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Extra-abdominal desmoid tumor located in the axilla.

Pacheco Compaña FJ, Alvarez Jorge A, Delgado Sotorrío C - Arch Plast Surg (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, Complejo Hospitalario Universitario de A Coruna, A Coruna, Spain.

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Desmoid tumors are rare benign tumors biologically classified between nonaggressive fibrous tumors and low-grade fibrosarcomas... On one hand, they present as infiltrating masses that might reappear if resection is incomplete, and on the other hand, they are composed of well-differentiated fibroblasts that do not metastasize... Desmoid tumors can be classified according to their location into intra-abdominal, abdominal, and extra-abdominal types... The abdominal desmoid tumor appears in the anterior abdominal wall, most commonly found in women during or after pregnancy... Surgical treatment is the technique of choice... It is necessary to perform a wide resection in order to decrease the recurrence rates... There is no consensus in determining how wide the excision margins must be in the resection as it is difficult to differentiate tumor tissue from healthy tissue... These tumors present a high rate of recurrence (between 15% and 77%), particularly in cases where resection with wide margins is difficult, such as facial tumors... Due to the fact that desmoid tumors have estrogen receptors, the possibility of associating hormonal therapy with tamoxifen for the treatment of these tumors has been raised... In conclusion, the extra-abdominal desmoid tumor is a rare benign tumor that presents itself as an aggressive fibrosis of the musculoaponeurotic tissue... The treatment of choice is wide-margin surgical resection... In order to avoid recurrence, there are other forms of treatment, such as radiotherapy, chemotherapy, and hormonal therapy.

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Axillary dissection after tumor resection. A skin incision was made in the axillary region and was extended to the inner arm. The axillary brachial plexus and vessels were dissected, which showed that one of the axillary veins was infiltrated. The teres major muscle, subscapularis muscle and latissimus dorsi muscle were also infiltrated. A, brachial plexus; B, axillary vein; C, teres major muscle; D, subscapularis muscle; E, latissimus dorsi muscle.
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Figure 2: Axillary dissection after tumor resection. A skin incision was made in the axillary region and was extended to the inner arm. The axillary brachial plexus and vessels were dissected, which showed that one of the axillary veins was infiltrated. The teres major muscle, subscapularis muscle and latissimus dorsi muscle were also infiltrated. A, brachial plexus; B, axillary vein; C, teres major muscle; D, subscapularis muscle; E, latissimus dorsi muscle.

Mentions: Surgical treatment revealed a soft tissue tumor that infiltrated one of the two axillary veins, the teres major muscle, the subscapularis muscle, and the latissimus dorsi muscle, without infiltration of the brachial plexus. A bloc resection of the tumor and the infiltrated structures was done (Fig. 2). The safety margin was approximately 2 cm, but an intraoperative biopsy confirmed the presence of a tumor next to the plexus. A macroscopic study showed a mass of 7 cm×5 cm×4.5 cm with a tumor of 4 cm×4 cm×3 cm. It was whitish, firm, and rubbery with poorly defined margins (Fig. 3). The histopathological examination revealed a tumor composed of a proliferation of well-differentiated myofibroblasts with a low cell density and an infiltrative growth pattern. There were no cytologic findings of malignancy and less than one mitosis per high power field. However, the tumor was very locally aggressive as it infiltrated and destroyed the adjacent muscle and the adipose tissue (Fig. 4). In the immunohistochemical study, the tumor cells were positive for the mesenchymal marker vimentin (Fig. 5), focally positive for the muscle marker actin, and negative for CD34 and the S-100 protein. The Ki67 proliferative index was low, less than 5%. With these results, the diagnosis was desmoid tumor. Because the tumor was near the excision margin, the patient was treated with a total dose of 54 Gy of postoperative radiotherapy. CT and ultrasound-guided biopsy were carried out with no evidence of recurrence five months after surgery. Nine months after surgery, the patient has no symptoms of recurrence.


