Desmoplastic fibroma of the ulna bone

Abstract

A fibroma is a benign tumour composed of fibrous connective tissue and they can grow in all organs. They can be classified based on consistency into hard or soft fibroma, based on histological characteristics into desmoplastic, chondromyxoid, ossifying, non-ossifying fibroma. They can also be classified based on tissue of origin or location in the body, it can also be classified into superficial or deep fibroma. This is a report of a 15-year-old Nigerian boy with a recurrent left ulnar tumour which was rapidly growing and has been excised three times. Preoperative investigations, i.e., plain radiograph, full blood count and fine needle aspiration cytology were done. Patient could not afford CT scan which was requested for. First excision was in 2009. Recurred within 1 year and had a repeat excision in 2011. He had a second recurrence 9 months after and had to have another excision. The last tumour excision left only the part of the left ulna that forms the proximal radioulnar joint and elbow joint. Patient has been followed up after the last excision for 18 months with no recurrence.

Desmoplastic fibroma of the ulna

“…6 It can be asymptomatic at the initial stages and later present with a variable symptoms including pain, swelling, deformity, effusion into the joint space or loss of function and pathological fractures. 7,8 Desmoplastic fibroma can involve any bone but is most often found in the mandible (22%), followed by the femur (15%), pelvic bones (13%), radius (12%), and tibia (9%). 1,9 The etiological factors of desmoplastic fibroma are not known, although an association with trauma, endocrine factors, genetic aberrations, have been suggested.…”

“…Aggressive curettage is also recommended in view of its high recurrence rate. 8 Other treatment strategies include radiotherapy and pharmacological treatments if needed. In cases where resection cannot be done adjuvant radiotherapy helps in controlling recurrence.…”

Osseous Tumor Reporting and Data System—Multireader Validation Study

“…These masses are recommended to be followed at 3, 6, 12, and 24 months, or until the lesion spontaneously resolves or significantly regresses. Representative masses include histiocytosis in appropriate age group, intraosseous myxoma, chondromyxoid fibroma, giant cell tumor (GCT), chondroblastoma, synovial chondromatosis with bone involvement, enchondroma protuberance in hands and feet, desmoplastic fibroma, fibrous dysplasia, Paget disease, epithelioid hemangioma, and so on 31–45 . Postcontrast imaging of such lesions usually shows variable enhancement.…”

“…Representative masses include histiocytosis in appropriate age group, intraosseous myxoma, chondromyxoid fibroma, giant cell tumor (GCT), chondroblastoma, synovial chondromatosis with bone involvement, enchondroma protuberance in hands and feet, desmoplastic fibroma, fibrous dysplasia, Paget disease, epithelioid hemangioma, and so on. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Postcontrast imaging of such lesions usually shows variable enhancement. Diffusion-weighted imaging, if obtained, exhibits moderate-marked hyperintensity of the lesion on DWI and mild-moderate hyperintensity on ADC images, with generally a mean ADC value = 1.2-2.0 Â 10 −3 mm 2 /s.…”