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Boyd J, Jonard B, Weiner S. Desmoplastic Fibroma in the Distal Humerus of a 14-Year-Old Boy: A Case Report. JBJS Case Connect 2020; 9:e0155. [PMID: 31834017 DOI: 10.2106/jbjs.cc.18.00155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of a 14-year-old male who presented with a pathologic elbow fracture. Imaging demonstrated a lytic distal humerus metaphyseal lesion with a soap bubble appearance. After fracture healing, frozen sections obtained at open biopsy suggested fibrous tissue; thus, curettage and bone grafting was performed. Pathology confirmed desmoplastic fibroma. The patient experienced a recurrence 18 months later and had repeat curettage and allograft strutting. He had no evidence of re-recurrence 2 years after the second surgery. CONCLUSIONS Desmoplastic fibroma may mimic the presentation of many bone lesions. Recurrence is common despite curettage and bone grafting. This patient performed well without wide resection.
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Affiliation(s)
- Jason Boyd
- Department of Orthopaedic Surgery, Summa Health, Akron, Ohio.,Department of Orthopaedics, Emory University, Atlanta, Georgia
| | - Brandon Jonard
- Department of Orthopaedic Surgery, Summa Health, Akron, Ohio
| | - Scott Weiner
- Department of Orthopaedic Surgery, Summa Health, Akron, Ohio
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Karimi A, Derakhshan S, Moradzadeh Khiavi M, Mosavat F, Mirjalili F. Desmoplastic Fibroma of the Jaws: A Case Series and Review of Literature. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:134-143. [PMID: 32215029 PMCID: PMC7081768 DOI: 10.30699/ijp.2020.103833.2049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022]
Abstract
Desmoplastic fibroma (DF) is a benign, locally aggressive neoplasm that rarely occurs in the facial skeleton. It usually presents during the first three decades of life. Due to its aggressiveness and high recurrence rate, early diagnosis is imperative, and complete surgical removal of the lesion is the treatment of choice. Herein, we present three cases of DF namely a 2 year-old girl with a mandibular DF, a 9 year-old boy with a maxillary lesion and a 1.5-year old boy with a mandibular DF. Complete clinicopathological information, treatment plan and long-term follow-up of patients are discussed. Histopathologic features of 3 cases revealed non-capsulated spindle cell tumor with fascicular or swirling patterns in incisional biopsy. Immunohistochemical staining was performed to make a definitive diagnosis. Strongly positive nuclear immunoreactivity for β-catenin confirmed the diagnosis of desmoplastic fibroma in 3 cases. Segmental mandibulectomy, partial maxillectomy and hemimandibulectomy were done for the cases. There was no recurrence in our reported cases after 8 and 11 months and 3 years follow up, respectively. It is noteworthy that despite the aggressive nature of DF, young patients often respond well to wide resection treatment.
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Affiliation(s)
- Abbas Karimi
- Department of Oral and Maxillofacial Surgery , Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Derakhshan
- Department of Oral and Maxillofacial Pathology , Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Monir Moradzadeh Khiavi
- Department of Oral and Maxillofacial Pathology , Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Mosavat
- Department of Oral and Maxillofacial Radiology, Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Mirjalili
- Department of Oral and Maxillofacial Radiology, Dentistry School, Kashan University of Medical Sciences, Kashan, Iran
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Madakshira MG, Bal A, Verma RK. Desmoplastic fibroma of the mandible: a rare gnathic bone tumor with a review of the literature. AUTOPSY AND CASE REPORTS 2019; 9:e2019091. [PMID: 31641651 PMCID: PMC6771450 DOI: 10.4322/acr.2019.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Desmoplastic fibroma (DF) is a rare bone tumor, which is known to involve mostly the gnathic bones. In this setting, the clinical presentation is usually represented by a bulging tumor of the face. Radiologically, the tumor is usually characterized by an expansile lytic bone lesion. The histopathology of the tumor shows a poorly circumscribed hypocellular lesion rich in collagen fibers with interspersed spindle cells having bland nuclear chromatin. Despite the lack of mitoses and nuclear pleomorphism, DF has an aggressive nature, presenting as a destructive growth causing entrapment of neuro-vascular bundles, sinusitis, or trismus. Some cases of DF show mutations in the adenomatous polyposis coli pathway shown by nuclear localization of the β-catenin protein. Few reports showed an association with tuberous sclerosis, though most of these cases were sporadic. We discuss a rare case of desmoplastic fibroma involving the mandible, and a review of the literature of the DF cases involving the gnathic bones.
