challenge due to their rarity. The use of MRI and CT scans is crucial for accurate diagnosis, despite their histologically benign nature. It is important to note that these tumors can mimic malignant lesions, emphasizing the necessity for a thorough and meticulous evaluation during the diagnostic process. CONCLUSION This case underscores the diagnostic and therapeutic complexities associated with nasopharyngeal desmoid tumors. Increased reporting and documentation of such cases are essential to enhance the understanding and management of this rare condition.
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Affiliation(s)
| | - Elias Mdawr
- Department of ENT, Ibn Al-Nafees Hospital, Damascus, Syria
| | | | - Wasem Halakey
- Department of ENT, Ibn Al-Nafees Hospital, Damascus, Syria
| | - Mhd Hani Hamchou
- General Assembly of Damascus Hospital, Radiology Department, Damascus, Syria
| | - André Torbey
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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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] [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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Sahni M, Singh S, Lakhera KK, Babu A, Sharma R. Maxillary Fibromatosis: A Rare Clinical Report and Its Review of Literature. Indian J Otolaryngol Head Neck Surg 2024; 76:1430-1433. [PMID: 38440668 PMCID: PMC10908677 DOI: 10.1007/s12070-023-04225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
Fibromatosis is a rare locally aggressive benign tumour which arises from the musculoaponeurotic structures throughout the body. In the oral and maxillofacial region, It has been described under a variety of synonyms, including 'extra articular desmoids', 'desmoids tumours', 'grade-1 fibrosarcomas','non metastasizing fibrosarcoma'and 'aggressive fibromatosis'. The pecularity of this entity in paranasal sinuses is that it is rare in this location and are locally aggressive with higher rates of recurrence in a relatively restricted area.The purpose of this study is to present a rare case report and reviewing the literature of this entity.
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Affiliation(s)
- Manish Sahni
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Kamal Kishore Lakhera
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Agil Babu
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
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4
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Kasliwal A, Ahuja P, Jain K. Desmoid Fibromatosis of Maxillary Sinus Masquerading as Nasal Polyp: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1355-1360. [PMID: 38440630 PMCID: PMC10909069 DOI: 10.1007/s12070-023-04347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 03/06/2024] Open
Abstract
Desmoid fibromatosis is also known as aggressive fibromatosis. It is a neoplastic monoclonal proliferation of fibroblasts, with an incidence of 2 to 4 per million per year. Its incidence peaks at 8 years of age and in the third/fourth decades of life. Here we discussed a patient in third decade of life who presented with unilateral nasal blockage with a picture suggestive of sinonasal polyposis on examination. On histopathology, he was diagnosed with Desmoid fibromatosis. Though a rare entity, Desmoid fibromatosis should be kept in mind as a differential diagnosis for appropriate patient management. As per our knowledge, in India this is the first documented case of desmoid fibromatosis arising from maxillary sinus.
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Affiliation(s)
- Ashwath Kasliwal
- Department of Otorhinolaryngology, Eternal Heart Care Centre, Jaipur, India
| | - Paridhi Ahuja
- Department of Otorhinolaryngology, Eternal Heart Care Centre, Jaipur, India
| | - Khushi Jain
- Department of Pathology, Dr. K.C. Kasliwal Ear Nose Throat Centre, Jaipur, India
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5
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Sharma AE, Kerr DA, Cipriani NA. Small biopsies in the head and neck: Bone and soft tissue. Semin Diagn Pathol 2023; 40:353-370. [PMID: 37453847 DOI: 10.1053/j.semdp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/30/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.
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Affiliation(s)
- Aarti E Sharma
- Hospital for Special Surgery, New York, NY, United States
| | - Darcy A Kerr
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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6
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Pribuišis K, Vaidelys L, Piluckis J, Padervinskis E, Vaitkus S, Šarauskas V. Recurring desmoid tumor of the neck: A case report. Clin Case Rep 2023; 11:e7227. [PMID: 37077724 PMCID: PMC10106930 DOI: 10.1002/ccr3.7227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
The infiltrative growth pattern of desmoid tumors and their proximity to important anatomical structures make them difficult to manage. Mutilating surgery should be avoided, while surveillance or radiotherapy remain valid options.
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Affiliation(s)
- Kipras Pribuišis
- Department of OtolaryngologyAcademy of Medicine, Lithuanian University of Health SciencesKaunasLithuania
| | - Lukas Vaidelys
- Department of OtolaryngologyAcademy of Medicine, Lithuanian University of Health SciencesKaunasLithuania
| | - Julius Piluckis
- Department of OtolaryngologyAcademy of Medicine, Lithuanian University of Health SciencesKaunasLithuania
| | - Evaldas Padervinskis
- Department of OtolaryngologyAcademy of Medicine, Lithuanian University of Health SciencesKaunasLithuania
| | - Saulius Vaitkus
- Department of OtolaryngologyAcademy of Medicine, Lithuanian University of Health SciencesKaunasLithuania
| | - Valdas Šarauskas
- Department of Pathology, Academy of MedicineLithuanian University of Health SciencesKaunasLithuania
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7
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Raghani MJ, Agarwal SS, Ansari HMN. Infantile fibromatosis of the mandible- Is radical treatment justified? Natl J Maxillofac Surg 2023; 14:136-139. [PMID: 37273428 PMCID: PMC10235749 DOI: 10.4103/njms.njms_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/06/2023] Open
Abstract
Infantile fibromatosis is characterized by proliferation of fibrous soft tissue with a potential of invading the adjacent structures but lacks the ability to metastasize, thus making it a fairly benign lesion with borderline characteristics. The pathology resembles sarcomatous growth, therefore making it difficult for the clinician to correctly diagnose. There are two variants of extra-abdominal desmoid juvenile and adult variant depending upon the age group it predominately involves. Fibromatosis is comparatively a rare tumour with unpredictable growth and varying local recurrence rates. The mass usually grows slowly, rapid growth and recurrences being mostly associated with the juvenile forms. The disease may present as single or multifocal lesion with widespread distribution, thus requiring whole body scans to identify any insidious growth elsewhere. Here, we report a case of recurrent juvenile/infantile fibromatosis in a 2-year-old child, conservatively managed without any growth disturbance and signs of recurrence.
