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Kumar SA, Singh H, Kaman L, Nada R, Mittal BR. Annotating the Role of 18F-FDG PET/CT in Fibromatoses: A Benign Masquerader of Malignancies-Is It Really an Advantageous Tool? Nucl Med Mol Imaging 2024; 58:140-146. [PMID: 38633285 PMCID: PMC11018563 DOI: 10.1007/s13139-024-00846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/03/2023] [Accepted: 01/29/2024] [Indexed: 04/19/2024] Open
Abstract
Fibromatoses are a heterogeneous group of benign proliferating fibroblasts and myofibroblasts which have a high predilection for recurrence and local invasion, especially deep fibromatoses or desmoid fibromatosis. 18F-FDG PET/CT, the workhorse of oncological imaging in nuclear medicine, can be employed to figure out the nature and aggressiveness of the lesions and various sites of involvement and to monitor treatment response to systemic therapies like tyrosine kinase inhibitors in case of deep or desmoid fibromatoses which is shown in the current research work.
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Affiliation(s)
- Srinivas Ananth Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harmandeep Singh
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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2
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Yamada H, Ikumi A, Yoshii Y, Yamazaki M. Isolated Distal Interphalangeal Joint Flexion Contracture of the Ring Finger due to Dupuytren Disease: A Case Report. J Hand Surg Asian Pac Vol 2023; 28:722-726. [PMID: 38073413 DOI: 10.1142/s2424835523720220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Dupuytren disease is a common benign fibromatosis of the palmar and finger fascia caused by pathological cord formation. As both the retrovascular and lateral cords are jointly responsible for the flexion contracture of the distal interphalangeal (DIP) joint, isolated DIP joint contracture caused by Dupuytren disease is rare. We present a 34-year-old right-hand-dominant male patient with a 6-month history of an isolated DIP joint flexion contracture in the right ring finger due to Dupuytren disease. Surgical fasciotomy of the retrovascular cord improved the contracture without adverse events. It is important to pay attention to the anatomical relationships between the pathological cord and neurovascular bundle to avoid neurovascular injury during fasciotomy in patients with Dupuytren disease, especially in isolated DIP joint contracture cases. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
| | | | - Yuichi Yoshii
- Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan
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3
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Garg V, Gangadharaiah BB, Rastogi S, Upadhyay A, Barwad A, Dhamija E, Gamangatti S. Efficacy and tolerability of sorafenib in desmoid-type fibromatosis: A need to review dose. Eur J Cancer 2023; 186:142-150. [PMID: 37062211 DOI: 10.1016/j.ejca.2023.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Sorafenib is currently one of the recommended treatments for symptomatic patients with desmoid-type fibromatosis (DTF). In this study, we aim to assess the clinical efficacy and tolerability of sorafenib in DTF patients. METHODOLOGY Patients aged>18 years with a histological diagnosis of DTF and who have received sorafenib were enroled in this prospective observational study. Demographic data, clinical profile, the initial dose of sorafenib, treatment-related toxicities, dose modifications, and responses were recorded. The primary objective was to assess the objective response rate (ORR). The secondary objectives were to evaluate progression-free survival (PFS), tolerability, and adverse effects of sorafenib. Response assessment was based on response evaluation criteria in solid tumours 1.1 criteria. Adverse effects were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 criteria. Time to event was calculated by Kaplan-Meier analysis, and survival was compared by log-rank test. Univariate and multivariable cox regression analysis were used to find independent predictors of relapse. RESULTS A total of 104 patients were enroled in the study. The median age of the study population was 32 (range, 18-81) years, and 66.35% of patients were females. On response assessment, ORR was 46.1% and stable disease was observed in 31.7% patients. ORR was higher in the appendicular site (51.7%) compared to the abdominal site (27.2%). PFS at 1 and 2 years was 86.6% (79.6-92.7%) and 73.7% (62.4-82.8%), respectively. Two-thirds (66.6%) of patients had already received some form of treatment. At the time of analysis, 70 (67.3%) patients were continuing sorafenib. Only 4.8% stopped sorafenib due to progression, 10.5% due to intolerable adverse effects, and 17.3% due to other reasons. The common treatment-related toxicities were hand-foot skin reaction (HFSR) (89.4%), fatigue (79.8%), alopecia (70.1%), and diarrhoea (48.0%). In the patients with a starting dose of ≥400 mg (48.0% of patients), discontinuation was necessitated in 12% of patients, and further dose reduction was required in 58%, while only about 13% required dose reduction or discontinuation at a starting dose of 200 mg (51.9% of patients). Responses were not compromised due to lower starting doses. CONCLUSIONS Sorafenib has good activity in DTF, but it is associated with significant toxicity. The adverse effect profile is distinct in Indian patients with higher HFSR and alopecia. Due to the high rate of dose reduction/discontinuation with a starting dose of 400 mg, a starting dose of 200 mg may be recommended in Indian patients.
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Affiliation(s)
- Vikas Garg
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India.
| | | | - Sameer Rastogi
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India.
| | | | | | - Ekta Dhamija
- Department of Radiodiagnosis, BRAIRCH, AIIMS, Delhi, India.
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Mazhoud I, Maghrebi A, Skhiri W, Gargouri B, Hajji A, Salem AB. Fibromatosis of the breast; another diagnosis of cancer like lesions: About 4 cases reports. Int J Surg Case Rep 2023; 105:108023. [PMID: 36958146 PMCID: PMC10053021 DOI: 10.1016/j.ijscr.2023.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Desmoid fibromatosis is a benign monoclonal fibroblastic tumor that was first reported in 1832 and arises from musculoaponeurotic structures. It is an uncommon tumor that can mimic breast carcinoma in both hits clinical and radiological presentation. This entity mainly affects patients in their fourth and fifth decades of life. CASE PRESENTATION Our four patients were of young women in their 2nd and 3rd decade that consulted for masses of the breast. These lesions were suspicious for malignancy in both their clinical and radiological features despite not having any family history of breast carcinoma. CLINICAL DISCUSSION Only histology provides the diagnosis, it is locally invasive, non-metastatic but with a high potential of recurrence and the sole treatment is complete and wide local excision with clear margins. CONCLUSION Although it is a rare clinical scenario, the presence of an unusual breast or chest wall tumor such as a desmoid tumor should be considered when obvious breast changes and history do not correlate with routine diagnostic measures.
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Affiliation(s)
- Ines Mazhoud
- Department of Radiology, Maternity Center, Monastir, Tunisia
| | - Amel Maghrebi
- Department of Radiology, Maternity Center, Monastir, Tunisia.
| | - Wissal Skhiri
- Department of Radiology, Maternity Center, Monastir, Tunisia
| | | | - Ahmed Hajji
- Department of Gynecology and Obstetrics, Maternity Center, Monastir, Tunisia
| | - Amina Ben Salem
- Department of Radiology, Maternity Center, Monastir, Tunisia
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5
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Pena-Burgos EM, Pozo-Kreilinger JJ, Tapia-Viñe M, Iglesias-Urraca C, González-García MC. Fibrous hamartoma of infancy. Radiologic-pathologic study of 21 cases: 8 with predominant pseudoangiomatous pattern. Ann Diagn Pathol 2023; 62:152075. [PMID: 36493659 DOI: 10.1016/j.anndiagpath.2022.152075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Fibrous hamartoma of infancy (FHI) is a very rare benign soft tissue lesion that principally affects the axilla, trunk, and upper extremities of children younger than 2 years. It is usually cured by local excision. Histologically, these lesions have a triphasic morphology in an organoid pattern: mature adipose tissue, fibroblastic/myofibroblastic trabeculae, and small round cell nests in a myxoid matrix. However, morphologic variants have recently been described. Focal areas with a pseudoangiomatous pattern have been found in some FHI, but few cases with predominant pseudoangiomatous areas have been previously described in the medical literature. We report 21 new cases of FHI, 8 of them with a predominant pseudoangiomatous pattern. Our cases with a predominant pseudoangiomatous pattern did not present specific radiological findings.
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Affiliation(s)
| | | | - M Tapia-Viñe
- La Paz University Hospital, Radiology Department, Spain
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6
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Ballouz TL, Margolis JH. Mediastinal Desmoid Tumor Presents as Lymphadenopathy in Patient with Lymphoma: A Case Report. Case Rep Oncol 2023; 16:765-770. [PMID: 37900844 PMCID: PMC10601720 DOI: 10.1159/000532097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/14/2023] [Indexed: 10/31/2023] Open
Abstract
Desmoid tumors are rare mesenchymal neoplasms that are rapidly growing but do not metastasize. We present a case of a 75-year-old man with a history of non-Hodgkin lymphoma in remission incidentally found to have an enlarging internal mammary lymph node on screening CT, subsequently diagnosed as a desmoid tumor via biopsy. The patient was deemed unfit for surgical resection and instead underwent urgent radiation and immunotherapy. This report highlights a unique case of desmoid tumor presenting as mediastinal lymphadenopathy.
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Affiliation(s)
- Tara L. Ballouz
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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7
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Abu-Jeyyab M, Al-Asbahi H, Al-Jafari M, Al-Tarawneh BK, Nashwan AJ. Aggressive Fibromatosis of the Left Mesocolon Mimicking a Gastrointestinal Stromal Tumor: A Case Report. Case Rep Oncol 2023; 16:1148-1155. [PMID: 37900798 PMCID: PMC10601818 DOI: 10.1159/000534038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
Mesenteric fibromatosis (MF) is a proliferative fibroblastic lesion of the intestinal mesentery. It constitutes 8% of all desmoid tumors, representing 0.03% of all neoplasms. It is benign histologically, although it could infiltrate locally and recur following excision; however, it is free from the potential to metastasize. It is spontaneous or associated with familial adenomatous polyposis (FAP]) mutation as a part of Gardner's syndrome. This case report discusses the radiological, intraoperative, and histopathological findings from a 45-year-old male patient who presented with abdominal pain and a palpable mass in the left hemiabdomen. The pain was dull and aching, extending to the back and unrelated to any other gastrointestinal symptoms. There was no history of severe weight reduction. Furthermore, he is not a smoker. There were no comorbidities, severe medical diseases, or prior surgical procedures. Computerized tomography revealed a well-defined, lobulated, heterogeneously enhancing altered signal intensity mass at the mesocolon. Ultrasonography of the abdomen showed an intra-abdominal mass. Macroscopic mass characteristics include a well-defined mass measuring 22 × 14 × 11 cm connected to a small intestine segment measuring 21 × 2 × 2 cm. Histopathological and immunohistochemical examinations of the resected tumor, including positive nuclear immunostaining for beta-catenin, confirmed a postoperative diagnosis of desmoid-type fibromatosis. Based on its clinical presentation and computed tomography results, this case demonstrated how desmoid-type fibromatosis of the colon might mimic gastrointestinal stromal tumors (GISTs). Due to the varied therapies and follow-up methods used for these lesions, the differential diagnosis between desmoid-type fibromatosis and GIST is clinically significant.