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Affiliation(s)
- Manoj Gopal Madakshira
- Post Graduate Institute and Medical Education and Research (PGIMER), Department of Histopathology. Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute and Medical Education and Research (PGIMER), Department of Histopathology. Chandigarh, India
| | - Roshan Kumar Verma
- Post Graduate Institute and Medical Education and Research (PGIMER), Department of Otolaryngology and Head & Neck Surgery. Chandigarh, India
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Skinner HR, Vargas A, Solar A, Foncea C, Astorga P. Desmoplastic Fibroma of the Mandible in a Pediatric Patient: A Case Report of Resection and Reconstruction With A Six-Year Follow-Up. J Oral Maxillofac Surg 2017; 75:1568.e1-1568.e10. [PMID: 28384463 DOI: 10.1016/j.joms.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Abstract
Desmoplastic fibroma (DF) of bone is considered a benign but locally aggressive tumor of fibroblastic origin. DF is rare, representing less than 1% of all bone tumors. Approximately 84% of patients are younger than 30 years. DF has a slow but aggressive growth potential and can recur locally when it has not been completely excised. Complete resection is the treatment of choice to decrease recurrence and morbidity. Mandibular reconstruction is mandatory in pediatric patients to ensure correct craniofacial development. The present report describes the case of a pediatric patient with mandibular DF in whom complete resection and immediate reconstruction with a fibula flap proved a satisfactory treatment option, with low morbidity and excellent esthetic and functional results at 6-year follow-up.
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Affiliation(s)
- Hernán Ramírez Skinner
- Associate Professor, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Alex Vargas
- Associate Professor, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonieta Solar
- Assistant Professor of Pathology, Bone, Oral and Head and Neck Pathology, Department of Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Foncea
- Resident in Oral and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Astorga
- Observer, Department of Surgical Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Woods TR, Cohen DM, Islam MN, Rawal Y, Bhattacharyya I. Desmoplastic fibroma of the mandible: a series of three cases and review of literature. Head Neck Pathol 2014; 9:196-204. [PMID: 25113037 PMCID: PMC4424202 DOI: 10.1007/s12105-014-0561-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/03/2014] [Indexed: 11/24/2022]
Abstract
The desmoplastic fibroma (DF) is a rare, fibroblastic lesion of bone that histologically resembles the desmoid tumor of soft tissue. Although classified as benign, it frequently demonstrates aggressive behavior, often causing tooth mobility, extensive bone destruction, and has a moderate to high recurrence rate. We present three cases of DF in the mandible: the first in a 13 year old female involving the mandibular body in the region of teeth #s 27-#28, the second in a 57 year old female with a lesion apical to tooth #30, and the third in a 20-year-old female involving the left posterior mandible. Clinical, histologic, immunohistochemical (IHC) and radiographic features of this rare neoplasm are discussed. The challenges encountered in establishing an accurate diagnosis due to significant microscopic overlap with other spindle cell lesions are also detailed. Additionally, the findings of IHC stains including vimentin, smooth muscle actin, S-100 protein, β-catenin, HHF-35 and proliferation marker, Ki-67 on 3 cases are reported. The potential for misdiagnosis is high, especially in early lesions, since immunohistochemistry has been reported in literature to be inconsistent when differentiating DFs from other spindle cell lesions. A comparative review of DF and similar entities in the jaws with current considerations in treatment and prognosis is presented.
