Effective high intensity focused ultrasound treatment in recurrent aggressive breast fibromatosis: a case report

Breast Fibromatosis: Radiologic-Pathologic Correlation

Fibromatosis of the breast is a rare, benign locally infiltrative tumor without metastatic potential. Patients typically present with a painless, palpable, firm breast mass, which may be mobile or fixed to the pectoralis muscle. While some cases are related to familial mutations in the adenomatous polyposis coli (APC) gene, the majority are sporadic due to somatic mutations or prior injury to the breast tissue. On mammography, fibromatosis is typically seen as an irregular, dense, spiculated mass. US demonstrates a hypoechoic, irregular mass with indistinct margins. Fibromatosis is indistinguishable from breast cancer on imaging, and core biopsy is required for definitive diagnosis. Wide local excision is the historical standard for treatment; however, recurrence rates are high, and other emerging therapies are being explored. This article reviews the clinical features, imaging and histopathologic findings, along with brief overview of management.

High-intensity focused ultrasound treatment as an alternative regimen for myxofibrosarcoma

Myxofibrosarcoma is a common soft-tissue sarcoma in elderly patients, characterized by an infiltrative growth pattern and a high risk for persistent local recurrence. A 35-years-old woman was diagnosed with myxofibrosarcoma on the right upper arm and the tumor is surgically resected. The tumor relapsed 7 months later. Then the patient received five cycles of low power cumulative high-intensity focused ultrasound (HIFU) treatments, which completely ablated the tumor without complications. Now the patient is disease free with a high quality of life more than 30 months. This case indicates HIFU ablation might be a novel, promising therapy for recurrent myxofibrosarcoma.

Intermittent ice-cooling to prevent skin heat injury caused by high-intensity focused ultrasound therapy targeting desmoid-type fibromatosis: A case report

Introduction

Desmoid-type fibromatosis (DF) is a fibrous tumor characterized by low-grade malignant and easy invasive growth and high recurrence. High-intensity focused ultrasound (HIFU) therapy has been identified as a novel non-invasive approach for DF treatment; however, the ultrasonic energy generated by HIFU can cause skin heat injury.

Case

A 31-year-old female patient with signs and symptoms of DF received treatment in our institution. The patient had undergone HIFU treatment six times from April 27, 2018, to August 21, 2019. After HIFU therapy for the third time, she had a third-degree skin burn showing as orange peel-like change and spent three months to promote the recovery of the skin lesions. An intermittent ice-cooling strategy was used to avoid skin damage during the fourth HIFU treatment. This patient did not have any apparent skin injury during the last three HIFU therapy and acquired satisfactory anti-tumor therapeutic effect.

Conclusions

There are differences in the thermal selectivity of tumor tissues, which leads to different critical thermal injury temperature values that the tissue can tolerate. Ice-cooling can lower skin tissue temperature and reduce the thermal damage caused by HIFU treatment.

Management of aggressive fibromatosis

Aggressive fibromatosis or desmoid tumor is a rare disease resulting from fibroblasts which do not metastasize. However, desmoid tumors belong to low-grade malignant tumors since they have high potential to infiltrate surrounding tissues, causing high local recurrence rates and may affect surrounding organs, threatening life quality and expectancy. Although surgery, watch and wait, radiotherapy, chemotherapy, high intensity focused ultrasound, ablation techniques or several agents have all been frequently investigated for the treatment of this type of disease, none are deemed as standard therapy for high recurrence rates that have been supported by any data. The present review retrieved literature on treatment options for desmoids to summarize the latest treatment modalities and refine their efficacy, as well as their side effects, in order to provide a more comprehensive treatment reference for clinicians.