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Affiliation(s)
| | - Hanan Al-Asbahi
- General Surgery Department, Al-Basheer Hospital, Amman, Jordan
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8
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Godse R, Dany M, Tamazian S, Wan J, Jen M, Rubin AI. Infantile Digital Fibromatosis/Inclusion Body Fibromatosis: A Comprehensive Literature Review. Skin Appendage Disord 2023; 9:1-7. [PMID: 36632366 PMCID: PMC9827721 DOI: 10.1159/000526253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/19/2022] [Indexed: 01/14/2023] Open
Abstract
Infantile digital fibromatosis (IDF), or inclusion body fibromatosis, is a rare benign tumor that commonly presents as a solitary nodule composed of spindle cells within the dermis on the digits of infants and children. Evaluation often includes a biopsy and typical therapies include observation, intralesional corticosteroid injections, and complete surgical resection. Given the rarity of IDF, few clinicians have direct or extensive experience diagnosing or treating it. Here we present a comprehensive review of the presentation, diagnosis, and treatment for IDF.
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Affiliation(s)
- Rama Godse
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohammed Dany
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shant Tamazian
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melinda Jen
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam Ian Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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9
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila LF. Imaging palpable tumors in pediatrics: Part 2. Radiologia (Engl Ed) 2023; 65:43-54. [PMID: 36842785 DOI: 10.1016/j.rxeng.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 02/28/2023]
Abstract
Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.
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Affiliation(s)
- D Llanos
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I de la Pedraja
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L Campos
- Servicio de Dermatología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J Armijo
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L F Ávila
- Servicio de Cirugía Pediátrica, Hospital Universitario Clínico San Carlos, Madrid, Spain
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10
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Alsayegh H, Alzaid T, Khawaji A, Alshaalan M, Alothman M. Aggressive gluteal fibromatosis: a rare case associated with spontaneous superior gluteal artery pseudoaneurysm. Skeletal Radiol 2022:10.1007/s00256-022-04263-7. [PMID: 36527494 DOI: 10.1007/s00256-022-04263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Deep fibromatosis is a locally aggressive neoplasm commonly involving the extremities. Several authors have described imaging features and complications associated with deep fibromatosis. We present the case of a 33-year-old man who presented with a right gluteal fibrous mass identified on magnetic resonance imaging (MRI), which was associated with a pseudoaneurysm originating from the right superior gluteal artery on serial follow-up with MRI and computed tomography. No intervention was done, and after conservative management, spontaneous thrombosis of the pseudoaneurysm was developed. Such imaging finding is the first report of a spontaneous development of pseudoaneurysm caused by deep fibromatosis, which could be a life-threatening condition and should be considered when dealing with deep fibromatosis and deciding on the appropriate treatment.
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Affiliation(s)
- Hassan Alsayegh
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
| | - Tariq Alzaid
- Department of Pathology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Khawaji
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Meshaal Alshaalan
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Maram Alothman
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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11
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Mohammadi S, Mohammadi S, Khosraviani F. A Submandibular Fibromatosis; A Case Report and Review of Literature. Med J Islam Repub Iran 2022; 36:94. [PMID: 36419942 PMCID: PMC9680815 DOI: 10.47176/mjiri.36.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
- Shabahang Mohammadi
- Department of Otorhinolaryngology-Head & Neck Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Mohammadi
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, Corresponding author:Saba Mohammadi,
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12
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Prendergast K, Kryeziu S, Crago AM. The Evolving Management of Desmoid Fibromatosis. Surg Clin North Am 2022; 102:667-677. [PMID: 35952695 DOI: 10.1016/j.suc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Desmoid fibromatosis is a rare disease caused by genetic alterations that activate β-catenin. The tumors were previously treated with aggressive surgeries but do not metastasize and may regress spontaneously. For these reasons, in the absence of symptoms and when growth would not induce significant complications, active observation is considered first-line therapy. When intervention is required, surgery can be considered based on anatomy and risk of postoperative recurrence, but increasingly nonoperative therapies such as liposomal doxorubicin or sorafenib are prescribed. Cryoablation, chemoembolization, and high-intensity focused ultrasound can also be used to obtain local control in selected patients.
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Affiliation(s)
- Katherine Prendergast
- Sarcoma Biology Laboratory, Memorial Sloan Kettering Cancer Center, 417 East 68th Street, ZRC 445, New York, NY 10065, USA
| | - Sara Kryeziu
- Department of General Surgery, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Aimee M Crago
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA.
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13
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Goswami D, Singha B, Mallya V, Singh CB, Singh K. Aggressive Intra-Abdominal Fibromatosis in an Adolescent Girl - An Unusual Sequelae to Ovarian Germ Cell Tumor. J Pediatr Adolesc Gynecol 2022; 35:404-6. [PMID: 34958924 DOI: 10.1016/j.jpag.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/25/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Abdominal fibromatosis presenting as an abdominal mass is a rare occurrence in a gynecological setting. The diagnosis might not be suspected preoperatively, and management could be challenging. CASE An 18-year-old girl with ovarian germ cell malignancy was managed with staging laparotomy and chemotherapy. She developed a large abdominal mass 10 months later. An abdominopelvic mass (40 × 20 cm) was removed at laparotomy. The histopathological diagnosis was intra-abdominal fibromatosis. A rapidly growing abdominal mass recurred postoperatively. After discussion with the tumor board, chemotherapy with methotrexate and vinblastine was started. The tumor was not responsive, and the patient succumbed after the second cycle of chemotherapy. SUMMARY AND CONCLUSION Abdominal fibromatosis should be considered among the differential diagnoses of a rapidly growing abdominal mass after resection of an ovarian germ cell tumor.
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Guo W, Wang H, Chen T, Yang W, Wang SF, Chen SL. Clinical features and ultrasound findings of a rare musculoskeletal system disease-neuromuscular choristoma. BMC Musculoskelet Disord 2022; 23:464. [PMID: 35581638 PMCID: PMC9112477 DOI: 10.1186/s12891-022-05238-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neuromuscular choristomas (NMCs), are extremely rare developmental lesions that, have been previously established associated with recurrent fibromatosis after surgery, leading to several operations or even amputation. However, reports on the ultrasound imaging features and clinical conditions of NMCs are rare. The purpose of this study is to describe the ultrasound features and clinical analysis of NMCs to provide suggestions to identify the optimal management strategy. Methods From September 2020 to September 2021, 7 patients with a confirmed diagnosis of NMC who underwent ultrasound examination in our department were enrolled in our study. Physical examinations were performed to detect motor deficits, sensory deficits, neuropathic pain, limb undergrowth, muscular atrophy, cavus foot and bone dysplasia. Ultrasound imaging was performed and investigated both in affected nerves and neuromuscular choristomas associated desmoid-type fibromatosis (NMC-DTF). All patients had a definite history and regular follow-up. The clinical course, physical examinations, ultrasound features and pathologic results of NMC patients were analyzed. Results Seven patients with an average age of 7.0 ± 7.2 years (range: 2–22 years) were enrolled in our study. The affected nerves included the sciatic nerve (6 cases) and the brachial plexus (1 case). Six patients (85.7%) presented with limb undergrowth, 6 (85.7%) with muscular atrophy, and 5 (71.4%) with cavus foot deformity. Based on ultrasound findings, all the visibly affected nerve segments presented with hypoechoic and fusiform enlargement with intraneural skeletal muscle elements. Five patients (71.4%) had NMC-DTFs at the site of the affected nerve. All NMC-DTFs were shown as hypoechoic solid lesions adjacent to the nerve and were well circumscribed. In the subset of the surgery group, all 5 patients presented with progression to NMC-DTFs at the site of the NMCs. No fibromatosis was detected in the other two nonsurgical patients. Conclusions Understanding the typical ultrasound features and clinically associated conditions would support the early diagnosis of this rare disease. When a potential diagnosis is determined, an invasive procedure such as biopsy or resection might not be a good choice given the frequent occurrence of complications such as aggressive recurrence.
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Affiliation(s)
- Wen Guo
- Department of Ultrasound, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Haidian District, 52 Fucheng Road, Beijing, 100142, China
| | - Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Haidian District, 52 Fucheng Road, Beijing, 100142, China
| | - Shu-Feng Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Shan-Lin Chen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
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Anneberg M, Svane HML, Fryzek J, Nicholson G, White JB, Edris B, Smith LM, Hooda N, Petersen MM, Baad-Hansen T, Keller JØ, Jørgensen PH, Pedersen AB. The epidemiology of desmoid tumors in Denmark. Cancer Epidemiol 2022; 77:102114. [PMID: 35121405 DOI: 10.1016/j.canep.2022.102114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION/AIM The epidemiology, demographic, clinical, treatment, and healthcare resource utilization (HRU) characteristics of desmoid tumor (DT) patients treated at two sarcoma centers in Denmark is described. METHODS Using Danish health registers, we studied DT patients treated at two sarcoma centers between 2009 and 2018. For each patient, ten persons from the general population were randomly matched on birth year, sex, and region of residence. RESULTS Of the 179 DT patients identified, 76% were female and the median patient age was 38 years at diagnosis (interquartile range: 31-50). An average annual incidence of DTs over the study period was 3.2 per 1000,000 individuals with the observed annual incidence of DTs ranging from 2.2 (2011) to 4.3 (2017) per 1000,000 individuals. No notable linear time trend in incidence was observed. Anatomical DT sites included extra-abdominal (49%), abdominal wall (40%), and intra-abdominal or retroperitoneal areas (8%). In total, 56% of patients were initially treated surgically. However, while 75% of patients diagnosed with DT between 2009 and 2014 were initially treated surgically, this was true for only 32% of patients diagnosed with DT between 2015 and 2018. A total of 56% of DT patients used chemotherapeutic agents, tyrosine kinase inhibitors, NSAIDs, opioids, antidepressants, or steroids at some point during the three years before their DT diagnoses. In contrast, 70% of surgically treated and 63% of non-surgically treated patients used one of these drugs in the subsequent three years, including NSAIDs (45% surgical vs. 33% non-surgical), opioids (39% surgical vs. 27% non-surgical), and steroids (22% surgical vs. 18% non-surgical). The average number of inpatient and outpatient visits, days of hospitalization, and additional surgical procedures were higher among DT patients than the comparison cohort. CONCLUSION DTs are rare but have a large impact on patients' health, HRU, and medication utilization.