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Affiliation(s)
- Manish J. Raghani
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subham S. Agarwal
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Hafiz M. N. Ansari
- Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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8
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Zhong YW, Lyu XM, Shi Y, Guo CB, Zhang JG, Zheng L. Long-term result of 125 I seed brachytherapy for pediatric desmoid tumor in the head and neck. Pediatr Blood Cancer 2023; 70:e30037. [PMID: 36184787 DOI: 10.1002/pbc.30037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Desmoid tumor (DT) is rare and challenging, often affects the head and neck (HN) region in children, and its appropriate treatments are under-discussed. This study aimed to retrospectively evaluate the long-term effectiveness and safety of 125 I seed brachytherapy for pediatric DT in HN. PROCEDURE Seven pediatric patients with a median age of three years who suffered from DT in HN treated with 125 I brachytherapy from January 2008 to June 2018 were included. Among these, five underwent sole brachytherapy and the others combined with surgery under prescription doses ranging from 10,000 to 12,000 cGy. The rate of local control (LC), complete response (CR), and partial response (PR) was calculated after evaluation by radiological and pathological means. Radiation-associated toxicities were also evaluated. RESULTS The LC rate was 7/7 during the follow-up time ranging from 43 to 135 months and with a mean of 57 months. No recurrent lesion was found in the patients receiving surgery combined with brachytherapy. In patients treated with sole brachytherapy, the radiological PR rate and CR rate were 4/5 and 1/5, respectively. In those reaching radiological PR, 3/4 were pathological CR. Slight acute radiation-associated toxicities were observed in all patients, and no late or severe acute toxicity was observed. CONCLUSION 125 I brachytherapy is effective and safe in the management of pediatric DT in HN as the sole modality or combined with surgery in the long term.
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Affiliation(s)
- Yi-Wei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Xiao-Ming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,National Center of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China
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9
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Peroša N, Urbančič J, Felbabić T, Stefanović M, Pižem J, Bošnjak R. Desmoid-type fibromatosis of paranasal sinuses with intracranial extension in a child-acase-based review. Childs Nerv Syst 2021; 37:3673-3680. [PMID: 34611763 DOI: 10.1007/s00381-021-05200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Desmoid-type fibromatosis (DF) is clonal fibroblastic proliferation that arises in the deep soft tissues, tends to reoccur, and is locally invasive. Desmoid-type fibromatosis of paranasal sinuses with intracranial extension is a rare condition that is even rarer in a small child. We aim to share with the reader our literature review, decision-making, and endoscopic endonasal operation procedure that combined gained us favorable results against this benign tumor with unpredictable natural history and disease course. CASE REPORT We describe the decision-making process in the management of a 3-year-old boy with a history of sudden vision loss and vomiting. MR showed an expansive well-delineated homogeneous tumor in the sphenoid sinus with intracranial extension and optic nerves compression. The diagnosis of a sporadic form of desmoid-type fibromatosis was made using genetic testing of tumor tissue. A total gross removal was carried out with endoscopic endonasal microsurgical approach. At a 3-month follow-up, the patient is without any signs of recurrance. CONCLUSION The treatment of children with desmoid-type fibromatosis requires a multidisciplinary approach by clinicians experienced with the management of pediatric cancer. While the desmoid-type fibromatosis is a benign, locally invasive tumor, observation should be the first step in the management. In case of life-threatening or symptomatic cases, operations that preserve function and structure should be the first choice for this benign tumor with unpredictable natural history and disease course.
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Affiliation(s)
- Nina Peroša
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Felbabić
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Milica Stefanović
- Department of Oncology and Haematology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jože Pižem
- Faculty of Medicine, Institute of Pathology, University of Ljubljana, Ljubljana, Slovenia
| | - Roman Bošnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
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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] [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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11
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Zhao CX, Dombrowski ND, Perez-Atayde AR, Robson CD, Afshar S, Janeway KA, Rahbar R. Desmoid tumors of the head and neck in the pediatric population: Has anything changed? Int J Pediatr Otorhinolaryngol 2021; 140:110511. [PMID: 33271436 DOI: 10.1016/j.ijporl.2020.110511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pediatric head and neck desmoid tumors are rare neoplasms that can cause significant morbidity due to infiltration of vital anatomic structures. The goal of this study is to review presentation, evaluation, and management of these tumors. METHODS Retrospective study of children with head and neck desmoid tumors treated from 1999 to 2018 and literature review. RESULTS 11 patients (5 boys, 6 girls) were included. Presentation included firm neck mass (n = 8), trismus (n = 2) and tongue lesion (n = 1). All patients had preoperative imaging with CT (n = 2), MRI (n = 1) or both (n = 8). Five patients underwent needle biopsy, five had open biopsy and one was diagnosed on pathology from primary excision. Seven patients were treated by primary surgical resection, with positive surgical margins in six cases due to proximity to vital neurovascular structures. None needed chemotherapy, had disease recurrence or progression. Three patients with unresectable disease were treated with chemotherapy. One patient was monitored with imaging without any treatment and did not have disease progression. Follow-up ranged from 6 months to 6 years (median 21 months). Ten patients (7 surgical, 2 chemotherapy, 1 observation) were either disease-free or had stable disease at last follow-up. CONCLUSION Pediatric head and neck desmoid tumors, though rare and histologically benign, are locally infiltrative and aggressive. When feasible, surgical treatment results in good disease control despite positive margins. A balance between achieving negative margins and minimizing functional deficits should be considered. Chemotherapy can be successfully utilized in patients where surgery entails a high risk of morbidity and mortality.
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Affiliation(s)
- Cher X Zhao
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Boston, MA, United States; Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, MA, United States; Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Salim Afshar
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA, United States; Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, United States
| | - Katherine A Janeway
- Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States; Department of Otolaryngology, Harvard Medical School, Boston, MA, United States.
