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Hoch CC, Knoedler L, Knoedler S, Bashiri Dezfouli A, Schmidl B, Trill A, Douglas JE, Adappa ND, Stögbauer F, Wollenberg B. Integrated Molecular and Histological Insights for Targeted Therapies in Mesenchymal Sinonasal Tract Tumors. Curr Oncol Rep 2024; 26:272-291. [PMID: 38376625 PMCID: PMC10920452 DOI: 10.1007/s11912-024-01506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of mesenchymal sinonasal tract tumors (STTs), a distinct subset of STTs. Despite their rarity, mesenchymal STTs represent a unique clinical challenge, characterized by their rarity, often slow progression, and frequently subtle or overlooked symptoms. The complex anatomy of the sinonasal area, which includes critical structures such as the orbit, brain, and cranial nerves, further complicates surgical treatment options. This underscores an urgent need for more advanced and specialized therapeutic approaches. RECENT FINDINGS Advancements in molecular diagnostics, particularly in next-generation sequencing, have significantly enhanced our understanding of STTs. Consequently, the World Health Organization has updated its tumor classification to better reflect the distinct histological and molecular profiles of these tumors, as well as to categorize mesenchymal STTs with greater accuracy. The growing understanding of the molecular characteristics of mesenchymal STTs opens new possibilities for targeted therapeutic interventions, marking a significant shift in treatment paradigms. This review article concentrates on mesenchymal STTs, specifically addressing sinonasal tract angiofibroma, sinonasal glomangiopericytoma, biphenotypic sinonasal sarcoma, and skull base chordoma. These entities are marked by unique histopathological and molecular features, which challenge conventional treatment approaches and simultaneously open avenues for novel targeted therapies. Our discussion is geared towards delineating the molecular underpinnings of mesenchymal STTs, with the objective of enhancing therapeutic strategies and addressing the existing shortcomings in the management of these intricate tumors.
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Affiliation(s)
- Cosima C Hoch
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum Munich, Munich, Germany
| | - Ali Bashiri Dezfouli
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Benedikt Schmidl
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Anskar Trill
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Fabian Stögbauer
- Institute of Pathology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany.
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Sakai T, Nishida Y, Ito K, Ikuta K, Urakawa H, Koike H, Imagama S. Clinical results of active surveillance for extra-abdominal desmoid-type fibromatosis. Cancer Med 2023; 12:5245-5254. [PMID: 36210645 PMCID: PMC10028109 DOI: 10.1002/cam4.5329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of choice for desmoid-type fibromatosis (DF) has been changed to active surveillance (AS). However, few studies have reported clinical outcomes of AS modality in Asian countries. This study aimed to clarify the significance of AS as a DF treatment modality. METHODS A total of 168 lesions from 162 patients with extra-abdominal DF were included. The mean age at diagnosis was 39 years (1-88 years), and the median maximum tumor diameter at the first visit was 64.1 mm (13.2-255.8 mm). The clinical outcomes of AS and the risk factors requiring active treatment (AT) (defined as an event) from AS modality were investigated. RESULTS Of the 168 lesions, 94 (56%) were able to continue AS, with a 5-year event-free survival of 54.8%. Of the 68 lesions with PD, 21 (30.9%) lesions were able to continue AS. Neck location (p = 0.043) and CTNNB1 S45F mutation (p = 0.003) were significantly associated with the transition to AT, and S45F mutation was a significant factor associated with the transition to AT by multivariate analysis (hazard ratio: 1.96, p = 0.048). AT outcomes after AS were evaluable in 65 lesions, and 49 (75%) lesions did not require a transition to a second AT. CONCLUSIONS AS was revealed as an effective treatment modality. The transition to AT needs to be considered for neck location and CTNNB1 S45F mutation DF. Good results can be obtained by selecting a treatment method that considers the tumor location even in cases that require intervention.
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Affiliation(s)
- Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Rare Cancer Center, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Rare Cancer Center, Nagoya University Hospital, Nagoya, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Kan Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Ikuta
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Koike
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ratan R, Roland CL, Bishop AJ. Desmoid Fibromatosis: Management in an Era of Increasing Options. Curr Oncol Rep 2021; 23:41. [PMID: 33719012 DOI: 10.1007/s11912-021-01026-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Desmoid fibromatosis (DF) is a locally aggressive clonal neoplasm with locally aggressive behavior and no metastatic potential. Historical treatment of DF has consisted primarily of up-front surgery when feasible. In recent years, recognition that DF can spontaneously stabilize or involute has allowed for many patients to be managed with watchful waiting rather than intervention. This review is intended to review recent developments in the treatment of DF. RECENT FINDINGS Recent studies have demonstrated prospectively that patients with DF often have improvement in their lesions without intervention, enabling an initial period of surveillance as a standard option for patients with mild symptoms. Given the lengthening list of effective systemic treatments, including sorafenib, pazopanib, and experimental agents, there has been a less reliance on local therapies for those patients who require treatment. For patients with DF that require treatment, there is a growing list of options that includes radiation therapy (RT), percutaneous ablation, and a growing list of systemic agents with favorable toxicity profiles.
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Affiliation(s)
- Ravin Ratan
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA.