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Affiliation(s)
- Marie Anneberg
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Helene M L Svane
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jon Fryzek
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; EpidStrategies, Johns Hopkins Campus , 9601 Medical Center Dr., Rockville, MD 20850, USA
| | - Gina Nicholson
- EpidStrategies, Johns Hopkins Campus , 9601 Medical Center Dr., Rockville, MD 20850, USA
| | - Jessica B White
- SpringWorks Therapeutics, Inc., 100 Washington Blvd., Stamford, CT 06902, USA
| | - Badreddin Edris
- SpringWorks Therapeutics, Inc., 100 Washington Blvd., Stamford, CT 06902, USA
| | - L Mary Smith
- SpringWorks Therapeutics, Inc., 100 Washington Blvd., Stamford, CT 06902, USA
| | - Naushin Hooda
- EpidStrategies, Johns Hopkins Campus , 9601 Medical Center Dr., Rockville, MD 20850, USA
| | - Michael M Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Johnny Ø Keller
- Department of Orthopedic Surgery, Aarhus University Hospital, Denmark
| | - Peter H Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Lee JH, Paeng SH, Cho HJ, Kim ST, Lee WH. Desmoid Fibromatosis in the Multifidus Muscle Misdiagnosed as Intramuscular Schwannoma by Incisional Biopsy: A Case Report. Korean J Neurotrauma 2021; 17:212-216. [PMID: 34760837 PMCID: PMC8558029 DOI: 10.13004/kjnt.2021.17.e24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022] Open
Abstract
Desmoid fibromatosis is a locally aggressive myofibroblastic neoplasm. In this study, we report a case of desmoid fibromatosis in the paraspinal muscle that was misdiagnosed as intramuscular schwannoma through incisional biopsy at another hospital. We performed total excision of the mass lesion with a clear margin. We found that for an accurate diagnosis, magnetic resonance imaging, incisional biopsy and excisional biopsy were required.
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Affiliation(s)
- Jae Hun Lee
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Won Hee Lee
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
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17
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Pieta A, Zioga A, Skalkou A, Venetsanopoulou AI, Drosos AA, Voulgari PV. Fibroblastic rheumatism: an uncommon arthritis. A case-based review. Rheumatol Int 2021. [PMID: 34611730 DOI: 10.1007/s00296-021-05004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Fibroblastic rheumatism (FR) is an uncommon disease of the skin, characterized by the presence of non-tender cutaneous nodules accompanied often by other rheumatic manifestations. This condition shows male predominance, no age preference and unpredictable course, resulting frequently in permanent joint damage. A 60-year-old man came to our department with a 4-year history of multiple non-tender nodules and morning stiffness affecting mainly the upper extremities. Clinical examination revealed arthritis of the hands, confirmed by imaging tests. Laboratory exams were unremarkable. A skin nodule biopsy showed a dermal collagenous lesion with myxoid areas composed of spindle and stellate cells. Immunohistochemical staining demonstrated positivity for CD68 and negativity for CD34, S100, EMA and desmine. FR was diagnosed and the patient started methylprednisolone 16 mg/day. Hydroxychloroquine 400 mg/day and methotrexate 15 mg/weekly were further added as steroid-sparing agents with clinical benefit. Clinicians should be aware of this underreported entity, which can rapidly lead to irreversible deformities.
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18
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Hammood ZD, Salih AM, Kakamad FH, Abdullah AM, Ali BS, Pshtiwan LRA. Desmoid fibromatosis of the breast; a rare case report. Int J Surg Case Rep 2021; 87:106363. [PMID: 34562723 PMCID: PMC8473648 DOI: 10.1016/j.ijscr.2021.106363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction Desmoid tumor is an uncommon tumor with variable spectrum ranged from being a locally lesion to an aggressive and destructive one. The current case aims to report a rare condition of desmoid type fibromatosis of the breast. Presentation of case A 59-year-old female presented with a right breast mass for 9-months. Mammography showed a small speculated iso-hyper dense mass, just anterior to the pectoralis muscle measuring about 15 mm (M5) in longest axis. Ultrasound examination revealed an irregular mass with internal vascularity and posterior shadowing in the right breast with a single borderline lymph node (25 ∗ 14 mm of 4 mm cortex). Wide local excision with sentinel axillary lymph nodes biopsy was performed. Histopathological examination of the specimen confirmed the diagnosis of desmoid type fibromatosis of the breast. Discussion The etiology of this tumor is unknown, however, physical, hormonal and genetic factors have a significant role in the development of desmoid tumor. Conclusion Desmid type fibromatosis of the breast is an uncommon, benign, locally aggressive fibroblastic tumor with lack of metastatic potential, it may present with features of malignancy. Desmoid tumor is an uncommon tumor. The occurrence of desmoid tumor in the breast is even rarer. Differentiation from malignant disease is a challenging task. The current report discusses a case of desmoid type fibromatosis of the breast.
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Affiliation(s)
- Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq.
| | - Ari M Abdullah
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Bakhan Sharif Ali
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Lana R A Pshtiwan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
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19
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Alghamdi HM. Invasive giant pancreatic desmoid-type fibromatosis with curative resection: A case report. Int J Surg Case Rep 2021; 86:106327. [PMID: 34481134 PMCID: PMC8416951 DOI: 10.1016/j.ijscr.2021.106327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Desmoid-type Fibromatoses (DTF) tumours are rare, benign fibrous tumours with aggressive invasive behaviour that account for approximately 0.03% of all neoplasms. We report the success in curing a rare, invasive, and huge pancreatic intraabdominal DTF. Presentation of case A 42 years old male was medically free apart from recurrent left upper abdominal pain, anorexia, and nausea for more than ten years and no significant past surgeries, trauma, or family history of cancer. The patient has a non-tender large abdominal mass at the left hypochondria area extending down to the pelvis below the umbilicus with a rigid and smooth surface. The computed tomography scan showed a huge heterogeneous mass appears to be of pancreatic origin, measuring about 23 cm by 15 cm by 11 cm. The patient underwent radical antegrade modular pancreato-splenectomy, segmental transverse colectomy, adrenalectomy, and subsequent colo-colic anastomosis. The accurate gross size of the tumour specimen was 26 × 17 × 9 cm, and the weight was found to be 3.6 kg. Immunohistochemistry confirmed the diagnosis of pancreas DTF. The follow up to 5 years confirmed no recurrence reported clinically or by imaging. Discussion The Pancreas origin of DTF is a rarely reported subset with an incidence of around 5% of all DTF. Establishing the diagnosis is fundamentally based on the characteristic pathological and immunohistochemical studies, for the only available cure modality by complete radical resection to be promptly offered. Conclusion Our case is rare and uniquely the largest pancreatic DTF reported in the literature with curative resection despite being locally invasive. Desmoid-type Fibromatoses (DTF) tumours are rare, benign fibrous tumours with aggressive invasive behaviour. Account for approximately 0.03% of all neoplasms. The Pancreas is a rarely reported subset with an incidence of around 5% of all DTF. Accurate diagnosis is fundamentally by characteristic pathological and immunohistochemical studies. Cure can be achieved only by complete radical resection We report curative resection of a rare and the largest pancreatic locally invasive DTF (26x17x9 cm in size and weight 3.6Kg)
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Affiliation(s)
- Hanan M Alghamdi
- King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University College of Medicine, Department of Surgery, Saudi Arabia.
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20
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Abstract
Pediatric fibroblastic/myofibroblastic tumors are rare but include a wide variety of benign to malignant tumors. Given their uncommon frequency, they may present as a diagnostic dilemma. This article is focused on using clinical and pathologic clues in conjunction with the increasingly relevant and available molecular techniques to classify, predict prognosis, and/or guide treatment in these tumors.