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12
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Liechty AE, Liu Y, Kao DS. Brachial Plexus Desmoid Tumor: Care for Functional Preservation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3293. [PMID: 33425605 PMCID: PMC7787275 DOI: 10.1097/gox.0000000000003293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Desmoid tumors are a rare, locally invasive, non-metastasizing tumor of mesenchymal origin. Most of such tumors occur sporadically, but some arise as part of germline adenomatous polyposis coli mutations. They tend to aggregate in the abdomen, thorax, extremities, and the head and neck region. They are challenging to treat, with a high rate of recurrence even if achieving negative margins. We present the case of an 18-year-old woman with a desmoid tumor involving her brachial plexus. A non-oncological resection was performed, with a focus on functional preservation. Residual disease is being treated with β-catenin inhibitor and monitored with serial MRI.
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Affiliation(s)
- Andrew E. Liechty
- From the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash
| | - Yusha Liu
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Dennis S. Kao
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash
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13
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Pallarés Martí B, Oishi N, Valdivieso L, Zapater E, Basterra J. A giant desmoid neck tumor: a case report. Braz J Otorhinolaryngol 2020; 87:634-637. [PMID: 33334709 PMCID: PMC9422679 DOI: 10.1016/j.bjorl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Natsuki Oishi
- Valencia General Hospital, ENT Department, Valencia, Spain.
| | | | - Enrique Zapater
- Valencia Medical School, Surgical Department, Valencia, Spain
| | - Jorge Basterra
- Valencia Medical School, Surgical Department, Valencia, Spain
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14
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Niu X, Jiang R, Hu C. Radiotherapy in the treatment of primary or recurrent unresectable desmoid tumors of the neck. Cancer Invest 2019; 37:387-392. [DOI: 10.1080/07357907.2019.1656731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xiaoshuang Niu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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15
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Postoperative radiotherapy in primary resectable desmoid tumors of the neck: a case-control study. Strahlenther Onkol 2019; 195:1001-1006. [PMID: 31172208 DOI: 10.1007/s00066-019-01479-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Desmoid tumors (DTs) are rare soft tissue tumors, which frequently recur after surgery. The optimal treatment approach is still controversial due to lack of randomized data. The purpose of the study was to review a relative large series of DTs of the neck with emphasis on the value of postoperative radiotherapy (RT). METHODS A total of 68 patients with DTs of the neck region with or without postoperative RT between 1/2008 and 12/2017 were included. They were individually matched for factors including age, gender, tumor size and margin status with a cohort of patients who underwent operative without postoperative RT. The event-free survival (EFS) was compared in the two groups. RESULTS For the study, 34 patients and 34 matched control subjects were identified. The two groups did not differ in terms of age (p = 0.810), gender (p = 0.328), tumor size (p = 0.803) and margin status (p = 0.799). Patients who received surgery plus RT had a significantly higher 3‑year EFS than those who received surgery alone (74.6% vs. 13.3%, P < 0.001). Factors including postoperative RT and margin status were independent factors of EFS. The values of P were <0.001 and 0.003 and the hazard ratios (95% confidence interval) were 11.929 (4.732-30.072) and 0.299 (0.133-0.671), respectively. None of the patients treated with RT developed serious complications. CONCLUSIONS According to our results, postoperative radiotherapy is an effective treatment in desmoid tumors of the neck. Multi-institutional and prospective studies are warranted to further validate our findings.
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16
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Rodrigues G, Sanjeev Ballal D, Pai K, Carnelio S, Singhal V, Akhtar S. Facial fibromatosis: benign and aggressive, yet treatable! JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fibromatosis or desmoid tumors are locally aggressive neoplasms that have a propensity for local invasion and recurrence. The mainstay of treatment is excision with negative margins and the role of radiotherapy is controversial. Desmoids arising in the head and neck area are rare and pose a dilemma to the surgeon due to large number of vital structures that preclude resection with wide margins. This leads to a high incidence of recurrence. We present a case of a 24-year-old male who presented with an asymptomatic left sided facial swelling causing cosmetic deformity. A subcutaneous lipoma/fibroma/neuroma was suspected and a fine needle aspiration done was inconclusive. Computed tomography revealed a subcutaneous swelling that was excised. Histopathology revealed it to be a desmoid tumor. At the end of 4-year-follow-up, he has no local recurrence.
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17
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Timbergen MJM, van de Poll-Franse LV, Grünhagen DJ, van der Graaf WT, Sleijfer S, Verhoef C, Husson O. Identification and assessment of health-related quality of life issues in patients with sporadic desmoid-type fibromatosis: a literature review and focus group study. Qual Life Res 2018; 27:3097-3111. [PMID: 30014458 PMCID: PMC6244798 DOI: 10.1007/s11136-018-1931-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE Sporadic desmoid-type fibromatosis (DTF) is a rare, chronic, non-metastasising, disease of the soft tissues. It is characterised by local invasive and unpredictable growth behaviour and a high propensity of local recurrence after surgery thereby often having a great impact on health-related quality of life (HRQL). This study aims to review currently used HRQL measures and to asses HRQL issues among DTF patients. METHODS A mixed methods methodology was used consisting of (1) a systematic literature review, according to the PRISMA guidelines (2009), using search terms related to sporadic DTF and HRQL in commonly used databases (e.g. Embase, Medline Ovid, Web of science, Cochrane Central, Psyc Info, and Google scholar), to provide an overview of measures previously used to evaluate HRQL among DTF patients; (2) focus groups to gain insight into HRQL issues experienced by DTF patients. RESULTS The search strategy identified thirteen articles reporting HRQL measures using a wide variety of cancer-specific HRQL tools, functional scores, symptom scales (e.g. NRS), and single-item outcomes (e.g. pain and functional impairment). No DTF-specific HRQL tool was found. Qualitative analysis of three focus groups (6 males, 9 females) showed that participants emphasised the negative impact of DTF and/or its treatment on several HRQL domains. Six themes were identified: (1) diagnosis, (2) treatment, (3) follow-up and recurrence, (4) physical domain, (5) psychological and emotional domain, and (6) social domain. CONCLUSION A DTF-specific HRQL tool and consensus regarding the preferred measurement tool among DTF patients is lacking. Our study indicates that HRQL of DTF patients was negatively affected in several domains. A DTF-specific HRQL measure could improve our understanding of short- and long-term effects and, ideally, can be used in both clinic and for research purposes.