| | - Christina L Roland
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1484, Houston, TX, 77030, USA
| | - Andrew J Bishop
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 0097, Houston, TX, 77030, USA
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Windfuhr JP, Vent J. Extranasopharyngeal angiofibroma revisited. Clin Otolaryngol 2017; 43:199-222. [PMID: 28714226 DOI: 10.1111/coa.12939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Angiofibromas in the head and neck region usually arise in the nasopharynx, but may also occur elsewhere. This study aims at evaluating the incidence and clinical features of extranasopharyngeal angiofibroma (ENA). MATERIAL AND METHODS Systematic review of the literature (Medline® and Google™ ) up to 31 December 2015. RESULTS 174 cases of ENA were retrieved from a total of 170 publications. In contrast to former publications and previous understanding, the nasal septum was by far the most common site of the disease. Four patients had a congenital lesion, the oldest patient was 87 years old (mean: 28.7 years; median: 23 years). Male gender was predominantly affected, but the sex ratio was more balanced (2.13:1) than in previous reports in the literature until 12/2015. The majority of patients presented with nasal obstruction, either in combination with epistaxis (25.8%) or other symptoms (12.6%). Symptoms had developed within 13.1 months on average (median: 4 months). Brisk bleeding resulted in 11 of 43 biopsy procedures. Surgical resection as first-line therapy was performed in 170 patients. A tumour regrowth within 12 months was registered in four patients. CONCLUSION The increasing awareness of ENA and the willingness to publish case reports-not only in Medline-listed journals-resulted in a significant increase of published case reports lately. Although extremely rare, ENAs have to be taken into account in the differential diagnosis of unclear masses, particularly in adult patients presenting with a rapidly developing nasal obstruction resulting from a nasal septum tumour. Female gender or normal vascularity does not exclude the diagnosis. Transnasal resection is sufficient in most cases, and recurrences are rare. Pathologists as well as clinicians should consider ENA in their differential diagnosis of any mass of the upper airway.
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Affiliation(s)
- J P Windfuhr
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of Maria Hilf, Moenchengladbach, Germany
| | - J Vent
- Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Cologne/Koeln, Germany
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Miyashita H, Asoda S, Soma T, Munakata K, Yazawa M, Nakagawa T, Kawana H. Desmoid-type fibromatosis of the head and neck in children: a case report and review of the literature. J Med Case Rep 2016; 10:173. [PMID: 27286970 PMCID: PMC4902910 DOI: 10.1186/s13256-016-0949-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022] Open
Abstract
Background Desmoid-type fibromatosis is defined as an intermediate tumor that rarely occurs in the head and neck of children. There is no doubt as to the value of complete surgical excision for desmoid-type fibromatosis. However, in pediatric patients, surgeons may often be concerned about making a wide excision because of the potential for functional morbidity. Some studies have reported a lack of correlation between margin status and recurrence. Therefore, we discussed our findings with a focus on the state of surgical margins. Case presentation We report an unusual case of a 9-month-old Japanese girl who prior to presenting at our hospital underwent debulking surgery twice with chemotherapy for desmoid-type fibromatosis of the tongue at another hospital. We performed a partial glossectomy and simultaneous reconstruction with local flap and achieved microscopic complete resection. We also reviewed available literature of pediatric desmoid-type fibromatosis in the head and neck. Conclusions We described successful treatment for the refractory case of pediatric desmoid-type fibromatosis. The review results showed that some microscopic incomplete resections of tumors in pediatric patients with desmoid-type fibromatosis tended to be acceptable with surgical treatment.
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Affiliation(s)
- Hidetaka Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Seiji Asoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Kanako Munakata
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiromasa Kawana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
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Delayed cerebrospinal fluid rhinorrhea four years after gamma knife surgery for juvenile angiofibroma. J Craniofac Surg 2015; 25:e565-7. [PMID: 25377982 DOI: 10.1097/scs.0000000000001164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Juvenile angiofibroma (JA) is a highly vascularized tumor that often recurs or regrows. Recently, gamma knife surgery (GKS) was attempted on unresectable or remnant JA. We experienced a JA case that developed cerebrospinal fluid (CSF) rhinorrhea 4 years after GKS. Two surgical excisions using midfacial degloving approach were performed before GKS. After radiosurgery, the tumor was controlled, and no early complications were observed. However, 4 years after, intractable CSF leakage developed as a late complication, and we thus performed 4 subsequent endoscopic surgical repairs. The CSF leakage is very rare but can occur as a late complication of GKS and should be treated aggressively.
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Perić A, Sotirović J, Cerović S, Zivić L. Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2014; 56:133-41. [PMID: 24693794 DOI: 10.14712/18059694.2014.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.
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8
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Honeyman JN, Quaglia MPL. Desmoid tumors in the pediatric population. Cancers (Basel) 2012; 4:295-306. [PMID: 24213241 PMCID: PMC3712683 DOI: 10.3390/cancers4010295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022] Open
Abstract
Desmoid tumors are benign soft tissue tumors associated with locally aggressive growth and high rates of morbidity, but they do not metastasize via lymphatic or hematogenous routes. While most of the data on desmoid tumors originates in the adult literature, many of the findings have been applied to the management of pediatric patients. This article discusses the epidemiology, etiology, clinical presentation, pathology, and treatment of this rare tumor in the pediatric population and includes a literature review of the most recent large series of pediatric patients with desmoid tumors.
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Affiliation(s)
- Joshua N Honeyman
- Department of Surgery, Pediatrics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Abstract
Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.
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Corsten M, Donald P, Boggan J, Gadre A, Gandour-Edwards R, Nemzek W. Extra-abdominal fibromatosis (desmoid tumor) arising in the infratemporal fossa: a case report. Skull Base Surg 2011; 8:237-41. [PMID: 17171074 PMCID: PMC1656708 DOI: 10.1055/s-2008-1058191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aggressive fibromatosis (or desmoid tumor) refers to a histologically benign but locally aggressive lesion arising from musculoaponeurotic structures in various anatomic sites. Extra-abdominal desmoids represent about one third of all desmoid tumors; of these only about 11 to 15% arise in the head and neck. Desmoid tumors arising in the infratemporal fossa are exceedingly rare; to our knowledge only one such tumor has been reported in the literature. We present a desmoid tumor arising in the infratemporal fossa with intracranial extension in a twenty-seven year old male and review the literature on this rare condition.