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Affiliation(s)
- Jessica L Davis
- Department of Pathology, Oregon Health & Science University, L-471, Portland, OR 97239, USA.
| | - Erin R Rudzinski
- Department of Laboratories, Seattle Children's Hospital, OC.8.720, Seattle, WA 98105, USA
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21
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Abstract
Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The disease process is most common in white, middle-aged and older men occurring at the distal palmar crease leading to nodules and contracture, which in many cases recur after surgical treatment. In a similar process, plantar fibromatosis (Ledderhose disease) is a proliferation of fibroblasts and myofibroblasts on the plantar aponeurosis of mostly middle-aged patients that may lead to painful nodules but usually does not lead to contracture. Both processes are histologically similar, composed of a bland cellular proliferation of spindle cells with a bluish appearance and with a variable amount of background collagen, depending on the age of the lesion. The etiology of both lesions is still uncertain, while treatment ranges from observation to surgery, with some pharmacologic agents being investigated with mixed success. In this paper we provide an overview of both processes with regards to clinical and radiologic findings, pathophysiology, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Brian D Stewart
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alessandra F Nascimento
- CWRU School of Medicine, University Hospitals, Bone and Soft Tissue Pathology, Cleveland, OH, USA
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22
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Carter JM, Maldonado AA, Howe BM, Okuno S, Spinner RJ. Frequent CTNNB1 p.S45 Mutations and Aggressive Clinical Behavior in Neuromuscular Choristoma-Associated Fibromatosis. Neurosurgery 2021; 88:804-811. [PMID: 33442732 PMCID: PMC7955962 DOI: 10.1093/neuros/nyaa534] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/04/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Neuromuscular choristoma (NMC) is a peripheral nerve malformation frequently associated with a fibromatosis (NMC-DTF) that mimics sporadic desmoid-type fibromatosis (DTF). Sporadic DTF is often managed conservatively but its clinical behavior varies. CTNNB1 mutational subtypes in sporadic DTF have prognostic value. We have previously identified CTNNB1 mutations in NMC, and 3 paired NMC-DTF but the clinical behavior of NMC-DTF is poorly understood. OBJECTIVE To evaluate patients with NMC-DTF to determine (1) CTNNB1 mutational subtypes in NMC-DTF, and (2) associated clinical behavior and response to treatment. METHODS Retrospective review of clinical, imaging, and pathologic features of patients with NMC and NMC-DTF, and molecular testing for CTNNB1 mutations. RESULTS Among 7 patients with NMC of the sciatic nerve (median age: 18 yr), NMC-DTF (mean size 10.7 cm) developed shortly following NMC biopsy (N = 5) or spontaneously (N = 2): 6 NMC-DTF had CTNNB1 p.S45X mutations and 1 NMC-DTF had a p.T41A mutation. All patients with CTNNB1-p.S45-mutated NMC-DTF developed local progression after wide local excision or active surveillance, including one distal metachronous NMC-DTF. No patient had spontaneous disease stabilization. Following adjuvant radiation or systemic therapy, disease stabilization was achieved in 4 (of 6) patients. One patient progressed on sorafenib treatment. CONCLUSION NMC-DTF frequently contain CTNNB1 p.S45 mutations, behave aggressively, and require adjuvant therapies for disease stabilization. We now use imaging alone to diagnose NMC, and routinely surveille the NMC-affected nerve segment to identify early NMC-DTF. In contrast to sporadic DTF, earlier adoption of systemic therapeutic strategies may be required for optimal disease management of NMC-DTF.
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Affiliation(s)
- Jodi M Carter
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Scott Okuno
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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23
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Sobczuk P, Agnieszczak IM, Grycuk W, Czarnecka AM, Świtaj T, Koseła-Paterczyk H, Morysiński T, Zdzienicki M, Rutkowski P. What is the best front-line approach in patients with desmoid fibromatosis? - A retrospective analysis from a reference center. Eur J Surg Oncol 2021; 47:2602-2608. [PMID: 33994241 DOI: 10.1016/j.ejso.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Desmoid fibromatosis (DF) is a locally aggressive, not metastasizing tumor associated with high local recurrence rates. Surgery was a standard-of-care for DF treatment; however, recently, conservative treatment and active surveillance are preferred. This study aimed to evaluate the real-life outcomes of DF treatment. MATERIALS AND METHODS All consecutive patients diagnosed with DF and treated between 01.1999 and 12.2018 at one sarcoma reference institution were included in this retrospective analysis. Kaplan-Meier estimator, long-rank test, Cox regression model, and Chi2 tests were used for statistical analyses. RESULTS The analyses included 363 patients (254 female, 109 male). 195 patients (53.7%) underwent surgical resection, and 139 (38.3%) experienced a watch-and-wait approach with or without concomitant therapy with nonsteroid anti-inflammatory drugs (NSAIDs) in the first line. Disease recurrence/progression occurred in 43.2% of patients treated with surgery and 42.6% in the watch-and-wait group, resulting in 5-year event-free survival (EFS) rates of 60% and 55%, respectively. There was no difference in EFS between both groups (HR1.28, 95%CI 0.91-1.79). Surgery without prior biopsy and extra-abdominal wall location was associated with inferior outcomes. CONCLUSIONS Results of DF treatment in our center showed that watch-and-wait approach ± NSAIDs has similar efficacy to upfront surgery and allows to avoid unnecessary surgery in approximately half of the patients, primarily when tumors are located in unfavorable sites, like extremities.
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Affiliation(s)
- Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
| | - Izabela M Agnieszczak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Poland
| | - Wiktoria Grycuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tadeusz Morysiński
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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DeVita R, Faraji N, Nakfoor R, Elliott R, Kosmas C. Hyaline fibromatosis syndrome: A rare case of multifocal intra-articular involvement. Clin Imaging 2021; 70:51-55. [PMID: 33120290 DOI: 10.1016/j.clinimag.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Hyaline fibromatosis syndrome (HFS) is a rare, progressive, autosomal recessive disorder that presents with connective tissue deposition of amorphous hyaline material within the musculocutaneous tissue and/or visceral organs. HFS presents clinically in infancy or early childhood and can result in severe disability and life threatening complications. Given the rarity of the disorder, the imaging characteristics of HFS are seldom described in the literature. We describe a case of a 25-year-old patient presenting with bilateral knee pain, limited range of motion in her extremities, and lower extremity weakness with detailed MR imaging demonstrating the first case of multifocal intra-articular deposition of hyaline material within several joints.
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Affiliation(s)
- Robert DeVita
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Navid Faraji
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Rachael Nakfoor
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Christos Kosmas
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
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25
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O Adegoke O, E Ajao A, H Ano-Edward G. Congenital infantile digital fibromatosis: a case report and review of the literature. Afr Health Sci 2020; 20:1865-1869. [PMID: 34394250 PMCID: PMC8351811 DOI: 10.4314/ahs.v20i4.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Infantile digital fibromatosis (IDF), also called inclusion body fibromatosis is an uncommon benign tumour occurring in the digits of young children. In about a third of cases, it is congenital and the diagnosis is based on the presence of peculiar intracytoplasmic inclusions on histology. Recurrence rate post-surgery is high. However, spontaneous regression has been reported. We present a case of a 5-month-old infant who had excision of a right second toe mass, which has been present from birth. Histological examination revealed this to be infantile digital fibromatosis. To the best of our knowledge, no report of this has been made in Nigeria. It is important that this diagnosis be entertained in young children with masses on the digits as this will influence the management instituted.
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26
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Kahraman D, Karakoyunlu B, Karagece U, Ertas U, Gunhan O. Desmoplastic fibroma of the jaw bones: A series of twenty-two cases. J Bone Oncol 2020; 26:100333. [PMID: 33204607 PMCID: PMC7653059 DOI: 10.1016/j.jbo.2020.100333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/24/2022] Open
Abstract
In desmoid-type soft tissue fibromatosis we could see the beta-catenin in the nuclei of neoplastic cells as a diagnostic feature. Beta-catenin in the nuclei of neoplastic cells could not be detected in the present DF series. Most of the DF cases expressed only cytoplasmic beta-catenin immunostainings. Immunohistochemical staining difference of jaw bone desmoplastic fibromas from other soft tissue and bone lesions may be related to the origination of jaw bone from the neural crest.
Desmoplastic fibroma (DF) is an intraosseous counterpart of desmoid-type soft tissue fibromatosis. It is most frequently seen in the jawbones. The clinical and radiological features of the present cases were nonspecific. The accumulation of beta-catenin in the nuclei of neoplastic cells which is a diagnostic feature of desmoid-type soft tissue fibromatosis could not be detectED in the present DF series. The aim of this study is to report a series of 22 cases of DF involving either mandible or maxilla. A retrospective evaluation of desmoplastic fibroma and beta-catenin, smooth muscle actin, nestin, cyclin D1 immunostaining’s patterns. Most of the DF cases expressed only cytoplasmic beta-catenin immunostainings. We suggest that nuclear beta-catenin staining may not be used as a corroborating the diagnosis of DF. Immunohistochemical staining difference of jaw bone desmoplastic fibromas from other soft tissue and bone lesions may be related to the origination of jaw bone from The neural crest. Strong nestin and cyclin D1 positivity in our series supported this. A combined clinical, radiological, and histopathological analysis of the DF cases is essential in the diagnosis and management.
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Affiliation(s)
- Devrim Kahraman
- TOBB ETU School of Medicine, Department of Pathology, Beştepe, Yaşam Cd. No:5, 06560 Yenimahalle, Ankara, Turkey
- Corresponding author at: TOBB ETU, Tıp Fakultesi Hastanesi, Yaşam caddesi No: 5 PK: 06510, Ankara, Turkey.
| | - Berkem Karakoyunlu
- TOBB ETU School of Medicine, Beştepe, Yaşam Cd. No:5, 06560 Yenimahalle, Ankara, Turkey
| | - Ulker Karagece
- Private Goren Pathology Laboratory, Cumhuriyet, 1/64-65-66, Sakarya Cd., 06420 Çankaya, Ankara, Turkey
| | - Umit Ertas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, 25240 Yakutiye, Erzurum, Turkey
| | - Omer Gunhan
- TOBB ETU School of Medicine, Department of Pathology, Beştepe, Yaşam Cd. No:5, 06560 Yenimahalle, Ankara, Turkey
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27
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Khanna K, Mofakham FA, Gandhi D, Jain N. Desmoid fibromatosis of the pancreas--A case report with radiologic-pathologic correlation. Radiol Case Rep 2020; 15:2324-2328. [PMID: 32994833 PMCID: PMC7501420 DOI: 10.1016/j.radcr.2020.08.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreas is an exceptionally rare location for desmoid tumors. There are very few case reports of pancreatic fibromatosis in the English radiology literature. We present a case of a 45-year-old male with a mixed solid and cystic desmoid tumor of the pancreas which was surgically resected and was followed by recurrence in the mesentery. This will be the first case report of pancreatic desmoid with documented recurrence of fibromatosis in the mesentery which was also surgically resected and confirmed on pathology. In this case report, we discuss this entity's radiological findings with pathology correlation, clinical findings and management along with literature review.