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Affiliation(s)
- Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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18
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Recurrent Desmoid Tumor of the Neck: A Case Report of a Benign Disease with Aggressive Behavior. Case Rep Otolaryngol 2018; 2018:6573587. [PMID: 30622828 PMCID: PMC6304189 DOI: 10.1155/2018/6573587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022] Open
Abstract
We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases.
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19
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Delides A, Plioutas I, Konstantoudakis S, Maragoudakis P. Aggressive desmoid fibromatosis of the neck after total thyroidectomy. EAR, NOSE & THROAT JOURNAL 2018; 97:112-113. [PMID: 29940677 DOI: 10.1177/0145561318097004-506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexander Delides
- The 2nd Otolaryngology Department, Attikon University Hospital, Athens, Greece
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20
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Avinçsal ÖM, Shinomiya H, Otsuki N, Sasaki R, Nibu KI. Successful Management of Aggressive Fibromatosis of the Neck: A Case Report. Balkan Med J 2018; 35:278-281. [PMID: 29843498 PMCID: PMC5981128 DOI: 10.4274/balkanmedj.2017.0509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Aggressive fibromatoses are histologically benign fibrous neoplasms originating from musculoaponeurotic structures throughout the body. They are locally invasive and erode adjacent vital structures. The head and neck region constitutes 7-25% of all extra-abdominal cases. Case Report: Here, we report the case of a patient with aggressive fibromatosis in the left side of the neck. While the tumor deeply invaded the scalene muscles, the lesion was successfully treated by surgery followed by radiotherapy. The patient has been disease free for the last 7 years following treatment. Conclusion: Due to its unusual location in the head and neck region, aggressive fibromatosis should be considered in the differential diagnosis of invading lesions of the neck.
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Affiliation(s)
- Özgür Mehmet Avinçsal
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryohei Sasaki
- Department of Internal Medicine, Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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21
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Zheng Z, Jordan AC, Hackett AM, Chai RL. Pediatric desmoid fibromatosis of the parapharyngeal space: A case report and review of literature. Am J Otolaryngol 2016; 37:372-5. [PMID: 27040413 DOI: 10.1016/j.amjoto.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%-15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common. We present a case of a 14-month-old male with an 8-cm desmoid tumor in the right parapharyngeal space and provide an overview of diagnosis and management of pediatric head and neck fibromatosis. This is the largest desmoid tumor of the parapharyngeal space in the youngest patient described in the literature.
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Affiliation(s)
- Zhong Zheng
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Adrienne C Jordan
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Alyssa M Hackett
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Raymond L Chai
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA; Institute of Head, Neck and Thyroid Cancer, Mount Sinai Beth Israel, New York, NY, USA.
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22
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Al-Saraf A, Yassan L, Cipriani NA, Agrawal N, Chang P, Ginat DT. Desmoid-Type Fibromatosis of the Tongue. Head Neck Pathol 2016; 10:527-529. [PMID: 27091208 PMCID: PMC5082041 DOI: 10.1007/s12105-016-0716-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
Desmoid-type fibromatosis rarely occurs in the oral tongue. Diagnostic imaging, including ultrasound, is useful for delineating the extent of the lesion and can aid in treatment planning. However, definitive diagnosis is made based on the characteristic histologic features, which include cytologically bland spindle cells with surrounding collagenous matrix and minimal mitotic activity. Immunohistochemical analysis of these lesions reveals that they are classically positive, at least focally, for smooth muscle actin, calponin and muscle-specific actin. These features are exemplified in this sine qua non radiology-pathology correlation article.
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Affiliation(s)
- Ali Al-Saraf
- Department of Radiology, The University of Chicago, Chicago, IL USA
| | - Lindsay Yassan
- Department of Pathology, The University of Chicago, Chicago, IL USA
| | | | - Nishant Agrawal
- Department of Otolaryngology, The University of Chicago, Chicago, IL USA
| | - Paul Chang
- Department of Radiology, The University of Chicago, Chicago, IL USA
| | - Daniel T. Ginat
- Department of Radiology, The University of Chicago, Chicago, IL USA ,University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637 USA
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23
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Muccino E, Gentile G, Mantero S, Marchesi M, Rancati A, Zoja R. The medico-legal observation of an aggressive urogenital fibromatosis with isolated development not related to any traumatic event. Forensic Sci Int 2016; 260:e1-e6. [PMID: 26786144 DOI: 10.1016/j.forsciint.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/26/2015] [Accepted: 01/02/2016] [Indexed: 11/29/2022]
Abstract
Desmoid tumor is a fibroproliferative neoplasm with an intermediate malignancy and it can be localized in every bodily district: some locations are considered exceptional, like the urogenital localization. The Author point out a rare case of giant idiopathic scrotal fibromatosis that was found during an autopsy. A widower, that lived alone in poor hygienic conditions, was found dead in his house. The Judicial Authority ordered the autopsy, that was performed two days later at the Medico-Legal Section of Milan University. External examinations revealed only the considerable dimension of the scrotum (cm 24 × 41). The cause of death was fixed in a cardiac tamponade due to a natural heart laceration localized in correspondence of a transmural infarction. The toxicological exam resulted negative, while the histopathological and immunohistochemical analysis qualify the scrotal mass as a desmoids tumor. Due to the absence of predisposing conditions and of fibroproliferative infiltration in bladder and retroperitoneal space, the neoplasm was configured as an idiopathic desmoid tumor. The presented case gives the reason for the discussion concerning medico-legal aspects that are typical of rare neoplasms.
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Affiliation(s)
- Enrico Muccino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Guendalina Gentile
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Stefano Mantero
- Centro Nazionale delle Ricerche-Istituto di Ricerca Genetica e Biomedica (IRGB)- Istituto Clinico Humanitas, Via Manzoni 113, 20089 Rozzano MI, Italy
| | - Matteo Marchesi
- Azienda Ospedaliera Papa Giovanni XXIII-Piazza OMS 1, 24127 Bergamo
| | - Alessandra Rancati
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy.