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11
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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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Sharma A, Ngan BY, Sándor GKB, Campisi P, Forte V. Pediatric aggressive fibromatosis of the head and neck: a 20-year retrospective review. J Pediatr Surg 2008; 43:1596-604. [PMID: 18778992 DOI: 10.1016/j.jpedsurg.2008.02.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 02/01/2008] [Accepted: 02/01/2008] [Indexed: 11/29/2022]
Abstract
UNLABELLED Aggressive fibromatosis in children is a rare, benign condition that is locally infiltrative and destructive. It often presents as a rapidly growing, painless lump in the head and neck region. To date, only small series and case reports have been reported, and the management of the condition remains unclear. Recently, nuclear beta-catenin expression has been suggested as a tumor-specific marker for aggressive fibromatosis (desmoid). AIM The aims of the study were to review our experience of the presentation, management, and treatment outcome of pediatric aggressive fibromatosis in the head and neck and to identify the presence of the desmoid tumor marker beta-catenin within this population. METHOD The study was conducted as a retrospective case review of children diagnosed with aggressive fibromatosis in the head and neck for a period of 20 years and a review of the literature. Pathologic review of the original tumor specimens was undertaken for evidence of positive tumor margins and presence of nuclear beta-catenin expression. RESULTS A total of 10 patients (6 males, 4 females) were identified. The age at presentation ranged from 12 months to 14 years. In total, 8 patients were treated with surgery alone. This included 7 patients with extension of the tumor to the resection margin; all had good long-term outcomes with no disease progression. Two patients received chemoradiotherapy, one as primary treatment, and the other as adjuvant treatment after gross incomplete resection. Both resulted in poor outcomes requiring further treatments. Within our series of pediatric fibromatosis, only 4 cases (40%) had positive results for any nuclear beta-catenin expression, and 6 (60%) of 10 patients had negative results for beta-catenin. CONCLUSION Our experience is that total gross resection and preservation of form and function is of higher priority than achieving a negative resection margin. Pediatric fibromatosis though aggressive is still a benign condition, and careful thought should be taken before considering adjuvant chemoradiotherapy. Nuclear beta-catenin expression should not be considered a specific tumor marker for pediatric aggressive fibromatosis of the head and neck. Pediatric aggressive fibromatosis in this region may be a distinct subtype of desmoid tumor from its adult form.
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Affiliation(s)
- Alok Sharma
- Department of Otolaryngology Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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de Tella OI, Silva LRF, Stavale JN, Herculano MA, de Paiva Neto MA, Agner C. Aggressive intracranial fibromatosis: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 64:516-9. [PMID: 16917630 DOI: 10.1590/s0004-282x2006000300031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 03/04/2006] [Indexed: 11/22/2022]
Abstract
UNLABELLED Fibromatosis is a locally aggressive, proliferative fibroblastic lesion affecting musculoaponeurotic structures, most often in the limbs and trunk. Intracranial fibromatosis is extremely rare and requires aggressive treatment to prevent recurrence. CASE DESCRIPTION We present the case of a 20 year old woman with aggressive skull base fibromatosis. The lesion extended through the sphenoid, ethmoid sinus and nasal cavity, destroying the right roof of the orbit and penetrating in anterior skull base. A combined anterior craniofacial approach was performed; complete resection with surgical margin was impossible due to the localization of the tumor and relation to important neurovascular structures. Complete resection with surgical margin is often impossible because of its widely infiltrative nature. Radiotherapy and chemotherapy are often required to improve local control of the lesion.
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Papagelopoulos PJ, Mavrogenis AF, Mitsiokapa EA, Papaparaskeva KT, Galanis EC, Soucacos PN. Current trends in the management of extra-abdominal desmoid tumours. World J Surg Oncol 2006; 4:21. [PMID: 16584569 PMCID: PMC1456964 DOI: 10.1186/1477-7819-4-21] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 04/03/2006] [Indexed: 11/10/2022] Open
Abstract
Extra-abdominal desmoid tumours are slow-growing, histologically benign tumours of fibroblastic origin with variable biologic behaviour. They are locally aggressive and invasive to surrounding anatomic structures. Magnetic resonance imaging is the modality of choice for the diagnosis and the evaluation of the tumours. Current management of desmoids involves a multidisciplinary approach. Wide margin surgical resection remains the main treatment modality for local control of the tumour. Amputation should not be the initial treatment, and function-preserving procedures should be the primary treatment goal. Adjuvant radiation therapy is recommended both for primary and recurrent lesions. Chemotherapy may be used for recurrent or unresectable disease. Overall local recurrence rates vary and depend on patient's age, tumour location and margins at resection.
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Affiliation(s)
| | - Andreas F Mavrogenis
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
| | - Evanthia A Mitsiokapa
- Department of Physical Medicine and Rehabilitation, Thriassion Hospital, Elefsis, Greece
| | | | - Evanthia C Galanis
- Department of Medical Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Panayotis N Soucacos
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
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Seper L, Hoppe P, Kruse-Lösler B, Büchter A, Joos U, Kleinheinz J. [Aggressive fibromatosis in the jaw and facial region with bone involvement. A review]. ACTA ACUST UNITED AC 2006; 9:349-62. [PMID: 16142459 DOI: 10.1007/s10006-005-0639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aggressive fibromatosis (AF) involving bones of the head is rare and surgery is often complicated by a high recurrence rate. Interdisciplinary treatment is of the utmost importance to avoid extensive, mutilating resection. Two cases emphasize the difficulties in the management. CASE REPORTS A 67-year-old woman was referred to our unit with a blepharochalasis of the left upper palpebra and a palsy of the face on the left side. Her medical history included 12 operations over the previous 4 years for an extensive AF. MATERIAL AND METHODS Our review includes all case reports of AF involving bones of the head published between 1960 and 2004. Additionally, our two cases are presented. Signs, symptoms and outcome were analyzed in relation to different treatment options. CONCLUSION According to the literature, surgery is the most common treatment for AF in the head and neck region. Alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations.
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Affiliation(s)
- L Seper
- Klinik und Poliklinik für Mund- und Kiefer-Gesichtschirurgie, Westfälische Wilhelms-Universität Münster.
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16
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Mannan AASR, Ray R, Sharma SC, Hatimota P. Infantile Fibromatosis of the Nose and Paranasal Sinuses: Report of a Rare Case and Brief Review of the Literature. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300715] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Infantile fibromatosis is an uncommon, usually cutaneous, nonmetastasizing but locally aggressive fibroblastic proliferation. Involvement of the sinonasal area is extremely uncommon, and only 5 cases have been previously reported. We report a new case, which occurred in a 2-year-old boy. The mass involved the nasal cavity and the paranasal sinuses and extended into the cranial cavity. We also discuss the clinicopathologic features of this lesion, including its ultrastructural characteristics, and we review the literature.