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Affiliation(s)
- Kanika Khanna
- Wayne State University School of Medicine, Department of Radiology, Abdominal Imaging, Henry Ford Hospital, Detroit, MI, USA
| | | | - Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611, USA
| | - Nitin Jain
- Department of Diagnostic Radiology, Ascension St. John Macomb and Oakland Hospitals, Warren and Madison Heights Campuses, Troy, MI, USA
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Timbergen MJM, Starmans MPA, Padmos GA, Grünhagen DJ, van Leenders GJLH, Hanff DF, Verhoef C, Niessen WJ, Sleijfer S, Klein S, Visser JJ. Differential diagnosis and mutation stratification of desmoid-type fibromatosis on MRI using radiomics. Eur J Radiol 2020; 131:109266. [PMID: 32971431 DOI: 10.1016/j.ejrad.2020.109266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/18/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Diagnosing desmoid-type fibromatosis (DTF) requires an invasive tissue biopsy with β-catenin staining and CTNNB1 mutational analysis, and is challenging due to its rarity. The aim of this study was to evaluate radiomics for distinguishing DTF from soft tissue sarcomas (STS), and in DTF, for predicting the CTNNB1 mutation types. METHODS Patients with histologically confirmed extremity STS (non-DTF) or DTF and at least a pretreatment T1-weighted (T1w) MRI scan were retrospectively included. Tumors were semi-automatically annotated on the T1w scans, from which 411 features were extracted. Prediction models were created using a combination of various machine learning approaches. Evaluation was performed through a 100x random-split cross-validation. The model for DTF vs. non-DTF was compared to classification by two radiologists on a location matched subset. RESULTS The data included 203 patients (72 DTF, 131 STS). The T1w radiomics model showed a mean AUC of 0.79 on the full dataset. Addition of T2w or T1w post-contrast scans did not improve the performance. On the location matched cohort, the T1w model had a mean AUC of 0.88 while the radiologists had an AUC of 0.80 and 0.88, respectively. For the prediction of the CTNNB1 mutation types (S45 F, T41A and wild-type), the T1w model showed an AUC of 0.61, 0.56, and 0.74. CONCLUSIONS Our radiomics model was able to distinguish DTF from STS with high accuracy similar to two radiologists, but was not able to predict the CTNNB1 mutation status.
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Affiliation(s)
- Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, the Netherlands.
| | - Martijn P A Starmans
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - Guillaume A Padmos
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, the Netherlands.
| | | | - D F Hanff
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, the Netherlands.
| | - Wiro J Niessen
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands.
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, the Netherlands.
| | - Stefan Klein
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
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Tafti D, Kao E, Alderete JF, Cecava ND. Desmoid-type fibromatosis of the lower extremity: A unique case of complete lesion resolution following core needle biopsy. Clin Imaging 2021; 69:213-8. [PMID: 32920469 DOI: 10.1016/j.clinimag.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022]
Abstract
Desmoid-type fibromatosis (DF) is a rare neoplasm characterized by fibroblastic and myofibroblastic proliferation. While characterized as a benign lesion that does not metastasize, desmoid-type fibromatosis exhibits a wide range of behavior from aggressive local tissue invasion and post-surgical recurrence to spontaneous regression. Tumor regression can occur following systemic medical therapy or rarely may occur in the absence of therapy. We present a case of a 50-year-old female with a left thigh vastus medialis intramuscular mass which underwent imaging work-up and subsequent core needle ultrasound-guided biopsy showing results of desmoid-type fibromatosis. Following biopsy, the tumor showed prompt, complete regression with complete MRI resolution 2 months following biopsy. The patient showed no evidence of disease recurrence out to one year on MRI surveillance. This case report will discuss desmoid-type fibromatosis imaging features, treatment strategies, spectrum of disease behavior, and atypical behavior such as the spontaneous tumor regression as seen in this case report. To our knowledge there have been no reported cases of DF spontaneous regression 2 months following a core needle biopsy. Understanding the variable behavior of desmoid-type fibromatosis can assist the radiologist in guiding management of these lesions with the goal of optimizing clinical outcomes and preventing unnecessary aggressive treatments for stable or regressing disease.
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Sharma S, Shahi AK, Prajapati VK, Singh B. Idiopathic gingival fibromatosis with massive gingival overgrowth: A rare case report. J Indian Soc Periodontol 2020; 24:379-382. [PMID: 32831513 PMCID: PMC7418552 DOI: 10.4103/jisp.jisp_426_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 11/28/2022] Open
Abstract
Idiopathic gingival overgrowth can present itself as a part of syndrome or as an isolated entity. This is a case report of a massive gingival enlargement in a 12-year-old female child with nonsyndromic gingival fibromatosis, which was treated by multidisciplinary approach involving surgical and prosthetic rehabilitation and at the same time instilling psychological benefit.
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Affiliation(s)
- Swati Sharma
- Department of Pedodontics and Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ajoy Kumar Shahi
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Virendra Kumar Prajapati
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Bishnupati Singh
- Department of Prosthodontics, Crown Bridge, Aesthetic Dentistry and Oral Implantology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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31
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Boland MR, Nugent T, Nolan J, O'Mahony J, O'Keeffe S, Gillham CC, Maguire A, Geraghty J, McCartan D, Evoy D, Prichard RS, McDermott EW, Alazawi D, Boyle TJ, Connolly EM. Fibromatosis of the breast: a 10-year multi-institutional experience and review of the literature. Breast Cancer 2020; 28:168-174. [PMID: 32780320 DOI: 10.1007/s12282-020-01145-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Breast fibromatosis is a rare clinical entity, but poses significant diagnostic and therapeutic challenges. In light of recent changes in management practices, the aim was to review our institutional experience of breast fibromatosis and provide a review of current available literature on such management. METHODS A search of pathological databases within two tertiary institutions for all patients diagnosed with fibromatosis of the breast over a 10-year period (2007-2016) was performed. Clinicopathological characteristics and modes of treatment were recorded for each patient. Concurrently a comprehensive literature search was performed and studies relating to breast fibromatosis and its management were identified and reviewed. RESULTS Sixteen patients were identified. Median age at diagnosis was 42 (range 21-70) and all patients were diagnosed with core biopsy. The most useful imaging modality in diagnosis was ultrasonography and magnetic resonance imaging. 13/16 were treated surgically whilst 3/16 were treated using a watch-and-wait approach. 6/13 (46%) required re-excision of margins and 2/13 (15%) had recurrence after surgery. On review of the literature, there is no dedicated guideline in place for the management of breast fibromatosis. Currently a 'watch and wait' approach is favoured over surgical intervention due to high levels of recurrence and associated surgical morbidity. All cases should be discussed at a sarcoma multidisciplinary team meeting and tyrosine kinase inhibitors should be considered in advanced cases. CONCLUSIONS Breast fibromatosis is rare but affects young patients. Active surveillance is now favoured over surgical resection due to high recurrence rates and extensive morbidity. Dedicated guidelines are required to ensure best outcomes.
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Affiliation(s)
- Michael R Boland
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland.
| | - Timothy Nugent
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
| | - Jack Nolan
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Johnny O'Mahony
- Departments of Radiology, St James' Hospital, Dublin, 8, Ireland
| | - Sylvia O'Keeffe
- Departments of Radiology, St James' Hospital, Dublin, 8, Ireland
| | - Charles C Gillham
- Departments of Radiation Oncology, St James' Hospital, Dublin, 8, Ireland
| | - Aoife Maguire
- Departments of Pathology, St James' Hospital, Dublin, 8, Ireland
| | - James Geraghty
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Damian McCartan
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Denis Evoy
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Enda W McDermott
- Department of Breast Surgery, St Vincents Hospital, Dublin, 4, Ireland
| | - Dhaffir Alazawi
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
| | - Terence J Boyle
- Departments of Breast Surgery, St James' Hospital, Dublin, 8, Ireland
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Abstract
Background Spontaneous disease stabilization of desmoid-type fibromatosis (DF) has been demonstrated in many reports, and the watchful waiting approach without any frontline treatment is becoming popular as an initial management strategy. In this study, we aimed to assess the disease stabilization rate and identify predictive factors for disease stabilization of DF in patients with conservative treatment. Methods We reviewed 76 patients with sporadic extra-abdominal DF who were managed with frontline conservative treatment in our institute. The minimum follow-up was 12 months. Stabilization was defined as radiological evidence of no change or continuous decrease in size of the tumor for six months or more. The primary endpoint was stabilization of DF. Possible patient-, disease-, and treatment-related factors predictive of disease stabilization were analyzed with multivariate analysis. Results At final follow-up, 54 of the 76 tumors (71%) were stable, and mean time to stabilization was 30.4 months (range, 7 to 112 months). On Kaplan-Meier survival analysis, the spontaneous stabilization rate was 25.4% at one year, 52.7% at two years, and 70.9% at three years. The mean time to spontaneous stabilization was longer in patients with ≤ 40 years of age (p = 0.022) or recurrence (p = 0.041). On multivariate analysis with the Cox proportional hazard method, recurrence (hazard ratio [HR], 1.79; p = 0.041) and younger age (HR, 2.04; p = 0.022) were identified as independent prognostic factors for longer time to disease stabilization. Conclusions Frontline conservative treatment seems to be the optimal treatment for most patients with DF. Younger patients or those with recurrence may require longer time to spontaneous disease stabilization.
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Affiliation(s)
- Yongsung Kim
- Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Mamer S Rosario
- Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, Seoul, Korea.,East Avenue Medical Center, Quezon City, Philippines
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ilkyu Han
- Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Kumar SS, Rajeevan K, Devarajan E. Desmoid-Type Fibromatosis-Clinical Study of an Uncommon Disease. Indian J Surg Oncol 2020; 11:71-74. [PMID: 32205974 PMCID: PMC7064704 DOI: 10.1007/s13193-019-00985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022] Open
Abstract
Desmoid-type fibromatosis is an uncommon disease which mimics sarcoma but is more locally aggressive but with less metastatic potential than sarcoma. Diagnosis is difficult and treatment protocols have changed to include more non-surgical options as compared with sarcoma. This is a retrospective study of the clinical presentation, imaging findings, treatment given, and outcomes of pathologically proven desmoid-type fibromatosis patients who presented to government medical college Kozhikode.