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24
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Xu H, Koo HJ, Lim S, Lee JW, Lee HN, Kim DK, Song JS, Kim MY. Desmoid-Type Fibromatosis of the Thorax: CT, MRI, and FDG PET Characteristics in a Large Series From a Tertiary Referral Center. Medicine (Baltimore) 2015; 94:e1547. [PMID: 26402812 PMCID: PMC4635752 DOI: 10.1097/md.0000000000001547] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to describe the radiologic findings of computed tomography (CT), magnetic resonance (MR) imaging, and ¹⁸F-fluorodeoxy glucose positron emission tomography (FDG PET) in desmoid-type fibromatosis of the thorax. We retrospectively evaluated 47 consecutive patients with pathologically proven desmoid-type fibromatosis from January 2005 to March 2015. Patients underwent CT (n = 36) and/or MR (n = 32), and 13 patients also underwent FDG PET. Based on CT and MR, the sizes, locations, margins, contours, presence of surrounding fat, extra-compartment extension, bone involvement, and neurovascular involvement of the tumors were recorded. The attenuation, signal intensity, enhancement pattern, and presence of internal low signal band or signal void of the tumors were evaluated. Initial image findings were then compared between 2 groups of tumors: group 1 with recurrence or progression, and group 2 with no recurrence or stable without treatment. Median age at diagnosis of the tumors was 45 years, range 4 to 96, female-to-male ratio 1.8. Median tumor long diameter was 65 mm (range, 22-126 mm). The most common locations were chest wall (42.6%), followed by supraclavicular area, shoulder or axillary area, and mediastinum. The tumors had well-defined margins (83.0%), lobulated in contours (66.0%) surrounding fat (63.8%), extra-compartment extensions (42.6%), bone involvements (42.6%), and neurovascular involvements (27.7%). On CT, tumors had low attenuation (60.0%) with mild enhancement (median 24 HU, range 0-52). On MR, they showed iso-signal intensity (SI) (96.9%) on T1-weighted images (WI), and high SI (90.6%) on T2WI images, with strong (87.5%) and heterogeneous (96.9%) enhancement. Internal low signal bands (84.4%) and signal voids (68.8%) were noted. The median value of maxSUV was 3.1 (range, 2.0-7.3). In group 1 (n = 19, 40.4%), 13 patients suffered recurrence and 6 experienced progression. Group 2 (n = 28, 59.6%) consisted of 21 patients with no recurrence and 7 stable patients receiving no treatment. Partially ill-defined margins (OR, 0.167; 95% CI 0.029-0.943; P = 0.043) was the independent predictor for recurrence or progression of tumor. Knowledge of the radiological findings in desmoid-type fibromatosis on CT, MR, and FDG PET may help to improve diagnosis. Tumors with partially ill-defined margins have a tendency to recur or progress.
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Affiliation(s)
- Hai Xu
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (HX, HJK, SL, JWL, HNL, MYK); Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China (HX); Department of Thoracic and Cardiovascular Surgery (DKK); and Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (JSS)
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25
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Fibroblastic and myofibroblastic tumors of the head and neck: Comprehensive imaging-based review with pathologic correlation. Eur J Radiol 2015; 84:250-60. [DOI: 10.1016/j.ejrad.2014.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 01/01/2023]
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26
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Aggressive fibromatosis of head and neck in a child. Indian J Otolaryngol Head Neck Surg 2015; 67:154-7. [PMID: 25621275 DOI: 10.1007/s12070-014-0796-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022] Open
Abstract
Aggressive fibromatosis is a broad group of benign fibrous tissue proliferations of similar microscopic appearance that are intermediate in their biological behavior between benign fibrous tissues and fibrosarcomas. They are rare lesions accounting for less than 3 % of all soft tissue tumours. Usual site is extremity whereas head and neck fibromatosis is a rare occurrence. We present a case of aggressive fibromatosis of the infratemporal fossa in a child, which was treated by surgical excision with adjuvant hormonal therapy.
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27
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Wang W, Koirala U, Ma S, Liu G, Ding M, Hu X, Lei D. Age-Based Treatment of Aggressive Fibromatosis in the Head and Neck Region. J Oral Maxillofac Surg 2014; 72:311-21. [DOI: 10.1016/j.joms.2013.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022]
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28
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Nagar M, Kaushal M, Shukla A, Deshmukh C, Kumar Mathur R, Munjal K. An interesting case of fibromatosis of neck with review of literature. Indian J Surg Oncol 2014; 4:378-81. [PMID: 24426762 DOI: 10.1007/s13193-013-0268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Milesh Nagar
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Manish Kaushal
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Arvind Shukla
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Chaitanya Deshmukh
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Raj Kumar Mathur
- Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh 452009 India
| | - Kavita Munjal
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh India
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29
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de Bree E, Zoras O, Hunt JL, Takes RP, Suárez C, Mendenhall WM, Hinni ML, Rodrigo JP, Shaha AR, Rinaldo A, Ferlito A, de Bree R. Desmoid tumors of the head and neck: a therapeutic challenge. Head Neck 2014; 36:1517-26. [PMID: 24421052 DOI: 10.1002/hed.23496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/22/2013] [Accepted: 09/09/2013] [Indexed: 12/23/2022] Open
Abstract
Desmoid tumor, or aggressive fibromatosis, is a rare, histologically benign, fibroblastic lesion that infrequently presents in the head and neck. Desmoid tumors often grow locally, invasively, and may, in rare instances, be fatal secondary to invasion into critical structures, such as airway or major vessels. The most common treatment is surgery, but desmoid tumors are characteristically associated with a high local recurrence rate after resection. Although the margin status seems to be of importance, operations that avoid function loss and esthetic disfigurement should be the primary goal. The efficacy of postoperative radiotherapy is controversial. Its potential benefit should be carefully balanced against possible radiation-induced adverse effects. Alternative treatment modalities, such as primary radiotherapy and medical treatment or a wait-and-see policy, may be preferable to mutilating surgery. Considering all the aforementioned, it seems obvious that desmoid tumors of the head and neck present a therapeutic challenge and require an individualized approach.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
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30
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Chu KF, Samara MS, Laver N, Wein RO. A rare presentation of a large extra-abdominal desmoid tumor of the posterior neck and back. Am J Otolaryngol 2013; 34:727-30. [PMID: 24035615 DOI: 10.1016/j.amjoto.2013.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe a difficult case of a large extra-abdominal desmoid fibroma of the posterior neck and back; to discuss the pathologic findings and treatment options of this case and to review the current literature for a rare presentation of this disease. METHOD A case report and review of the current relevant English literature, carried out using PubMed Medline, are presented. RESULTS We present a challenging case in which a locally invasive desmoid of the posterior neck and back had grown to such an extent that complete surgical excision in one procedure was not possible. CONCLUSION Extra-abdominal desmoid fibromas are rare tumors with multiple treatment options. The literature supports incomplete surgical resection when necessary to reduce postoperative morbidity. Further options described for residual or recurrent disease include repeat surgical excision, radiation therapy, and possible chemotherapy. For particularly large tumors, close observation and a planned second stage procedure are an appropriate choice.