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Affiliation(s)
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi
| | - Suresh C. Sharma
- Department of Otorhinolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi
| | - Pradeep Hatimota
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi
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17
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Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003; 14:181-90. [PMID: 12562642 DOI: 10.1093/annonc/mdg064] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite the use of surgery and radiotherapy, 20-35% of patients with aggressive fibromatosis (AF) will have local recurrence. The purpose of this review was to collect and analyze all available information regarding the role of non-cytotoxic and cytotoxic chemotherapy in AF that has been accumulated over the past few decades. PATIENTS AND METHODS A systematic review of published clinical trials, studies and case series was carried out using the Medline Express Databases and the Cochrane Collaboration Database from 1970 to October 2000. RESULTS Most studies published in the literature are in the form of successful case reports and single-arm series with small patient numbers. Most commonly used agents include hormonal agents, non-steroidal anti-inflammatory drugs (NSAIDs), interferons and cytotoxics. The literature data support the use of hormonal agents. Several questions, however, remain unresolved, such as which is the most suitable endocrine manipulation and what is the optimal dose and duration of treatment. NSAIDs and interferons have demonstrated activity against AF either alone or in combination with hormone therapy or chemotherapy but the precise mechanism of action is still unknown. Finally, there is growing evidence in the literature that chemotherapy is effective against AF with almost one in two patients being likely to respond. CONCLUSIONS The evidence in the literature supports the opinion that both non-cytotoxic and cytotoxic chemotherapies are effective against AF. However, the lack of sufficient patient numbers and randomized trials compromises the validity of the reported results and mandates further investigation with properly designed prospective studies including larger patient numbers, with main end points to include not only tumor response rate and survival but also quality-of-life issues.
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Affiliation(s)
- J Janinis
- Social Security Organization Oncology Center, Kifissia, Greece.
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18
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Abstract
Fibromatosis is a locally aggressive, proliferative fibroblastic lesion affecting musculoaponeurotic structures, most often in the limbs and trunk. Intracranial fibromatosis is extremely rare and requires aggressive treatment to prevent recurrence. We present the case of a 48 year old woman with aggressive skull base fibromatosis. The lesion extended through the sphenoid sinus, into both pterygoid recesses, destroying the right lateral wall of the sphenoid sinus and invading the cavernous sinus. There was also involvement of the floor of the sella, the clivus, the right petrous temporal bone and the right mastoid. The patient underwent partial resection of the lesion via an extended trans-sphenoidal approach. Postoperative MRI showed residual tissue. A review of the literature shows that intracranial fibromatosis usually appears in the first or second decade. Complete resection is often impossible because of its widely infiltrative nature. Radiotherapy and chemotherapy are often required to improve local control of the lesion.
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Affiliation(s)
- B Jenny
- Department of Neurosurgery, The Royal Melbourne Hospital, University of Melbourne, Australia
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19
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Shindle MK, Khanna AJ, McCarthy EF, O'Neill PJ, Sponseller PD. Desmoid tumor of the spinal canal causing scoliosis and paralysis. Spine (Phila Pa 1976) 2002; 27:E304-7. [PMID: 12065994 DOI: 10.1097/00007632-200206150-00025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This report describes a case of successful surgical excision of an intrathoracic paraspinal desmoid tumor with an intraspinous extension causing scoliosis and paralysis in a 12-year-old girl. OBJECTIVES The purpose of this report is to illustrate the potential spectrum of disease of a desmoid tumor and to make physicians aware of the rare possibility of an intraspinal extension of a paraspinal desmoid tumor. SUMMARY OF BACKGROUND DATA Surgical excision of desmoid tumors in the pediatric population is the standard of care for initial treatment. There have been no clinical reports in the spine literature of a desmoid tumor causing scoliosis or of a desmoid tumor with an intraspinous extension causing paralysis. METHODS The tumor was decompressed from a posterior approach followed by an anterior resection and an anterior spinal fusion. Two weeks later a posterior spinal fusion was performed to correct the spinal deformity. The patient also received radiation therapy after surgery for 5 weeks. RESULTS The patient tolerated the procedure well, has been free of recurrence for 9 years, and is currently doing well. CONCLUSION This case report should help expand the understanding of the spectrum of this uncommon tumor.
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Affiliation(s)
- Michael K Shindle
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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20
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Cupero TM, Thomas RW, Manning SC. Desmoplastic fibroma of the maxillary sinus. Otolaryngol Head Neck Surg 2001; 125:661-2. [PMID: 11743475 DOI: 10.1067/mhn.2001.119866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- T M Cupero
- Otolaryngology-Head and Neck Surgery Department, Madigan Army Medical Center, Tacoma, WA, USA.
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21
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Dormans JP, Spiegel D, Meyer J, Asada N, Alman BA, Pill SG, Himelstein B, Womer R. Fibromatoses in childhood: the desmoid/fibromatosis complex. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 37:126-31. [PMID: 11496351 DOI: 10.1002/mpo.1181] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J P Dormans
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
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22
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Hyodo M, Yumoto E, Wakisaka H, Mori T, Takada K. Gastric scirrhous carcinoma as a rare cause of aggressive fibromatosis in the neck. Am J Otolaryngol 2001; 22:38-42. [PMID: 11172213 DOI: 10.1053/ajot.2001.20697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aggressive fibromatosis is characterized by locally aggressive proliferation of fibroblasts and occasionally occurs in the head and neck. Although the etiology of this disease is still controversial, recent studies have shown that high levels of growth factors are found in these lesions. This article reports a case of 51-year-old woman with aggressive fibromatosis in the neck and inguinal region bilaterally. Gastric fiberscopic examination revealed a complication of advanced gastric scirrhous carcinoma. There were remarkably high levels of basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) in the serum. Postmortem autopsy examination was performed and scattered gastric carcinoma cells were observed in the fibromatosis lesions. Immunohistological staining showed positive expression of bFGF in the fibromatoses and stomach. We concluded that this was a rare case in which bFGF and PDGF released from gastric carcinoma cells caused aggressive fibromatosis by promoting unregulated proliferation of fibroblasts and collagen production locally.