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Affiliation(s)
- Sreekanth S. Kumar
- Department of Surgical Oncology, Government Medical College Kozhikode, Kozhikode, 673008 India
| | - K. Rajeevan
- Department of Pathology, Government Medical College Kozhikode, Kozhikode, 673008 India
| | - E. Devarajan
- Department of Radiology, Government Medical College Kozhikode, Kozhikode, 673008 India
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Abstract
Desmoid tumors (TDs) are derived from mesenchymal stem cells and their pathogenesis is strongly linked to the Wingless/Wnt cascade where the deregulation of β-catenin plays a major role. A mutation of the CTNNB1 encoding β-catenin is found in the majority of sporadic TD cases and constitutional mutations of APC have been described in heritable forms in patients with familial adenomatous polyposis (FAP). Estrogens could also play a role in pathogenesis and this is the basis for the use of hormone therapy. Other signaling pathways have been involved in the development of TDs such as Notch, Hedgehog, JAK/STAT, PI3 Kinase/AKT and mTOR. Metalloproteases are expressed in TDs and play a role in invasiveness. TGF-ß, as a growth factor, stimulates the transcriptional activity of β-catenin. Future studies will need to focus on better describing and understanding the immune environment of TDs. One of the major difficulties for the experimental study of TDs is the virtual absence of a preclinical model, either in vitro or in vivo. This is partly why the interactions between the different signaling pathways presented here and their consequences for the development of TDs are still poorly understood.
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Affiliation(s)
- Sébastien Salas
- AP-HM, Aix-Marseille university, department of medical oncology, 13005, Marseille, France.
| | - Frédéric Chibon
- Institut Claudius Régaud, Cancer Research Center in Toulouse (CRCT), IUCT-oncopole, Inserm U1037, 31000, Toulouse, France
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Asenov Y, Genadiev S, Timev A, Panaiotova J, Hadjiiska V, Veselin T, Sedloev T. Ruptured desmoid tumor imitating acute appendicitis - a rare reason for an emergency surgery. BMC Surg 2019; 19:194. [PMID: 31842856 DOI: 10.1186/s12893-019-0662-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Desmoid tumors, also known as aggressive fibromatosis, are extremely rare, accounting for less than 3% of soft-tissue sarcomas and less than 0,03% of all neoplasms. The diagnosis is usually delayed because of the lack of specific symptoms, and can sometimes lead to serious and, even fatal complications. CASE PRESENTATION We report the case of a 27-year-old male patient presenting with the clinical picture of acute appendicitis. During the operation, we found a tumor in the jejunum with a necrotic zone and perforation on its surface, causing hemorrhagic effusion into the abdominal cavity and subsequent peritonitis. The tumor was removed with negative margins via resection of the small bowel. The final histological result showed aggressive fibromatosis. CONCLUSIONS Aggressive fibromatosis remains a serious problem with the possibility of locally aggressive behavior with high rates of recurrence. Sometimes, its clinical and macroscopic recognition can be immensely tricky. As shown by our patient, on rare occasions, desmoid tumors can lead to acute surgical abdomen requiring an emergency operation.
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Abstract
After an adapted imaging, the diagnosis of a desmoid tumor (DT) is provided by a percutaneous microbiopsy, with a molecular analysis for beta-catenin or APC gene mutation. The therapeutic strategy must be decided in a specialized multidisciplinary tumor board (MTB). Surgery is no longer the first-line treatment for a DT. Except within a surgical complication, active surveillance is offered to the majority of patients, since more than half stabilize or regress after an initial progression, whether the location is peripheral or intra-abdominal. If the localization and/or volume are likely to be functional or life-threatening, medical induction therapy is discussed in MTB, before a local treatment whose potential sequelae would be definitive. Incomplete unplanned resection, recurrence, pregnancy or desmoids occurring in a polyposis context are no longer routine surgical indications. In an emergency setting (occlusion, peritonitis), it is discussed to treat only the mechanical complication and leave the DT in place, if its resection would lead to too much digestive resection, especially in patients who have already undergone colectomy for polyposis. The best indications for surgery are patients who have parietal locations with significant and documented progression, because surgery can be easily completed at the cost of an acceptable morbidity. In localizations where surgery would cause sequelae, medical treatment or other regional loco treatments are discussed in MTB.
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Affiliation(s)
- Sylvie Bonvalot
- Institut Curie, service de chirurgie sarcome et tumeurs complexes, Paris, France.
| | - Dimitri Tzanis
- Institut Curie, service de chirurgie sarcome et tumeurs complexes, Paris, France
| | - Toufik Bouhadiba
- Institut Curie, service de chirurgie sarcome et tumeurs complexes, Paris, France
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Panagiotopoulou IG, Shah N, Rowaiye B, Chandrakumaran K, Carr NJ, Moran B. Not all abdominal masses after colorectal cancer surgery are malignant: intra-abdominal fibromatosis masquerading as recurrence. Colorectal Dis 2019; 21:886-893. [PMID: 30927550 DOI: 10.1111/codi.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
AIM Intra-abdominal fibromatosis is an unusual mesenchymal tumour that can be locally aggressive without any metastatic potential. Fibromatosis may simulate cancer recurrence on imaging surveillance for colorectal cancer follow-up. The optimal treatment of recurrent peritoneal malignancy is cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Confirmatory biopsy of lesions suspicious for colorectal cancer recurrence may not be feasible, thereby rendering surgery the safest option. Our aim was to determine the incidence of fibromatosis in a cohort of patients undergoing CRS and HIPEC for suspected colorectal cancer recurrence. METHODS One hundred and seventy-one CRS and HIPEC cases were performed at our Peritoneal Malignancy Institute between February 2007 and October 2018 for colorectal peritoneal metastases and were included in a prospectively maintained database. RESULTS A total of 49 (29%) of 171 cases were performed for primary colorectal cancer with peritoneal metastases, whereas 122 (71%) of 171 cases were performed for suspected colorectal cancer recurrence detected on surveillance imaging after primary colorectal cancer resection. On histological analysis of the resected specimen, five (4.1%) of 122 cases undergoing CRS and HIPEC for colorectal recurrence had fibromatosis. CONCLUSION Fibromatosis can masquerade as colorectal cancer recurrence. In this series it occurred with an incidence of 4.1% among a cohort of patients undergoing CRS and HIPEC for probable recurrence. Surgical resection may be the only option to confirm the diagnosis and rule out malignancy.
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Affiliation(s)
- I G Panagiotopoulou
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N Shah
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Rowaiye
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - K Chandrakumaran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - N J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Hara R, Fujii T, Ohira S, Kaifu M, Miyaji Y, Nagai A. Intra-abdominal desmoid tumor mimicking local recurrence of renal cell carcinoma after laparoscopic partial nephrectomy. Urol Case Rep 2019; 24:100865. [PMID: 31211075 PMCID: PMC6562314 DOI: 10.1016/j.eucr.2019.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/01/2019] [Accepted: 03/13/2019] [Indexed: 11/28/2022] Open
Abstract
A 64-year-old man had an intra-abdominal mass that was detected in a follow-up examination after laparoscopic partial nephrectomy for renal cell carcinoma (RCC). CT showed an enhanced mass of 2.5-cm diameter near the right kidney, where partial nephrectomy had been performed. Local recurrence of RCC with duodenum invasion was suspected, and excision was performed. The final pathological diagnosis of desmoid tumor differed from the preoperative diagnosis. Therefore, we report this case as a rare example of intra-abdominal desmoid tumor mimicking local recurrence of RCC. To our knowledge, this is the first report of intra-abdominal desmoid tumor after laparoscopic partial nephrectomy.
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Affiliation(s)
- Ryoei Hara
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Tomohiro Fujii
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Shin Ohira
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Mikako Kaifu
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Atsushi Nagai
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
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Michelow P, Field AS. Spindle Cell Lesions of the Breast on Fine-Needle Aspiration Biopsy: A Miscellany of Masses. Acta Cytol 2019; 63:328-339. [PMID: 31117069 DOI: 10.1159/000500703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/02/2019] [Indexed: 12/17/2022]
Abstract
A variety of primary breast and metastatic lesions to the breast can present with spindle cell cytomorphology. These lesions may range from benign reactive or inflammatory lesions to high-grade malignancies. Spindle cell lesions of the breast are not often seen on fine-needle aspiration biopsy (FNAB) but need to be correctly managed when they are encountered. While mesenchymal lesions of the breast have a spindle morphology, lesions derived from the epithelium and myoepithelium can be spindled as well. By assessing if the lesion comprises spindle cells only or if other components such as epithelial cells are apparent and then determining whether the spindle cells appear bland or pleomorphic, together with close clinicoradiologic correlation and prudent use of ancillary tests, a variety of lesions can be diagnosed on FNAB. However, core needle biopsy or excision biopsy may be required in some patients. The cytomorphology, ancillary studies, and clinicoradiologic findings of a range of spindle cell lesions of the breast are further discussed.