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Affiliation(s)
- Katrina F Chu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Desmoid-type fibromatosis in the head and neck: CT and MR imaging characteristics. Neuroradiology 2013; 55:351-9. [DOI: 10.1007/s00234-012-1037-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/03/2012] [Indexed: 10/27/2022]
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Place TL, Mezhir JJ. Molecular characterization of desmoid tumors: decryption of the enigma. ONKOLOGIE 2012; 35:641-2. [PMID: 23147539 DOI: 10.1159/000344005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Shah SV, Girhe VJ, Akole RA, Deshmukh A. Well differentiated nonmetastasizing fibrosarcoma (aggressive fibromatosis) of mandible: a rare case report and a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 116:e98-102. [PMID: 22863606 DOI: 10.1016/j.oooo.2011.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/24/2011] [Accepted: 12/27/2011] [Indexed: 11/30/2022]
Abstract
Fibromatosis in the maxillofacial region is a very rare occurrence among diverse pathologic conditions, and because of the rarity of this tumor, definite treatment regimen is not established, which may be a contributing factor for a high recurrence rate. Fibromatosis may attain a large size and cause compression, infiltration, and destruction of adjacent structures. Such growth behavior presents severe management problems, especially in the head and neck region, where the presence of many vital structures within a small space makes the patient susceptible to the effects of the fibromatosis, likewise making complete excision difficult. We report the case of a 28-year-old female patient with aggressive desmoid fibromatosis involving the mandible, with a literature review of postoperative pharmacologic management to prevent recurrence.
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Affiliation(s)
- Seemit V Shah
- Department of Oral and Maxillofacial Surgery, CSMSS Dental College, Aurangabad, India.
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Hood B, Benglis DM, Levi AD, Vanni S. Occiput to thoracic fusion after surgical resection of desmoid tumor. World Neurosurg 2011; 79:207.e15-8. [PMID: 22079273 DOI: 10.1016/j.wneu.2011.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 01/24/2011] [Accepted: 01/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Desmoid tumors are rare clinical entities that cause significant morbidity based on their locally aggressive nature. Complete resection with wide margins is the standard of care; however, when arising in the neck, resection is limited due to proximity of the lesion to critical structures. CASE DESCRIPTION We describe a complete resection of a desmoid tumor requiring extensive resection of cervical extensor musculature. We were able to achieve a total resection of a cervical desmoid tumor with no evidence of recurrence at follow-up. CONCLUSIONS Complete resection of desmoid tumors is the standard of care. In this case, we felt that complete resection would lead to iatrogenic instability; therefore, an occiput to thoracic fusion was performed at the time of the resection.
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Affiliation(s)
- Brian Hood
- Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
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Sobani ZA, Junaid M, Khan MJ. Successful management of aggressive fibromatosis of the neck using wide surgical excision: a case report. J Med Case Rep 2011; 5:244. [PMID: 21707981 PMCID: PMC3141701 DOI: 10.1186/1752-1947-5-244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. CASE PRESENTATION We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis. CONCLUSION Due to the rarity of the condition no guidelines are available on the indications and extent of each modality. Due to its aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, we suggest that aggressive surgery is a viable management option and may be successfully used as a single modality treatment.
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Affiliation(s)
- Zain A Sobani
- Medical College, Aga Khan University, Stadium Road, Karachi, Pakistan.
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Longhi A, Errani C, Battaglia M, Alberghini M, Ferrari S, Mercuri M, Molinari M. Aggressive Fibromatosis of the Neck Treated with a Combination of Chemotherapy and Indomethacin. EAR, NOSE & THROAT JOURNAL 2011; 90:E11-5. [DOI: 10.1177/014556131109000610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes de-bulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.
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Affiliation(s)
- Alessandra Longhi
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milva Battaglia
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Alberghini
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Mercuri
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Molinari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
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Min R, Zun Z, Lizheng W, Minjun D, Shengwen L, Wenjun Y, Chenping Z. Oral and maxillofacial desmoid-type fibromatoses in an eastern Chinese population: a report of 20 cases. ACTA ACUST UNITED AC 2011; 111:340-5. [PMID: 21247785 DOI: 10.1016/j.tripleo.2010.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 09/26/2010] [Accepted: 10/13/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary desmoid-type fibromatoses arising from the oral and maxillofacial region are uncommon and hold the character of local invasion and regional recurrence. The purpose of this study was to analyze the clinicoepidemiologic characteristics of this rare disease in an eastern Chinese population. STUDY DESIGN Epidemiological and clinicopathological data on 20 patients were reviewed from the hospital records and analyzed accordingly. RESULTS Twelve males and 8 females with a ratio of 3:2 were involved. The mandible was the most common site of presentation. Suspected malignant change was found in 6 cases and an extremely high recurrence rate was also found in up to 53%. Abnormally high blood levels of alkaline phosphatase were found in 65% of patients, which had a close relation with tumor malignant change. CONCLUSION Chinese people are more susceptible to desmoid-type fibromatoses and are at an extremely high risk of regional malignant change. Elevated serum alkaline phosphatase levels may be taken as an indicator for malignant transformation.