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Affiliation(s)
- T. R. Woods
- />Division of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, PO Box 100414, JHMHC, Gainesville, FL 32610-0414 USA
| | - D. M. Cohen
- />Division of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, PO Box 100414, JHMHC, Gainesville, FL 32610-0414 USA
| | - M. N. Islam
- />Division of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, PO Box 100414, JHMHC, Gainesville, FL 32610-0414 USA
| | - Y. Rawal
- />Department of Oral and Maxillofacial Pathology, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN USA
| | - I. Bhattacharyya
- />Division of Oral and Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, PO Box 100414, JHMHC, Gainesville, FL 32610-0414 USA
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Maxillary desmoplastic fibroma with initial symptoms suggestive of sinusitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e510-3. [PMID: 23669201 DOI: 10.1016/j.oooo.2013.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 11/22/2022]
Abstract
Desmoplastic fibroma (DF) is a benign intra-osseous neoplasm characterized by the formation of abundant collagen fibers. It arises most commonly in the jaws and exhibits local aggressiveness and high recurrence rates after local resection. An uncommon case of expansive DF involving the right maxilla, maxillary sinus, and inferior orbital wall of a 49-year-old man whose initial symptoms were similar to acute sinusitis is presented, and the criteria for diagnosis and clinical management are discussed.
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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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Desmoplastic fibroma of the vidian canal in a child: case report. The Journal of Laryngology & Otology 2011; 125:753-6. [PMID: 21450129 DOI: 10.1017/s002221511100048x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To present a case of a child with a desmoplastic fibroma of the vidian canal, compressing the vidian nerve. CASE REPORT A 12-year-old girl with several years' history of right-sided facial pain was referred to our institution. Magnetic resonance imaging and computed tomography scans showed an expansile mass involving the right vidian canal. The patient underwent a complete endoscopic surgical resection aided by the FusionTM ENT navigation system. This was performed through a transnasal, trans-septal, trans-sphenoidal route via the right nostril, and achieved macroscopic clearance with minimal peri-operative morbidity. A biopsy of the lesion showed a fibro-osseous lesion consistent with desmoplastic fibroma. CONCLUSION Diagnosis and resection of this rare lesion at an earlier stage would have avoided delays in resolving the child's disabling pain. This emphasises the importance of early referral of unusual cases to tertiary centres.
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Rius Peris JM, Ferrís I Tortajada J. [Desmoplastic fibroma of the jaw: a rare kind of tumour]. An Pediatr (Barc) 2009; 72:94-5. [PMID: 19837637 DOI: 10.1016/j.anpedi.2008.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/05/2008] [Accepted: 11/05/2008] [Indexed: 10/20/2022] Open
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Iatrou IA, Theologie-Lygidakis N, Leventis MD. Case report: desmoplastic fibroma of the mandible in a child presenting with TMJ dysfunction. Eur Arch Paediatr Dent 2008; 9:105-8. [PMID: 18534181 DOI: 10.1007/bf03262620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Desmoplastic fibroma of bone is a rare intraosseous benign but locally aggressive tumor of connective tissue origin. The lesion may affect the metaphyses of the long bones but it may also involve the skull bones and more specifically the mandible, with most lesions appearing in the ramus-angle area. Treatment is surgical although additional chemotherapy or radiation has been applied. CASE REPORT A 10-year-old boy initially presented with restriction and deviation of mouth opening. Clinical and radiological examination revealed a tumor-like lesion of the mandible extending into the soft tissues, which on biopsy proved to be a desmoplastic fibroma. TREATMENT The surgical treatment included peripheral ostectomy of the mandible, via an intraoral approach, for the removal of the lesion and restoration of the bone defect with an iliac bone autograft. FOLLOW-UP The high recurrence rate of this type of lesion, demands a strict follow-up schedule. In the case presented, 5 years post-operatively, there are no signs of local recurrence. CONCLUSION Changes in mouth opening when not attributed to obvious reasons, such as trauma, should make a dentist suspicious and lead to further investigation. In the case presented, a central lesion was revealed in the radiograph and the patient was referred and treated early. Extended surgical removal of the tumor, with wide margins, proved to be the appropriate treatment.
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Affiliation(s)
- I A Iatrou
- University Clinic of Oral and Maxillofacial Surgery at the Children's Hospital, Faculty of Dentistry, University of Athens, Athens, Greece
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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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