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Affiliation(s)
- Pamela Michelow
- Department of Anatomical Pathology, Faculty of Health Science, University of the Witwatersrand and Cytology Unit, National Health Laboratory Service, Johannesburg, South Africa,
| | - Andrew S Field
- Department of Anatomical Pathology, St Vincent's Hospital, and University of New South Wales and Notre Dame University Medical Schools, Sydney, New South Wales, Australia
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Bohl MA, Leveque JC, Bayles S, Sethi R. Postoperative Development of Desmoid Tumor After Surgical Correction of Adult Spinal Deformity: Case Report and Review of Literature. World Neurosurg 2019; 128:4-10. [PMID: 31051304 DOI: 10.1016/j.wneu.2019.04.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Desmoid tumors are known to be rare and relatively slow growing with locally invasive histology and high recurrence rates. A rare subset of these tumors occurs adjacent to the spinal column after surgery. Since 1961, only 6 cases of postoperative paraspinal desmoid tumor have been reported. This report is the first to describe the occurrence of a paraspinal desmoid tumor after surgical correction of a spinal deformity. CASE DESCRIPTION A 56-year-old woman with multiple sclerosis reported 2-3 years of progressively worsening mid and low back pain that was worse with standing and ambulation and almost completely relieved with lying flat. Standing anteroposterior scoliosis radiographs revealed a thoracolumbar spinal deformity, which was surgically corrected with a T4 pelvis spinal fixation and fusion. At her 2-year postoperative clinic visit the patient reported good improvement in her preoperative symptoms but felt a fullness in her right upper back and neck that was nontender. Magnetic resonance imaging revealed a large tumor in this region. The tumor was resected en bloc, and pathology noted a 14.5 cm × 8.7 cm × 4.2 cm mass with spindle cell proliferation and positive staining for β-catenin (mutated gene found in 85% of desmoid tumors). CONCLUSIONS This is the first report of a postoperative desmoid tumor after spinal deformity correction and the seventh reported case in the spine literature. All reported cases have been women aged 39-57 years. The patient will be followed closely with magnetic resonance imaging given the known high local recurrence rate of this tumor.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
| | | | - Stephen Bayles
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rajiv Sethi
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Duazo-Cassin L, Le Guellec S, Lusque A, Chantalat E, Laé M, Terrier P, Coindre JM, Boulet B, Le Boulc'h M, Gangloff D, Meresse T, Chaput B, Al Ali A, Rimareix F, Bonvalot S, Vaysse C. Breast desmoid tumor management in France: toward a new strategy. Breast Cancer Res Treat 2019; 176:329-335. [PMID: 31016642 DOI: 10.1007/s10549-019-05245-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Desmoid tumors (DTs) are rare tumors that originate from myofibroblastic tissue. Recently, initial wait and see was recommended (ESMO guidelines Ann Oncol 2017) in the most frequent locations. This study investigates the outcome of breast desmoid tumor (BDT) according to the initial strategy. METHOD Data from all consecutive patients treated from a BDT in four referral centers were collected. Only intra-mammary desmoid tumors were included. A pathological review and a molecular analysis (CTNNB1 gene mutation) were performed (National re-reading network of sarcomas-RRePS). Patients were grouped according to initial strategy: surgery group (SG) and active surveillance group (ASG). RESULTS A total of 63 patients (61 women, 2 men) met the inclusion criteria. Median age was 50 years (16-86). CTNNB1 mutation was found in 61% (n = 36). SG included 46 patients (73%) (41 partial mastectomies, 2 mastectomies, and 3 mastectomies associated to parietectomies). Surgical margins were positive in 15 patients (33.3%). Median follow-up of SG was 24.9 (0.5-209) months; and 4 patients (8.7%) developed recurrence. ASG included 17 patients (27%). Their median follow-up was 42.2 (0-214) months, and 15 patients (88.2%) did not require any additional treatment. Six patients (35%) had a spontaneous regression, 9 patients (52%) were stable, and 2 patients presented a significant progression that was treated by partial mastectomy. CONCLUSION This study supports an initial nonsurgical approach to BDTs followed by surgery based on tumor growth in select cases, which is consistent with current ESMO recommendations.
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Affiliation(s)
- Ludwig Duazo-Cassin
- Département de Chirurgie Gynécologique et Oncologique, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Sophie Le Guellec
- Département de Pathologie, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Amélie Lusque
- Département de Biostatistiques, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Elodie Chantalat
- Département de Chirurgie Gynécologique et Oncologique, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Marick Laé
- Département de Pathologie, Institut Curie, Paris, France.,Service de Pathologie, Centre Henri Becquerel, INSERM U1245, UNIROUEN, Université de Normandie, Rouen, France
| | - Philippe Terrier
- Département de Pathologie, Gustave Roussy, Université Paris-Saclay Villejuif, Villejuif, France
| | | | - Bérénice Boulet
- Département de Radiologie oncologique, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Morwenn Le Boulc'h
- Département de Radiologie oncologique, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Dimitri Gangloff
- Service de Chirurgie Plastique, Reconstructive et des brûlés, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Thomas Meresse
- Service de Chirurgie Plastique, Reconstructive et des brûlés, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Benoit Chaput
- Service de Chirurgie Plastique, Reconstructive et des brûlés, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Amal Al Ali
- Département de Chirurgie Générale et Digestive, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Françoise Rimareix
- Département de Chirurgie Plastique, Institut Gustave Roussy, Paris, France
| | - Sylvie Bonvalot
- Département de Chirurgie Oncologique, Unité Sarcome, Institut Curie, Paris, France
| | - Charlotte Vaysse
- Département de Chirurgie Gynécologique et Oncologique, Centre Hospitalier Universitaire-Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France.
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Mori S, Noda Y, Kato D, Hirooka S, Ohtsuka T. Desmoid-type fibromatosis arising in a bifid rib chest wall. Gen Thorac Cardiovasc Surg 2019; 67:996-998. [PMID: 30790238 DOI: 10.1007/s11748-019-01088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
Desmoid-type fibromatosis is a rare soft tissue tumor and the chest wall is one of the common sites of its extra-abdominal occurrence. A bifid rib is one of the congenital rib abnormalities. We report a case of desmoid-type fibromatosis arising in a chest wall's bifid rib. A 42-year-old female complained of right chest pain without remarkable medical, traumatic, or familial history. Chest-computed tomography revealed a chest wall tumor located adjacent to a bifid costal cartilage of third rib. We performed chest wall resection of second and third ribs. Pathologically, the tumor was diagnosed a desmoid-type fibromatosis of the chest wall. We surmise mechanical stimulation due to the bifid rib may be related to the occurrence of the tumor. In case of desmoid-type fibromatosis without somatic gene mutation, traumatic history, wound, implants, or use of female hormonal agents, we should search also local congenital abnormality.
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Affiliation(s)
- Shohei Mori
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan.
| | - Yuki Noda
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Daiki Kato
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
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Ponniah I. Cartilage Analogue of Fibromatosis in the Maxillary Alveolar Bone. J Maxillofac Oral Surg 2019; 18:46-51. [PMID: 30728691 DOI: 10.1007/s12663-017-1070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022] Open
Abstract
Cartilage analogue of fibromatosis is a relatively common tumor in the palms and soles of young children and adolescence. The characteristic histological finding of the tumor is the differentiation toward cartilage formation within a background of fibromatosis-like growth. Therefore, the tumor may cause potential diagnostic problems in the maxillofacial bones where it has not been described. The purpose of the present report is to describe the imaging characteristics, histological and immunohistochemical features of an extremely rare case of cartilage analogue of fibromatosis in the maxillary alveolar bone of a 25-year-old female.
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Affiliation(s)
- Irulandy Ponniah
- Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, The Tamil Nadu Dr. MGR Medical University, Chennai, 600 003 India
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Rohit A, Peter A, Paul A, Anja B, Christian D, Renate D, Stefan G, Dietmar H, Johannes J, Peter K, Marco K, Martin L, Maximilian N, Christoph P, Gernot S, Gerald S, Tobias S, Matthias W, Armin Z, Markus G. Prospective observation of Clostridium histolyticum collagenase for the treatment of Dupuytren's disease in 788 patients: the Austrian register. Arch Orthop Trauma Surg 2019; 139:1315-1321. [PMID: 31317303 PMCID: PMC6689902 DOI: 10.1007/s00402-019-03226-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since March 2011, the microbial collagenase of Clostridium histolyticum (Xiapex®, Swedish Orphan Biovitrum AB, Stockholm, Sweden) has become available in the European Union for treatment of Dupuytren's disease. The purpose of this study was to evaluate potential safety risks of Xiapex® and to contribute to a better understanding for its use. METHODS A prospective, non-interventional, observational study using Xiapex® for Dupuytren's disease named XIANIS was conducted between 1.10.2011 and 01.10.2017. Treatment was conducted in accordance to the manufacturer information. Patients were invited for follow-up after 1 week, 1 month, 3 months and 1 year. Demographic data, treatment data, pain levels, anaesthetic application during passive manipulation, subjective function improvement, subjective satisfaction and adverse events were recorded. RESULTS 788 patients with 814 treatments were included who suffered from Dupuytren's contracture for a mean of 64 months. The metacarpophalangeal joint was affected in 57% of cases and the PIP joint in 40.8% with a mean contracture of 39° and 56°, respectively. A change in the contracture down to 0°-5° was reported in 66.5% of cases, while 25.5% achieved a partial improvement. The pain during the injection was rated 4.5 and 3.3 during passive manipulation. Adverse events were reported in the majority of treated patients with skin tears being one main common event (26%). Further adverse outcomes were bleeding/hematoma, joint swelling, injection-site swelling, pressure sensitivity, erythema, injection-site pain, peripheral edema, blood blisters, blisters, painless lymphadenopathy, painful lymphadenopathy, axillary pain, arthralgia and sensory abnormality. There were no reported tendon ruptures, anaphylactic reactions or ligament injuries. On 1-year follow-up, 29% showed an increased contracture of a mean of 24° with the need for surgical treatment in 2% of patients. 74% of patients were very satisfied and 72% showed a high functional improvement. CONCLUSION The injectable collagenase Clostridium histolyticum (Xiapex®) proved to be effective and safe in patients with Dupuytren's disease. Minor adverse events disappeared within 30 days and the need for surgical treatment within 1 year was very low (2%). No major complications or rare side effects were seen in this prospective observational study.
