Desmoid fibromatosis of submandibular region

Cervical Aggressive Fibromatosis Causing Airway Obstruction

Fibromatosis or desmoid tumors are rare benign fibroblastic lesions that are rarely present in the head and neck regions. When they do occur in these regions, however, they tend to be aggressive toward the surrounding tissue and be associated with heavy morbidity and mortality. We report the case of a 26-year-old Tunisian female who presented with acute obstructive dyspnea and a 3-week history of cervical swelling. The swelling was initially only located in the left submandibular area, it then gradually extended to all the anterior cervical supra- and infrahyoid regions causing a clinical presentation resembling that of obstructive dyspnea, the patient was admitted, and an emergency tracheotomy was performed. Tissue samples were taken, pathological analysis revealed an aggressive case of fibromatosis. The patient was treated with corticosteroids and antihormonal therapy, the fibrous mass shrunk considerably allowing the removal of the tracheotomy cannula, no tumor recurrence was noted during the observation period. Due to the rarity of this disease, especially in the cervical region, there are no therapeutic guidelines available.

A Submandibular Fibromatosis; A Case Report and Review of Literature

Background: Fibromatosis is a group of benign tumors originating from connective tissues of muscle, overlying fascia, periosteum, or aponeurosis. However, they might need several excisional resections, owing to compressive effects on adjacent vital structures. Case Report: Here, we discussed a case of submandibular fibromatosis in a 3-year-old girl. She underwent a conservative surgical procedure without a wide mandible bone resection. She received no adjuvant therapy. The postoperative period was uneventful with an appropriate cosmetic and functional outcome. A 1-year follow-up revealed no recurrence. Conclusion: Fibromatosis of the head and neck in children is a rare condition, which needs a multidisciplinary agreement for its appropriate management. A complete surgical removal often leads to a proper outcome. Adjuvant therapy should also be kept in mind for recurrent lesions not candidate for surgical removal or in case of remnant tumors.

Aggressive fibromatosis in the submandibular region of a child

Aggressive fibromatosis is proliferation of well‐differentiated fibroblasts. Submandibular region is rare location for fibromatosis. We report a case of a rapidly growing mass in submandibular region of 5‐year‐old girl, excised surgically and ascertained to be aggressive fibromatosis on histological examination. Recovery was uneventful, and she was disease‐free in 6‐month follow‐up.

Value of imaging findings in predicting post-operative recurrence of desmoid-type fibromatosis

Desmoid-type fibromatosis is a rare type of soft-tissue tumor originating from connective tissue of the fascia or aponeurosis, which exhibits aggressive growth, high likelihood of relapse and less frequent distant metastasis. The present study aimed to predict the recurrence rate and time by retrospectively analyzing the clinical data (sex, age and recurrence time), imaging findings [tumor location, maximum diameter, border, computed tomography (CT) enhancement ratio, magnetic resonance enhancement ratio and T2 signal ratio] and pathological features (Ki-67 and microscopic margin) in a total of 102 cases of pathologically confirmed desmoid-type fibromatosis. The risk ratio of each factor was calculated using the Cox proportional hazards regression model and the cumulative recurrence-free survival rate was determined using the Kaplan-Meier method and the log-rank test. The cohort comprised of 73 females and 29 males, with mean age of 32.86±12.64 years (range, 6–78 years). The 1-year and 2-year recurrence rate was 31 and 54%, respectively. The median age at recurrence was 29 years. Univariate analysis indicated that sex, maximum tumor diameter, CT enhancement ratio and Ki-67 had a significant effect on the recurrence time. Furthermore, multivariate analysis revealed that sex, maximum tumor diameter, Ki-67 and T2 signal ratio were independently associated with the time of recurrence, and the risk ratios were 0.424, 1.100, 1.084 and 1.268, respectively. Therefore, in male patients with a larger maximum tumor diameter, positivity for Ki-67 and a higher T2 signal ratio, desmoid-type fibromatosis was more likely to recur after surgery.

Sino-orbital desmoid tumor in a pediatric patient - Case report with review of literature

We report a case of a 2-year-old female who presented with bilateral progressive proptosis, visual loss, nasal obstruction, and breathing difficulty. Magnetic resonance imaging revealed a large sino-orbital mass that was extending to the orbital apex and skull base. An initial diagnosis of rhabdomyosarcoma was made elsewhere on the basis of the presence of round and spindle cell tumor. Subsequent biopsy with immunohistochemical staining was positive for nuclear staining with β-catenin, shifting the diagnosis to a myofibroblastic tumor, favoring desmoid-type fibromatosis. With image guidance, near complete excision of tumor was performed by a multidisciplinary team, while respecting danger zones such as the skull base and the optic nerve. Following a recurrence over 2 months, additional excision was performed with a 6-month treatment of methotrexate and vinblastine. Desmoid tumor is a rare form of soft tissue tumor uncommonly seen in the orbital area. Although benign, it is known to be recurrent and infiltrative. Few data are known and further information will aid in the management of these tumors.

Marginal versus segmental mandibulectomy for pediatric desmoid fibromatosis of the mandible - Two case reports and review of the literature

Desmoid fibromatosis (DF) is a rare, benign soft tissue neoplasm with high rate of local recurrence. Surgical management of DF in the head and neck can be challenging given the desire to balance the preservation of form and function with the need to minimize local recurrence by achieving complete resection. We present two contrasting cases which highlight the advantages of marginal mandibulectomy over segmental mandibulectomy in children with DF. We favor marginal mandibulectomy even with limited bone stock given the remarkable ability of children to generate new bone.