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Affiliation(s)
- M Hyodo
- Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan
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23
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Abstract
Fibromatosis is a histologically benign fibrous neoplasm that arises from the musculoaponeurotic tissues of the body. It can have significant morbidity when it occurs in the head and neck region because of the proximity of vital structures. This review article considers the etiology, demographics, pathology, natural history, and various treatment modalities for this lesion. Therapeutic guidelines are provided.
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Affiliation(s)
- N S Siegel
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA
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24
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Abstract
Desmoid tumors are rare soft tissue neoplasms derived from fascial or musculoaponeurotic structures. These tumors are histologically benign but may behave aggressively at the local level with multiple recurrences after complete resection being common. Chest wall desmoids account for approximately 20% of all patients with desmoid tumors. Patients with these lesions are often asymptomatic and thus commonly present with lesions greater than 10 cm in size. The treatment for these neoplasms remains margin negative surgical excision, and, given the often large size at presentation, may require extensive chest wall resection. When this is required, chest wall reconstruction with either prosthetic material and/or autologous tissue may be performed. There may be recurrence in as many as 75% of patients. Neither adjuvant radiotherapy or chemotherapy have been shown to reduce the rate of recurrence. Recurrence should also be treated with surgical resection because patients who undergo complete surgical resection of recurrence are as likely to remain disease free after resection as patients who present with primary disease.
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Affiliation(s)
- P J Allen
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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25
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Abstract
OBJECTIVE To analyze patients with recurrent extremity desmoids, in whom the surgical therapeutic option was either major amputation or observation. SUMMARY BACKGROUND DATA The biology and natural history of desmoid tumors are an enigma. These tumors invade surrounding structures and recur locally but do not metastasize. The morbidity of treating these tumors in the context of their relatively benign biology is uncertain. METHODS Between July 1982 and June 1998, the authors treated and prospectively followed 206 patients with extremity desmoid tumors. All patients underwent standardized surgical resection, the surgical goal always being complete resection with negative margins. When tumors recurred, they were evaluated for reresection. Amputation was considered when resection was not possible because of neurovascular or major bone involvement, or in the presence of a functionless, painful extremity. RESULTS During this period, 22 patients had disease that was not resectable without amputation. This was out of a total of 115 patients with primary disease and 91 patients with recurrent disease. All recurrences were local; in no patient did metastasis develop. In this group of 22 patients with unresectable disease, 7 underwent amputation and 15 did not. These 15 patients were followed, alive with disease, having no surgical resection. Four patients received systemic treatment with tamoxifen and nonsteroidal antiinflammatories, three received systemic cytotoxic chemotherapy, and two received both tamoxifen and chemotherapy. Six patients received no systemic treatment. The range of follow-up was 25 to 92 months. In all patients, there was no or insignificant tumor progression; in three patients who underwent observation alone, there was some regression of tumor. During follow-up, no patient has required subsequent amputation, and no patient has died from disease. CONCLUSIONS In desmoid tumors, aggressive attempts at achieving negative resection margins may result in unnecessary morbidity. Function- and structure-preserving procedures should be the primary goal. In select patients, whose only option is amputation, it may be prudent to observe them with their limb and tumor intact.
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Affiliation(s)
- J J Lewis
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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26
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Perez-Cruet MJ, Burke JM, Weber R, DeMonte F. Aggressive fibromatosis involving the cranial base in children. Neurosurgery 1998; 43:1096-102. [PMID: 9802853 DOI: 10.1097/00006123-199811000-00050] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Aggressive fibromatoses are proliferations of fibrous tissue that infiltrate surrounding tissues and tend to recur after surgical resection. We report a series of five children with aggressive fibromatosis involving the cranial base. METHODS A search of the database maintained by the Medical Informatics Department at The University of Texas M.D. Anderson Cancer Center identified 78 patients with aggressive fibromatosis of the head and neck. Of these patients, five demonstrated involvement of the cranial base. All five were children. A retrospective review of the charts, diagnostic images, and pathological findings for these five patients was performed. RESULTS Surgery, radiotherapy, chemotherapy, and hormonal therapy were the treatment methods used. Four patients underwent gross total resections, but tumor cells were present at the margins in all cases. Two of these four patients experienced recurrences; one patient was cured of disease by a second surgical resection and radiotherapy, and the other underwent a second gross total resection. The fifth patient underwent a subtotal resection. He has experienced four recurrences and continues to live with residual disease. One transformation to a Grade 2 fibrosarcoma was observed. CONCLUSION Fibromatoses of the cranial base are rare and seem to be most common in the pediatric age group. Gross total resection, preferably in the first attempt, should be the goal. Radiotherapy and hormonal therapy are useful adjunctive methods for the treatment of aggressive fibromatosis. Fibromatoses that involve the cranial base are most likely to require a multidisciplinary treatment approach.
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Affiliation(s)
- M J Perez-Cruet
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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27
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Abstract
Infantile fibromatosis, one of the fibrous tumours of infancy and childhood, is a fibroproliferative lesion characterized by aggressive local invasion without any tendency to metastasize, the absence of cytological evidence of malignancy and a high rate of local recurrence when incompletely excised. We report a case of infantile (desmoid-type) fibomatosis in a seven-year-old girl arising from the deep lobe of the parotid gland that was treated by complete surgical excision with preservation of the facial nerve. The clinical features, pathology and treatment are briefly discussed.