Extra-abdominal desmoid tumor located in the axilla.

Pacheco Compaña FJ, Alvarez Jorge A, Delgado Sotorrío C - Arch Plast Surg (2014)

Axillary dissection after tumor resection. A skin incision was made in the axillary region and was extended to the inner arm. The axillary brachial plexus and vessels were dissected, which showed that one of the axillary veins was infiltrated. The teres major muscle, subscapularis muscle and latissimus dorsi muscle were also infiltrated. A, brachial plexus; B, axillary vein; C, teres major muscle; D, subscapularis muscle; E, latissimus dorsi muscle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228228&req=5

Figure 2: Axillary dissection after tumor resection. A skin incision was made in the axillary region and was extended to the inner arm. The axillary brachial plexus and vessels were dissected, which showed that one of the axillary veins was infiltrated. The teres major muscle, subscapularis muscle and latissimus dorsi muscle were also infiltrated. A, brachial plexus; B, axillary vein; C, teres major muscle; D, subscapularis muscle; E, latissimus dorsi muscle.
Mentions: Surgical treatment revealed a soft tissue tumor that infiltrated one of the two axillary veins, the teres major muscle, the subscapularis muscle, and the latissimus dorsi muscle, without infiltration of the brachial plexus. A bloc resection of the tumor and the infiltrated structures was done (Fig. 2). The safety margin was approximately 2 cm, but an intraoperative biopsy confirmed the presence of a tumor next to the plexus. A macroscopic study showed a mass of 7 cm×5 cm×4.5 cm with a tumor of 4 cm×4 cm×3 cm. It was whitish, firm, and rubbery with poorly defined margins (Fig. 3). The histopathological examination revealed a tumor composed of a proliferation of well-differentiated myofibroblasts with a low cell density and an infiltrative growth pattern. There were no cytologic findings of malignancy and less than one mitosis per high power field. However, the tumor was very locally aggressive as it infiltrated and destroyed the adjacent muscle and the adipose tissue (Fig. 4). In the immunohistochemical study, the tumor cells were positive for the mesenchymal marker vimentin (Fig. 5), focally positive for the muscle marker actin, and negative for CD34 and the S-100 protein. The Ki67 proliferative index was low, less than 5%. With these results, the diagnosis was desmoid tumor. Because the tumor was near the excision margin, the patient was treated with a total dose of 54 Gy of postoperative radiotherapy. CT and ultrasound-guided biopsy were carried out with no evidence of recurrence five months after surgery. Nine months after surgery, the patient has no symptoms of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, Complejo Hospitalario Universitario de A Coruna, A Coruna, Spain.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Desmoid tumors are rare benign tumors biologically classified between nonaggressive fibrous tumors and low-grade fibrosarcomas... On one hand, they present as infiltrating masses that might reappear if resection is incomplete, and on the other hand, they are composed of well-differentiated fibroblasts that do not metastasize... Desmoid tumors can be classified according to their location into intra-abdominal, abdominal, and extra-abdominal types... The abdominal desmoid tumor appears in the anterior abdominal wall, most commonly found in women during or after pregnancy... Surgical treatment is the technique of choice... It is necessary to perform a wide resection in order to decrease the recurrence rates... There is no consensus in determining how wide the excision margins must be in the resection as it is difficult to differentiate tumor tissue from healthy tissue... These tumors present a high rate of recurrence (between 15% and 77%), particularly in cases where resection with wide margins is difficult, such as facial tumors... Due to the fact that desmoid tumors have estrogen receptors, the possibility of associating hormonal therapy with tamoxifen for the treatment of these tumors has been raised... In conclusion, the extra-abdominal desmoid tumor is a rare benign tumor that presents itself as an aggressive fibrosis of the musculoaponeurotic tissue... The treatment of choice is wide-margin surgical resection... In order to avoid recurrence, there are other forms of treatment, such as radiotherapy, chemotherapy, and hormonal therapy.

No MeSH data available.


Related in: MedlinePlus