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Affiliation(s)
- Ruan Min
- Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, P R China
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Abstract
OBJECTIVE The purpose of this study was to assess the diagnosis, treatment, and prognosis of aggressive fibromatosis in the head and neck. METHODS This is a retrospective study of patients with aggressive fibromatosis who underwent surgical interventions during the 9-year period from 2001 to 2010. Aggressive fibromatosis is treated by resection with an adequate safety margin. Radiotherapy is given to patient with tumor that cannot be completely removed. RESULTS Four patients with aggressive fibromatosis were identified under the 2005 World Health Organization classification guidelines, which, here reported, have been surgically treated. The lesions were located in the buccal mucosa in 1 patient, the tongue in 1 patient, and neck in 2 patients. Then, they were all treated by aggressive local resection. One patient who had a partially resected tumor underwent radiotherapy. The follow-up period ranged from 7 to 107 months. CONCLUSIONS For the cases of tumor that can be completely removed, the prognosis is excellent. Otherwise, the tumor is vulnerable to relapse. We recommend radiotherapy in patients who have unresectable or partially resected tumor when the tumor is adjacent to vital structures. Patients with aggressive fibromatosis should remain in long-term follow-up.
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Abstract
Desmoid tumors are benign fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. These rare neoplasms have been shown to account in 0.03% of all cancers. Twenty-five percent of all desmoid tumors occur in children under 15 years of age. The infrequency of these tumors has limited studies to case reports and retrospective reviews dictating the authors recommended treatments and management. We present a case report of desmoid tumor involving the left mandible in a 14-month-old infant. His treatment course included 2 excisions, removal of the free rib graft secondary to persistence of the tumor, and wound dehiscence, and later a free fibular osteomyocutaneous flap for reconstruction. We then retrospectively reviewed all published data of desmoid tumor involving the pediatric mandible since 1950 to 2007 in the PubMed database. Forty cases have been reported, which had a M:F ratio of 1:1 with an average age of 5.3 (standard deviation [SD] +/- 4.5) years. There appeared to be left-sided predominance of desmoid tumors in the pediatric mandible with a ratio of 3:1. The mean size of the tumors was 4.6 cm (SD +/- 2.1) at the largest diameter. We have tabulated the relevant data of all the cases including the methods of treatment and recurrence. It is found that when compared with conservative management, radiation therapy, chemotherapy, and curettage or surgical local excisions as treatment options the most efficient treatment was partial mandiblectomy, which resulted in complete tumor dissipation with no tumor recurrence. In summary, this is the largest review of the pediatric desmoid tumor of the mandible to date where we provide for the first time an algorithm for the management and treatment of the pediatric desmoid tumor of the mandible.
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40
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Kiverniti E, Cilasun U, Singh A, Kazi R, Clarke PM, Archer DJ. Aggressive Fibromatosis of the Oropharynx: A Multidisciplinary Approach to a Benign Disease. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908800509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 23-year-old woman with aggressive fibromatosis of the oropharynx that was initially treated elsewhere as a peritonsillar abscess. We discuss the characteristics of this rare tumor and review the literature, stressing the importance of postoperative follow-up for peritonsillar abscesses to avoid missing other important diagnoses, such as the one described here.
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Affiliation(s)
| | - Ulkem Cilasun
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, U.K
| | - Arvind Singh
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, U.K
| | - Rehan Kazi
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, U.K
| | - Peter M. Clarke
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, U.K
| | - Daniel J. Archer
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, U.K
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41
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Krokidis M, Raissaki M, Mantadakis E, Giannikaki E, Velegrakis G, Kalmanti M, Gourtsoyiannis N. Infantile fibromatosis of the mandible: a case report. Dentomaxillofac Radiol 2008; 37:167-70. [PMID: 18316509 DOI: 10.1259/dmfr/51942076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report an aggressive tumour in a 5-year-old girl causing facial disfigurement. Imaging confirmed a solid, diffusely enhancing mass at the right internal pterygoid muscle, infiltrating the adjacent bone. Surgical excision and reconstruction of the mandible were performed. Histology revealed aggressive infantile fibromatosis. No recurrence was noted 7 months later. Infantile fibromatosis may mimic malignancies and should be considered in aggressive mandibular soft tissue masses, in order to carefully plan biopsy and reconstructive surgery.
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Affiliation(s)
- M Krokidis
- Department of Radiology, University Hospital of Heraklion, Stavrakia-Voutes, 71500, Heraklion, Crete, Greece.
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Affiliation(s)
- Sandra L Wong
- University of Michigan, Ann Arbor, Michigan 48109-0932, USA.
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Abstract
Object
Desmoid tumors are fibrous, slow-growing, nonmalignant tumors with a low potential for metastasis. These lesions show a high propensity for infiltrative growth with local invasion.
Methods
The authors undertook a retrospective study of 15 desmoid tumors in 11 women and four men (ranging in age from 32 to 67 years; median 48 years) treated at their institution. This study included further resection for recurrent tumors in nine of 15 patients (60%).
Results
There were 13 patients (86%) with brachial plexus lesions, one patient (7%) with a lumbar plexus lesion, and one (7%) with a peroneal nerve lesion. There was a female predominance in the study group of 2.75:1. Four patients (27%) reported improvement in pain status, six (40%) reported no change from their preoperative pain levels, and five (33%) reported worsened pain symptoms. There was tumor recurrence in two patients (13%) leading to further surgical intervention.
Conclusions
This case series included many recurrent desmoid tumors of the brachial plexus. Most of these lesions were relatively large tumors, predominantly involved with the plexal elements adding to the challenge of the resection. Currently, function-sparing excision is considered the optimal treatment for desmoid tumors arising in extraabdominal sites. Adjunctive radiation or brachytherapy is reserved for a patient with further recurrence in whom resection would be disfiguring or in whom the disease is more refractory.
