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Collagenous fibroma (desmoplastic fibroblastoma) of the neck presenting with neurological symptoms.

Fong F, Odell E, Simo R - Head Neck Pathol (2008)

Bottom Line: We describe a unique case of a 41-year-old woman presenting with a posterior neck swelling and longstanding history of severe ongoing pain in the right scapular region, shoulder and neck, weakness of the palmar grip and limited right lateral neck flexion and rotation.A history of trauma to the right neck in adolescence was noted.In a literature search on Medline and Pubmed, we found no reported cases of collagenous fibromas presenting with neurological symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Guy's and St. Thomas' NHS Foundation Trust, London, UK. farina@doctors.org.uk

ABSTRACT
Collagenous fibromas are rare fibrous soft tissue tumours that usually arise in subcutaneous tissue or skeletal muscle at a variety of anatomical sites. These lesions commonly present as painless, slow-growing mobile masses. We describe a unique case of a 41-year-old woman presenting with a posterior neck swelling and longstanding history of severe ongoing pain in the right scapular region, shoulder and neck, weakness of the palmar grip and limited right lateral neck flexion and rotation. A history of trauma to the right neck in adolescence was noted. Histological analysis revealed a paucicellular lesion with spindle and stellate-shaped fibroblasts involving the cervical nerve roots, typical of collagenous fibroma. In a literature search on Medline and Pubmed, we found no reported cases of collagenous fibromas presenting with neurological symptoms. This report highlights the potential of these lesions to present with neurological symptoms due to infiltration of surrounding tissues, and that preceding trauma may contribute to the aetiology.

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Intraoperative appearance of tumour. The tumour (arrow) is shown in relation to the right upper cervical plexus (identified by the lower sling) and the right spinal accessory nerve (CN XI) (identified by the upper sling)
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Fig3: Intraoperative appearance of tumour. The tumour (arrow) is shown in relation to the right upper cervical plexus (identified by the lower sling) and the right spinal accessory nerve (CN XI) (identified by the upper sling)

Mentions: Following a discussion by the multidisciplinary head and neck oncology team, a surgical excision of the mass was recommended. This was performed through a transverse cervical incision. The tumour was identified intramuscularly, deep to the levator scapulae, scalenus anterior and posterior muscles, involving the upper cervical nerve roots (Figs. 3 and 4). Macroscopically, the tumour was a well-circumscribed firm oval mass, tan-grey in colour with a homogeneous consistency. The resected specimen consisted of mature fat, lymphoid tissue and nerve trunks containing a paucicellular fibrous lesion with spindle to stellate-shaped fibroblasts and a diffuse, permeative architecture mimicking infiltration and extending between and around nerves and muscle bundles. No mitotic figures or nuclear hyperchromasia was seen (Fig. 5). Fibroblasts exhibited a myofibroblastic phenotype on immunocytochemistry, expressing calponin but not smooth muscle actin, S100 protein, CD34 or HMB45. Nerve sheath tumours and solitary fibrous tumour were thus excluded. There were no cytological atypia to suggest a malignant neoplasm. The patient’s neurological symptoms improved following surgery and no recurrence was reported at 18-month follow-up.Fig. 3


Collagenous fibroma (desmoplastic fibroblastoma) of the neck presenting with neurological symptoms.

Fong F, Odell E, Simo R - Head Neck Pathol (2008)

Intraoperative appearance of tumour. The tumour (arrow) is shown in relation to the right upper cervical plexus (identified by the lower sling) and the right spinal accessory nerve (CN XI) (identified by the upper sling)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807529&req=5

Fig3: Intraoperative appearance of tumour. The tumour (arrow) is shown in relation to the right upper cervical plexus (identified by the lower sling) and the right spinal accessory nerve (CN XI) (identified by the upper sling)
Mentions: Following a discussion by the multidisciplinary head and neck oncology team, a surgical excision of the mass was recommended. This was performed through a transverse cervical incision. The tumour was identified intramuscularly, deep to the levator scapulae, scalenus anterior and posterior muscles, involving the upper cervical nerve roots (Figs. 3 and 4). Macroscopically, the tumour was a well-circumscribed firm oval mass, tan-grey in colour with a homogeneous consistency. The resected specimen consisted of mature fat, lymphoid tissue and nerve trunks containing a paucicellular fibrous lesion with spindle to stellate-shaped fibroblasts and a diffuse, permeative architecture mimicking infiltration and extending between and around nerves and muscle bundles. No mitotic figures or nuclear hyperchromasia was seen (Fig. 5). Fibroblasts exhibited a myofibroblastic phenotype on immunocytochemistry, expressing calponin but not smooth muscle actin, S100 protein, CD34 or HMB45. Nerve sheath tumours and solitary fibrous tumour were thus excluded. There were no cytological atypia to suggest a malignant neoplasm. The patient’s neurological symptoms improved following surgery and no recurrence was reported at 18-month follow-up.Fig. 3

Bottom Line: We describe a unique case of a 41-year-old woman presenting with a posterior neck swelling and longstanding history of severe ongoing pain in the right scapular region, shoulder and neck, weakness of the palmar grip and limited right lateral neck flexion and rotation.A history of trauma to the right neck in adolescence was noted.In a literature search on Medline and Pubmed, we found no reported cases of collagenous fibromas presenting with neurological symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Guy's and St. Thomas' NHS Foundation Trust, London, UK. farina@doctors.org.uk

ABSTRACT
Collagenous fibromas are rare fibrous soft tissue tumours that usually arise in subcutaneous tissue or skeletal muscle at a variety of anatomical sites. These lesions commonly present as painless, slow-growing mobile masses. We describe a unique case of a 41-year-old woman presenting with a posterior neck swelling and longstanding history of severe ongoing pain in the right scapular region, shoulder and neck, weakness of the palmar grip and limited right lateral neck flexion and rotation. A history of trauma to the right neck in adolescence was noted. Histological analysis revealed a paucicellular lesion with spindle and stellate-shaped fibroblasts involving the cervical nerve roots, typical of collagenous fibroma. In a literature search on Medline and Pubmed, we found no reported cases of collagenous fibromas presenting with neurological symptoms. This report highlights the potential of these lesions to present with neurological symptoms due to infiltration of surrounding tissues, and that preceding trauma may contribute to the aetiology.

Show MeSH
Related in: MedlinePlus