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Affiliation(s)
- Arora Rohit
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Angermann Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | - Binter Anja
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Deml Christian
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Sanatorium Kettenbrücke, Innsbruck, Austria
| | | | | | | | | | - Kaiser Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Keller Marco
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Kantonspital Baselland, Basel, Switzerland
| | | | - Neuwirth Maximilian
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Pezzei Christoph
- 0000 0001 0723 5126grid.420022.6Lorenz Böhler Unfallkrankenhaus, AUVA, Wien, Austria
| | - Schmidle Gernot
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | | | | | | | - Gabl Markus
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Turner B, Alghamdi M, Henning JW, Kurien E, Morris D, Bouchard-Fortier A, Schiller D, Puloski S, Monument M, Itani D, Mack LA. Surgical excision versus observation as initial management of desmoid tumors: A population based study. Eur J Surg Oncol 2018; 45:699-703. [PMID: 30420189 DOI: 10.1016/j.ejso.2018.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022] Open
Abstract
SYNOPSIS Desmoid tumors can be safely managed with watchful waiting, including either observation alone or tamoxifen/NSAIDs. Surgery at first presentation can be associated with significant treatment burden. BACKGROUND Immediate surgery was historically recommended for desmoid tumors. Recently, watchful waiting, (tamoxifen/NSAIDs or observation alone), has been advocated. METHODS All diagnoses of desmoid tumor within the Alberta Cancer Registry from August 2004 to September 2015 were identified. Patients with FAP were excluded. Demographics, tumor characteristics and treatment and outcome data were collected. Outcomes were compared between immediate surgery and watchful waiting. The effect of abdominal wall site on progression and recurrence and the effect of microscopic margin on recurrence were assessed with Fisher's exact test. RESULTS We identified 111 non-FAP patients. Median follow-up was 35 months from diagnosis. 74% were female. Mean age was 42. Fifty (45%) underwent watchful waiting, of whom 21(42%) progressed, with median PFS of 10 months. Fifty-three (48%) underwent resection at presentation, of whom 8 (15%) recurred, with median disease-free survival of 22 months. Abdominal wall lesions were equally represented in both groups, and equally likely to progress on watchful waiting (50% vs 39%, p = 0.53), but there was a trend toward decreased recurrence after surgery. (5% vs 23%, p = 0.08). Microscopic margin had no effect on recurrence (14% of margin negative vs 20% of margin positive, p = 1.0). CONCLUSIONS Watchful waiting was successful in 58% of patients, and a further 28% only required one aggressive treatment thereafter, for a total of 86%. Surgery had a favorable recurrence rate (15%), but some recurrences were associated with significant treatment burden. Treatment should be tailored to individual patients in a multidisciplinary setting. A trial of observation appears warranted in most patients. Recurrence rate was not affected by positive margins.
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Affiliation(s)
- Benjamin Turner
- Head and Neck Oncologic Surgery & Microvascular Fellowship, 2nd Floor, Faculty Clinics Building University of Florida, Jacksonville 653-1 West 8th Street, Jacksonville, FL, 32209, United States.
| | - Mohamed Alghamdi
- Division of Medical Oncology, University of Calgary, Calgary, AB, Canada; Department of Medical Oncology, King Saud University, Riyadh, Saudi Arabia
| | - Jan-Willem Henning
- Division of Medical Oncology, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Kurien
- Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Don Morris
- Division of Medical Oncology, University of Calgary, Calgary, AB, Canada
| | | | - Daniel Schiller
- Department of Surgery, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shannon Puloski
- Division of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Michael Monument
- Division of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Doha Itani
- Department of Pathology, University of Calgary, Calgary, AB, Canada
| | - Lloyd A Mack
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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Steadman L, Crook S. Fibromatosis arising from the pectoralis major muscle mimicking breast cancer. Radiol Case Rep 2018; 13:1174-1178. [PMID: 30233754 PMCID: PMC6140422 DOI: 10.1016/j.radcr.2018.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022] Open
Abstract
Fibromatoses are soft tissue tumors composed of fibroblasts which commonly appear in the muscular aponeurosis of the abdomen. Mammary fibromatoses occur in only 0.2% of breast neoplasms and have been reported in association with prior breast augmentation and Gardner's syndrome. Multiple imaging modalities have been used to characterize the appearance of breast fibromatosis; however, it remains a tissue diagnosis given the variability both within and across modalities. We present the case of a 25-year-old female with a history of palpable breast mass who was evaluated with ultrasound, diagnostic mammography, MRI, and CT. Ultrasound-guided biopsy revealed fibromatosis, and MRI ultimately revealed that the mass was arising from the pectoralis major muscle and extensively involved the chest wall.
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Affiliation(s)
- Laryn Steadman
- Indiana University School of Medicine, 550 N. University Blvd., Room 0663, Indianapolis, IN 46202, USA
| | - Susan Crook
- Indiana University School of Medicine, 550 N. University Blvd., Room 0663, Indianapolis, IN 46202, USA
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Kramer A, Har-Shai Y, Metanes I, Harel H, Wollstein R. The Use of Cryotherapy to Treat Infantile Digital Fibromatosis with a Functional Deficit: A Case Report. J Hand Surg Asian Pac Vol 2018; 23:278-281. [PMID: 29734898 DOI: 10.1142/s2424835518720177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infantile Digital Fibromatosis (IDF) is a rare benign lesion that can affect the fingers, often appearing at birth or early on in life. Treatment is controversial due to a high recurrence rate following surgical excision, and the tendency of the lesions to regress or resolve completely after the age of one year. Functional loss has rarely been described. We describe a case of IDF with joint contracture and significant functional deficit that was treated with cryotherapy and post procedural occupational therapy with an excellent result. Indications for treatment and cryotherapy as a therapeutic modality for IDF are discussed.
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Affiliation(s)
- Aviv Kramer
- * Department of Plastic Surgery, Carmel Lady Davis Medical Center, Israel
| | - Yaron Har-Shai
- * Department of Plastic Surgery, Carmel Lady Davis Medical Center, Israel.,† Departments of Orthopedic and Plastic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Isa Metanes
- * Department of Plastic Surgery, Carmel Lady Davis Medical Center, Israel
| | - Hani Harel
- * Department of Plastic Surgery, Carmel Lady Davis Medical Center, Israel
| | - Ronit Wollstein
- * Department of Plastic Surgery, Carmel Lady Davis Medical Center, Israel.,† Departments of Orthopedic and Plastic Surgery, Division of Hand and Upper Extremity Surgery, Technion Israel Institute of Technology, School of Medicine, Haifa, Israel.,‡ Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, PA, USA
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48
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Gupta R, Smita S, Sinha R, Sinha N, Sinha L. Giant fibroepithelial polyp of the thigh and retroperitoneal fibromatosis in a young woman: a rare case. Skeletal Radiol 2018; 47:1299-1304. [PMID: 29487969 DOI: 10.1007/s00256-018-2904-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
We present a case of 20-year-old woman who presented with a large pedunculated skin covered mass lesion arising from the left thigh, measuring 40 × 25 cm, with no history of pain or skin ulceration and a feeling of a lump with dragging pain in the left side of the abdomen for about 7 years. Subsequently, ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging of abdomen and left thigh region were carried out. The lesion was broad-based toward the left upper thigh with a central core of interspersed fat supplied by branches of the superficial and deep femoral arteries. Another lesion was seen in the left retroperitoneum anterior to the psoas muscle in a left paravertebral location encasing the left common iliac vessels extending into the left pelvic cavity and inguinal region inferiorly. The lesion showed dense post-acoustic shadowing on ultrasound, mild enhancement on contrast-enhanced computed tomography, and appeared hypointense on T1- and T2-weighted images. A left thigh lesion was excised, whereas incisional biopsy was done for the left retroperitoneal lesion. The diagnosis of a giant fibroepithelial polyp arising from the left thigh and left retroperitoneal fibromatosis was made. This is the first report of such a giant fibroepithelial polyp arising from the thigh with associated retroperitoneal fibromatosis.
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Affiliation(s)
- Ruchi Gupta
- Department of Radiodiagnosis, AIIMS Patna, Patna, India.
| | | | - Ruchi Sinha
- Department of Radiodiagnosis, AIIMS Patna, Patna, India
| | - Neetu Sinha
- Department of Radiodiagnosis, AIIMS Patna, Patna, India
| | - Lakshmi Sinha
- Department of Radiodiagnosis, AIIMS Patna, Patna, India
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Chang B, Ha JF, Zopf D. Treatment of extensive post tonsillectomy oropharyngeal stenosis secondary to fibromatosis. Int J Pediatr Otorhinolaryngol 2018; 107:107-109. [PMID: 29501289 DOI: 10.1016/j.ijporl.2018.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy. We demonstrate that surgical resection with a clear margin allowed for alleviation of stenosis without recurrences reported since the procedure.
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Affiliation(s)
- Brian Chang
- Department of Pediatrics Otolaryngology Head & Neck Surgery, Michigan Medicine, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Jennifer F Ha
- University of Western Australia Department of Surgery, Stirling Highway, Nedlands, WA 6009, Australia; St John of God Hospital, 1 Barry Marshall Parade, Murdoch, WA 6150, Australia; Perth Children's Hospital, Roberts Road, Subiaco, WA 6008, Australia
| | - David Zopf
- Department of Pediatrics Otolaryngology Head & Neck Surgery, Michigan Medicine, C.S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA.
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50
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Sugoor P, Gupta A, Patkar S, Rekhi B, Goel M. Sporadic Retroperitoneal Fibrosis: a Gentle Giant. Indian J Surg Oncol 2018; 9:71-73. [PMID: 29563740 DOI: 10.1007/s13193-017-0710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Fibromatosis covers a broad spectrum of benign fibrous tissue proliferation and is characterized by slow growing, locally infiltrative growth pattern with a high propensity for local recurrence. We report on a case of multicentric fibromatosis originating from the retroperitoneal space and submandibular triangle, in an 18-year-old lady. Computed tomography revealed a retroperitoneal abdominopelvic tumor extending from the left sub-diaphragmatic space to the pelvic inlet which had enveloped the solid viscera in the left upper quadrant with a displaced celiac axis. She also had a recurrent resectable fibromatosis in left submandibular gland. Histopathological evaluation revealed fibromatosis. Preoperatively, Vinblastin-, Methotrexate-, Tamoxifen-based systemic chemotherapy was offered for 12 weeks in an attempt to downsize the mass. An en bloc complete resection of tumor with multi-visceral resection was performed to achieve negative margins and since then, the patient has remained asymptomatic without any signs of tumor recurrence during the 12th month follow-up visit. Complete resection with negative margins is the treatment of choice and majority of the lesions are amenable for surgical resections. Adjuvant therapy using non-steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for un-resectable or recurrent cases.
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Affiliation(s)
- Pavan Sugoor
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Amit Gupta
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Shraddha Patkar
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Bharat Rekhi
- 2Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Mahesh Goel
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India.,3Gastrointestinal and HPB Surgery, Department of Surgical Oncology, Tata Memorial Center, Parel, Mumbai, 400012 India
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