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Affiliation(s)
- Kurtus Dafford
- 1Department of Neurosurgery, Tulane University Medical Center, New Orleans
| | - Daniel Kim
- 2Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans and
| | | | - David Kline
- 4Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Amerasinghe N, Rogers S, Rowlandson P, Kohler J, Hodgkins P. Fibromatosis (desmoid tumor) involving the orbit and cheek. J AAPOS 2006; 10:479-81. [PMID: 17070488 DOI: 10.1016/j.jaapos.2006.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 04/24/2006] [Indexed: 11/28/2022]
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McCall T, Rao G, Jensen R. Development and rapid growth of a desmoid tumor in the surgical corridor after suboccipital craniotomy for recurrent low-grade astrocytoma. J Neurooncol 2006; 80:167-70. [PMID: 16645711 DOI: 10.1007/s11060-006-9166-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
Desmoid tumors are histologically benign but locally invasive tumors that can occur in the head and neck. We present the rare case of a desmoid tumor that occurred in the surgical corridor after suboccipital craniotomy for recurrent low-grade astrocytoma. A 30-year-old woman underwent a repeat suboccipital craniotomy for recurrent low-grade astrocytoma. A gross total resection was achieved. Nine months later, a firm, palpable mass was noted near the surgical scar. No new neurologic deficits were noted on exam. A magnetic resonance imaging scan demonstrated a homogeneously enhancing lesion superficial to the dural graft. Surgical resection of the lesion was performed through the original midline incision. The mass was resected en bloc. Histology demonstrated clear surgical margins and a tumor of low cellularity consistent with a desmoid tumor. Desmoid tumors should be considered in the differential diagnosis for superficial masses occurring in the surgical bed after posterior cervical surgery.
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Affiliation(s)
- Todd McCall
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA
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Wang CP, Chang YL, Ko JY, Cheng CH, Yeh CF, Lou PJ. Desmoid tumor of the head and neck. Head Neck 2006; 28:1008-13. [PMID: 16983695 DOI: 10.1002/hed.20467] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND [corrected] Desmoid tumors are rare benign tumors but have a tendency toward local recurrence after resection because of their infiltrative growth and frequent entrapment of vital structures in the head and neck region. We report 24 desmoid tumors of the head and neck and propose a reasonable approach in the management of such cases. METHODS Twenty-four patients (9 male and 15 female; median age, 33 years; range, 0-66 years) with a desmoid tumor of the head and neck (neck, 15 patients; head, 9 patients) treated from 1990 to 2004 were retrospectively analyzed. The size ranged from 0.5 to 13 cm in diameter (mean, 3.6 cm). In the neck, 8 tumors were around the superficial layer of deep cervical fascia, whereas 4 tumors of the neck involved the prevertebral fascia and 2 involved brachial plexus. RESULTS Twenty patients received complete resection of the tumor, but the section margin was positive in 8 patients, of which 6 patients remained free of disease in a period of 13 to 105 months. Three patients, including 2 with positive section margin and 1 with negative margin, developed recurrences, which were successfully removed again. Two patients underwent partial resection of the tumor because of brachial plexus involvement. One of them achieved regression after postoperative radiotherapy and the other had spontaneous regression. The hypopharygneal tumor in a newborn had spontaneously complete regression, and tracheostomy was closed at the age of 6 years. One patient remained with stable disease for 14 months after biopsy of the tumor without excision. CONCLUSION The overall prognosis is still good despite frequent incomplete resection. Surgical resection of the tumor with close observation is suggested even if the section margin is positive. If a desmoid tumor cannot be removed grossly, regression or arrested growth of the remaining tumor is expected. Radiotherapy might be reserved for a growing tumor.
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Affiliation(s)
- Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
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González-García R, Escorial-Hernández V, Muñoz-Guerra MF, Rodríguez-Campo FJ, Reina-Durán T, Nieto-Llanos S, Naval-Gías L. Fibromatosis of the tongue: A case report. ACTA ACUST UNITED AC 2005; 100:e31-4. [PMID: 16037766 DOI: 10.1016/j.tripleo.2005.02.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Raúl González-García
- Department of Oral and Maxillofacial, Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain.
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Watzinger F, Turhani D, Wutzl A, Fock N, Sinko K, Sulzbacher I. Aggressive fibromatosis of the mandible: a case report. Int J Oral Maxillofac Surg 2005; 34:211-3. [PMID: 15695054 DOI: 10.1016/j.ijom.2004.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2004] [Indexed: 11/19/2022]
Abstract
An extensive tumour in a 7-year-old girl, leading to severe disfigurement, proved to be an aggressive fibromatosis on histological examination. Eighteen months after surgery there was no evidence of recurrent disease. This suggests that tumour resection and reconstruction of the mandible had been successful. Contrary to some reports, tumour resection led to curative therapy whereas radiotherapy failed.
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Affiliation(s)
- F Watzinger
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
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Abstract
Desmoid tumors of the head and neck are locally invasive neoplasms with a high propensity for inadequate resection and recurrence. The rarity of these neoplasms accounts for the fact that there are no prospective randomized data to evaluate the influence of adjuvant therapies, including radiotherapy, hormonal therapy, or cytotoxic chemotherapy. Several comprehensive retrospective series in the literature suggest that the margin status following resection does not necessarily correlate with local disease recurrence. As a result, we do not advocate the sacrifice of major neurovascular structures in an attempt to obtain negative margins. We present a review of desmoid tumors, emphasizing those occurring in the head and neck, and describe 3 cases that highlight the challenges that the anatomy of the head and neck presents in the management of this difficult disease.
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Affiliation(s)
- Brendan J Collins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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50
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Abstract
Because of its relative rarity and a wide variety of clinical manifestations, peripheral nerve tumors (PNTs) often present to specialists from widely different disciplines, thus often resulting in delayed diagnosis and a non-cohesive pattern of management. Critical appraisal of the history and physical examination followed by radiological investigations, by experienced medical personnel, ultimately suggests that the extremity mass is perhaps a PNT, rather than the wide variety and more common soft tissue tumors. Included in this appraisal is a search for a pre-disposition syndrome, the most common of which are neurofibromatosis-1 and -2 (NF1, NF2) and schwannomatosis, which may require life-long careful follow up. Intra-operative and post-operative management decisions in a multidisciplinary manner with knowledge of the biological, pathological and clinical behavior of the PNT, is of utmost importance. In the context of pre-disposition syndromes, where multiple tumors may exist along with other nervous system lesions, molecular biological insights and hopefully the biological therapies that stem from this knowledge are of interest. In this article the spectrum of PNTs and their management protocols, including the algorithm for treatment of malignant PNTs advocated by our institute, are presented and currently available genetic insights and probable role of experimental therapies are briefly reviewed.
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Affiliation(s)
- Asis Kumar Bhattacharyya
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Canada
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