A Case of Desmoid-Type Fibromatosis Arising after Thoracotomy for Lung Cancer with a Review of the English and Japanese Literature

Abstract

Chest wall desmoid-type fibromatoses are rare tumors 1) that occasionally arise from thoracotomy scars. 2,3) They are locally aggressive tumors that occasionally exhibit local recurrence after resection. 4) Desmoid tumors arising from thoracotomy scars in patients with lung cancer should be discriminated from chest wall recurrence or dissemination of lung cancer. To address this issue, we present our case and review cases of desmoid-type fibromatosis following a previous thoracotomy that were reported in English or Japanese. Case ReportA 62-year-old woman was found to have a chest wall tumor on chest computed tomography (CT) at a 1-year routine follow-up after video-assisted thoracoscopic segmentectomy for pT1aN0M0 lung adenocarcinoma. The tumor was 3.4 × 1.3 cm in size, and it was located in the previous thoracotomy site (Fig. 1A). Positron emission tomography (PET) revealed mild 18 F-fluorodeoxyglucose (FDG) accumulation in the tumor, with a maximal standardized uptake value (SUV max ) of 1.9. There was no effusion or other lesions on CT and PET. She had no apparent elevation of carcinoembryonic antigen (CEA; 1.9 ng/ml [normal range, <2.0 ng/ml]) compared to the preoperative CEA value of 1.3 ng/ml. CT-guided A Case of Desmoid-Type Fibromatosis Arising after Thoracotomy for Lung Cancer with a Review of the English and Japanese LiteratureTakeshi Mori, MD, PhD, Tatsuya Yamada, MD, Yasuomi Ohba, MD, PhD, Kentaro Yoshimoto, MD, PhD, Koei Ikeda, MD, PhD, Kenji Shiraishi, MD, PhD, and Makoto Suzuki, PhD, MD Chest wall desmoid-type fibromatoses are rare, locally aggressive tumors that occasionally arise from previous thoracotomy sites. Tumors arising from previous sites of thoracotomy to treat malignant disease should be discriminated from the pleural dissemination of the previous malignancy. In this study, we report a case of desmoid-type fibromatosis arising from a site for thoracotomy to treat lung cancer. Additionally we reviewed 15 reported cases of desmoid-type fibromatosis following thoracotomy and summarized their features. A 62-year-old woman was found to have a tumor on computed tomography (CT) at a 1-year routine checkup for lung cancer. The tumor (diameter, 3.4 cm) was located at the previous thoracotomy site. Positron emission tomography (PET) revealed mild 18 F-fluorodeoxyglucose (FDG) accumulation in the tumor, with a maximal standardized uptake value (SUV max ) of 1.9. CT-guided biopsy revealed only fibrous tissue. Eighteen months after the biopsy, CT revealed apparent tumor growth, and a biopsy revealed the same histology observed previously. The tumor was removed and diagnosed as desmoid-type fibromatosis. Currently, the patient is alive without recurrence 4 years after desmoid surgery.

Desmoid-Type Fibromatosis of the Thorax

“… 9 , 10 In addition, few studies included the use of 18 F-fluorodeoxyglucose positron emission tomography (FDG PET). 11 , 12 …”

Cicatricial Fibromatosis Diagnosis after Suspected Local Recurrence at the Bronchial Stump Following Lobectomy for Lung Cancer

“…The occurrence of cicatricial fibromatosis, especially adjacent to the bronchial stump that remained after thoracic surgery in the present case, is extremely rare. There are 16 reported cases of desmoid-type fibromatosis following thoracotomy [ 4 ], primarily at the chest wall or pleura. The uptake on F18 FDG PET/CT imaging (SUVmax, 6.5) in the present case was higher than the SUVmax of 1.9 previously reported for a tumor that originated at a thoracotomy site [ 4 ].…”

A massive pleural‐based desmoid tumour

“…However, antecedent trauma (e.g. thoracic surgery [5]) -which triggers aberrant wound healing and fibroproliferative disorders of mesenchymal tissue -is a recognized aetiological factor. Whether the prior tube thoracostomy in our patient had precipitated the development of desmoid growth was unclear.…”