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Affiliation(s)
- R C Ramanathan
- Department of Surgery, Royal Marsden Hospital, London, UK
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28
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Abstract
BACKGROUND Desmoid fibromatoses are a group of nonmetastasizing, well differentiated, unencapsulated fibrous tissue proliferations that have a tendency for local invasion and recurrence. Biologically, they fall in an intermediate category between benign fibrous lesions and fibrosarcoma. Because of the rarity of this lesion in the upper respiratory tract and inadequate characterization of its biologic potential in the literature, this study was undertaken. METHODS The files of the Armed Forces Institute of Pathology were reviewed for cases of fibromatosis involving the sinonasal and nasopharyngeal areas that occurred between 1885 and 1985. For each case, histologic materials were reviewed, clinical data tabulated, and follow-up obtained. RESULTS Twenty-five cases were identified. Sixteen patients were male and 9 female, ranging in age from 8 months to 62 years (mean, 29 years and 11 months). A single site was involved in 18 patients and multiple contiguous adjacent sites in 7. The maxillary sinus was the site most frequently involved (22 patients), followed by the nasal cavity (5 patients), the ethmoid sinus (4 patients), orbit (4 patients), sphenoid and frontal sinuses (2 patients each), and the nasopharynx (1 patient). Twenty-four patients were followed for periods ranging from 1 year to 20 years and 7 months (median, 6 years and 9 months; mean, 8 years and 2 months). At last follow-up, 18 patients were alive and well with no evidence of disease, 2 patients were alive with unknown disease histories, and 3 patients were alive with recurrent or residual disease. One patient died without evidence of disease. Five patients (21%) (4 adults and 1 child) developed recurrences; 3 patients had 1 recurrence at 6, 16, and 34 months, respectively, 1 patient had 2 recurrences at 3.5 and 5.5 months, and 1 patient was alive with recurrent disease at 6.5 years. One patient was lost to follow-up. CONCLUSIONS Twenty-five cases of desmoid fibromatosis involving the sinonasal tract and nasopharynx were described. These lesions appear to have lower recurrence rates and morbidity than desmoid fibromatoses arising in many other areas of the body.
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Affiliation(s)
- D R Gnepp
- Department of Pathology, Rhode Island Hospital, Brown University School of Medicine, Providence 02903, USA
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29
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Abstract
Desmoid fibromatosis is a rare tumor of the head and neck. Only five cases involving the sino-orbital region have been previously reported in the literature. In this report we describe the sixth such case, involving a 2-year-old boy, and review the literature.
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Affiliation(s)
- A A Maillard
- Department of Otolaryngology--Head and Neck Surgery, University of Texas--Houston Medical School, USA
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30
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Abstract
Fibromatosis is a locally infiltrative fibrous tissue proliferation with a tendency to recur locally. From a large series of head and neck patients treated between 1977 and 1994 in our institute, we retrieved the records of nine adult patients diagnosed with this disease. They serve as examples to demonstrate this rare entity in the head and neck. Five out of nine lesions were localized in level V (posterior triangle of the neck). The majority of patients were treated by surgery in combination with radiotherapy. None of the patients died of the disease.
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Affiliation(s)
- B E Plaat
- Department of Otolaryngology/Head and Neck Surgery, The Netherlands Cancer Institute, (Antoni van Leeuwenhoek Huis), Amsterdam
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31
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Plukker JT, van Oort I, Vermey A, Molenaar I, Hoekstra HJ, Panders AK, Dolsma WV, Koops HS. Aggressive fibromatosis (non-familial desmoid tumour): therapeutic problems and the role of adjuvant radiotherapy. Br J Surg 1995; 82:510-4. [PMID: 7613897 DOI: 10.1002/bjs.1800820424] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, even after apparently adequate resection. Wide local excision with a margin of at least 3 cm, depending on the anatomical location, should be performed to improve rates of recurrent disease. There is no consensus concerning the role of radiotherapy in the treatment of these lesions. The clinical findings of 39 cases diagnosed between 1972 and 1991 were reviewed retrospectively. Local control was effected in 19 of 32 patients treated with surgery alone after a median (range) follow-up of 72 (18-236) months. There were 40 cases of recurrent fibromatosis in 15 patients. Local control was obtained in 13 of 14 patients who received radiotherapy using a wide-field technique and doses of more than 50 Gy over a period of 5 weeks after marginal or incomplete resection of primary or recurrent lesions (P < 0.001). The results suggest that in a selected group of patients with aggressive fibromatosis radiotherapy may effectively achieve control of residual disease after surgery without marked disfigurement and loss of function.
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Affiliation(s)
- J T Plukker
- Department of Surgery, Groningen University Hospital, The Netherlands
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32
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Fowler CB, Hartman KS, Brannon RB. Fibromatosis of the oral and paraoral region. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 77:373-86. [PMID: 8015802 DOI: 10.1016/0030-4220(94)90200-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The fibromatoses represent a group of infiltrating fibrous proliferations that exhibit a clinical behavior and biologic potential intermediate between benign fibrous lesions and fibrosarcoma. The head and neck region is a common site of involvement for these lesions especially in children and young adults. However, the oral structures per se are not often the site of origin. In this study of 31 cases of fibromatosis that involved the oral and paraoral region, patient ages ranged from birth to 51 years with 74% appearing in the first decade. The most common clinical presentation was a painless mass that involved the cheek, tongue, or submandibular region. Erosion of bone was a frequent finding in lesions arising in soft tissue contiguous with the jaws. After surgical excision, lesions recurred in five patients for a recurrence rate of 23.8%. One lesion recurred twice. The average interval from initial treatment to recurrence was 7.6 months. The recurrence rate observed in this series is significantly lower than that generally reported for fibromatosis of the head and neck (50% to 70%). This is most likely due to the exclusion in this investigation of lesions in the supraclavicular region.
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Affiliation(s)
- C B Fowler
- Department of Oral Pathology, Wilford Hall USAF Medical Center, Lackland AFB, Tex
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Abstract
PURPOSE To determine the efficacy of different treatment modalities for desmoid tumors. MATERIALS AND METHODS We reviewed the treatment of 40 patients with histologically confirmed desmoid tumors seen at Duke University Medical Center between 1974 and 1990. RESULTS Radiotherapy was administered to 16 patients (Group I)--14 with recurrent disease s/p surgery and in two as initial treatment. The average size of the irradiated lesions was 9.3 +/- 3.9 X 8.4 +/- 3.5 cm. With a median follow-up of 57.5 months and a median administered dose of 5400 cGy (mean 5286 cGy, range 4960-5620 cGy), local control has been obtained in 15/16 patients (94%). Complete regression (5/16), partial regression (5/16), or stable disease (5/16) was produced in 15 patients while one patient failed and was salvaged via gross total resection. Continued regression has been seen up to 60 months after treatment. Fourteen patients underwent primary gross total resection and two underwent subtotal resection (Group II). None received post-operative radiotherapy. Three of 14 patients (21%) recurred after gross total resection. All three were salvaged with subsequent gross total resection. After subtotal resection, 2/2 patients recurred. With a mean follow-up of 52 months, 14 patients are without evidence of disease, one is dead with disease (unrelated cause of death), and one was lost to follow-up after recurrence. Eight patients have been treated with combinations of chemotherapy, NSAIDS, anti-estrogens, and immunotherapy with mixed results (Group III). A subset of seven patients with retroperitoneal disease taken from all three groups had large tumor burden (mean size 17 X 15 cm), an infiltrative nature, as well as a difficult location. The disease was surgically resectable in three patients. One is without evidence of disease 9 years after gross total resection alone. Disease has been stabilized with radiotherapy in the other two patients after multiple unsuccessful surgical resections. Of four patients with unresectable disease, two are dead of disease, one died of unrelated causes with disease, and regression of disease was obtained in the other with Gamma-interferon after unsuccessful treatment with tamoxifen and vincristine, doxorubicin, and cyclophosphamide chemotherapy. CONCLUSION Gross total resection is the indicated initial therapy, if it can be performed without significant disfigurement. Radiotherapy is also excellent for obtaining local control, even in patients with a large burden of recurrent disease. Doses in the range of 50 to 55 Gy give a chance of local control equal to that obtained with higher doses previously reported.
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Affiliation(s)
- J C Acker
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
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34
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Abstract
BACKGROUND Desmoid tumors are the source of significant morbidity and mortality in patients with Gardner syndrome. METHODS The authors present a case report and review of the literature. RESULTS A young woman with an extensive abdominal desmoid had a prolonged response to doxorubicin after she did not respond to more conventional treatments. CONCLUSIONS To the authors' knowledge, this is the first report of the successful treatment of desmoids with doxorubicin used as a single agent. Reports of the efficacy of chemotherapy in these and related tumors are reviewed.
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Affiliation(s)
- K Seiter
- Gastrointestinal Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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35
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Maddalozzo J, Tenta LT, Hutchinson LR, Crawford SE, Morse DS. Juvenile fibromatosis: hormonal receptors. Int J Pediatr Otorhinolaryngol 1993; 25:191-9. [PMID: 8436465 DOI: 10.1016/0165-5876(93)90053-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aggressive juvenile fibromatosis, though allegedly a benign process, is as frustrating to manage as it is perplexing to comprehend. The treatment is primarily surgical, with chemotherapy and radiation therapy recently finding support as adjuncts in selected circumstances. Though there is no agreement regarding the etiology of fibromatosis, many have suspected hormonal or traumatic influences. There has been historical, clinical and experimental data demonstrating that fibromatosis seems to be under the influence of estrogen. There have also been anecdotal reports that this tumor has regressed with the use of tamoxifen. To our knowledge, no one has tested these tissues for the presence of estrogen/progesterone receptors. Recently, over a short period of time, we at Children's Memorial Hospital, Chicago, have treated four youngsters with this disorder. All operative specimens were submitted for estrogen and progesterone assays. Although these cases were indistinguishable on histologic examination, two of the four exhibited the presence of estrogen/progesterone receptors. We propose, that from these observations, there potentially may be derived a histochemical classification based upon the presence or absence of estrogen/progesterone receptors. This would serve as an added reference in the definition and treatment of this disease. Should hormonal receptors be present, agents such as tamoxifen conceivably could be employed as part of a post-operative maintenance regimen similar to those protocols applied in the management of hormonally responsive breast cancer.
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Affiliation(s)
- J Maddalozzo
- Dept. of Otolaryngology (Head and Neck Surgery), Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL
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36
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Petri WH, Mack R, Hsu M, Yamashita DD. A submucosal mass in the floor of the mouth. J Oral Maxillofac Surg 1992; 50:1087-90. [PMID: 1388203 DOI: 10.1016/0278-2391(92)90496-m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- W H Petri
- Department of Oral and Maxillofacial Surgery, Louisiana State University, Medical Center, New Orleans 70119
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37
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Naidu RK, Aviv JE, Lawson W, Biller HF. Aggressive juvenile fibromatosis involving the paranasal sinuses. Otolaryngol Head Neck Surg 1991; 104:549-52. [PMID: 1903871 DOI: 10.1177/019459989110400423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aggressive juvenile fibromatosis is a destructive, locally invasive process, with a propensity for local recurrence after inadequate excision. Although it does not metastasize, uncontrolled growth can eventually lead to death. The role for radiation and chemotherapy is controversial and these modalities are best reserved for advanced unresectable or recurrent lesions. The treatment of choice is en bloc surgical resection with wide margins.
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Affiliation(s)
- R K Naidu
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY 10029-6574
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38
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Donohue WB, Malexos D, Pham H. Aggressive fibromatosis of the maxilla. Report of a case and review of the literature. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 69:420-6. [PMID: 2183123 DOI: 10.1016/0030-4220(90)90372-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aggressive fibromatosis is a rare tumor of the jaws. Its occurrence in the maxilla is even more exceptional. The case of a 14-year-old girl with a peripheral fibromatosis of the palatal process of the maxilla is described. The lesion manifested as a painless swelling. On initial excision, a diagnosis of fibroma was made. After recurrence and reevaluation of the microscopic slides, a final diagnosis of aggressive fibromatosis was established. The features of this case and 12 similar lesions of the maxilla previously described in the literature are analyzed and discussed.
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Affiliation(s)
- W B Donohue
- Faculty of Dental Medicine, Université de Montréal, Quebec, Canada
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39
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West CB, Shagets FW, Mansfield MJ. Nonsurgical treatment of aggressive fibromatosis in the head and neck. Otolaryngol Head Neck Surg 1989; 101:338-43. [PMID: 2508004 DOI: 10.1177/019459988910100307] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aggressive fibromatosis is a poorly defined, locally aggressive, yet histologically benign fibroblastic proliferative lesion that may occur in the head and neck. The lesion is highly cellular and locally infiltrative and has a propensity to invade and erode bone, compromising vital structures within the head and neck. However, it is not a true malignancy because it does not have malignant cytologic characteristics nor does it metastasize. We present two cases of aggressive fibromatosis occurring in young adult men. The first case involved a rapidly enlarging mass of the anterior maxilla that involved the upper lip, nasal alae, nasal septum, inferior turbinates, and hard palate. The patient underwent incisional biopsy to confirm the diagnosis. Because of difficulty in determining the actual margins of this extensive lesion and the significant morbidity that would have resulted from surgical resection, we elected to treat this patient with chemotherapy and radiation therapy. The second case was an extensive lesion involving the right temporal bone, pterygomaxillary space, and infratemporal, temporal, and middle cranial fossae. Incisional biopsy confirmed the diagnosis. Because of the lack of functional and cosmetic deficits and the unavoidable morbidity of a surgical resection, this patient was treated with radiation therapy. Although wide field resection is the most satisfactory form of treatment, in situations in which this modality would result in unacceptable morbidity or if surgical margins are positive, then radiation therapy and chemotherapy should be considered. Support for these therapeutic modalities is found in larger series of cases outside the head and neck.
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Affiliation(s)
- C B West
- Wilford Hall USAF Medical Center, Lackland Air Force Base, TX 78236
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Kwon PH, Horswell BB, Gatto DJ. Desmoplastic fibroma of the jaws: surgical management and review of the literature. Head Neck 1989; 11:67-75. [PMID: 2490064 DOI: 10.1002/hed.2880110112] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Desmoplastic fibroma of the jaws is a rare and locally aggressive tumor that has a high rate of recurrence. The cellularity, extent of the tumor, and completeness of the local excision may be factors in its tendency to recur. We reviewed the literature in an attempt to determine if there was any correlation between the histologic features of a desmoplastic fibroma, or the surgical procedure utilized, and the tumor's recurrence. From the information gathered, it was found that a more cellular desmoplastic fibroma or inadequate surgical procedure may be factors that contribute to the recurrence of the tumor. A case report of desmoplastic fibroma of the mandible in a 9-year-old child is presented. The tumor, which displayed areas of moderate cellularity, was resected via a partial hemimandibulectomy. There has been no recurrence to date (46 months).
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Affiliation(s)
- P H Kwon
- Department of Oral and Maxillofacial Surgery, Marquette University, Milwaukee, Wisconsin
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Affiliation(s)
- A C Shah
- Division of Otolaryngology, Case Western Reserve University, Cleveland Metropolitan General Hospital, OH 44109
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O'Ryan F, Eversole LR, Alikpala A. Juvenile fibromatosis of the infratemporal fossa. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1987; 64:603-8. [PMID: 3313153 DOI: 10.1016/0030-4220(87)90067-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of extensive juvenile fibromatosis of the infratemporal fossa in a 2-year-old child, which was evident only as progressive mandibular hypomobility, is reported. The current literature is reviewed with regard to the etiology of the fibroproliferative lesions, the histopathologic diagnosis, and treatment modalities. Although complete surgical resection is the treatment of choice, radiation therapy and chemotherapy have been recommended in extensive cases. Because of the immense size and location of the lesion in the case presented herein, the tumor was deemed inoperable and was treated with multimodality chemotherapy.
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Affiliation(s)
- F O'Ryan
- Center for Correction of Dentofacial Deformities, St. Luke's Hospital, San Francisco, Calif
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Abstract
No tumor system is more amenable to multidiscipline therapy than head and neck cancers. Diagnosis is enhanced by fine-needle cytology, computerized tomography (CT) scan, and tumor markers. Modified surgical techniques, CO2 laser, and immediate myocutaneous flap reconstruction have enhanced surgery. Endocurie therapy, radiosensitizers, and particle therapy supplementation have enhanced radiotherapy. Combination chemotherapy, immunotherapy, prostaglandin synthesis inhibitors, and retinoids have enhanced chemotherapy. Induction chemotherapy followed by surgery with or without postoperative radiotherapy is optimum multidisciplinary therapy. Reduction in exposure to tobacco, alcohol, sunlight, gamma irradiation, occupational toxins, and Epstein-Barr virus, and recognizing high-risk hereditary conditions, can help prevent these cancers.
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Chandler JR, Goulding R, Moskowitz L, Quencer RM. Nasopharyngeal angiofibromas: staging and management. Ann Otol Rhinol Laryngol 1984; 93:322-9. [PMID: 6087710 DOI: 10.1177/000348948409300408] [Citation(s) in RCA: 113] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We propose a system for staging nasopharyngeal angiofibromas based on clinical evaluation and computerized tomography. Twenty-three patients with this pathologic diagnosis have been managed at the University of Miami/Jackson Memorial Medical Center in the past two decades. In 13 patients, the clinical diagnosis was confirmed by transnasal biopsy as a minor outpatient procedure. This avoided unnecessary diagnostic studies, shortened the hospital stay, and expedited treatment. Computerized tomography has replaced conventional x-ray studies and routine tomography, although angiography is still necessary for proper evaluation of larger tumors. Stage groupings recommended on the basis of this experience are stage I--tumor confined to nasopharynx; stage II--tumor extending into nasal cavity and/or sphenoid sinus; stage III--tumor extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit, and/or cheek; and stage IV--tumor extending into cranial cavity. Surgical excision is recommended for stages I, II, and III. Stage IV tumors require surgical resection and/or radiation therapy with the possible addition of hormonal therapy.
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Sutton L, Raney B. Recurrent fibroma of the neck in an infant. MEDICAL AND PEDIATRIC ONCOLOGY 1984; 12:349-51. [PMID: 6493139 DOI: 10.1002/mpo.2950120511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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