Extra-abdominal Desmoid Tumor Mimicking Cervical Spine Schwannoma

Abstract

Extra-abdominal desmoid tumors (DTs) are rare tumors of apparent fibroblastic origin with unpredictable clinical behavior. Though histologically benign and slow growing, DTs can be proliferative, aggressive tumors, invading the surrounding areas. DTs located extra-abdominally are most commonly found in the extremities or proximal structures like the shoulders, chest wall, and neck. Spinal involvement is very rare. Here, we describe a case where an extra-abdominal DT mimicked a schwannoma in the posterior cervical spine. A 67-year-old female patient presented with acute neck and bilateral shoulder pain. After attempting conservative treatments with no symptomatic relief, a magnetic resonance imaging of the cervical spine was obtained, showing a paraspinal mass in the posterior elements from C2 to C4. The computed tomography guided needle biopsy showed rare spindle cells, suggestive of a spindle cell neoplasm, and complete surgical resection was performed. The pathology report was consistent with fibromatosis, leading to a final diagnosis of the extra-abdominal desmoid. This case demonstrates a rare presentation of an unusual tumor that often manifests with nonspecific symptoms or no symptoms at all.

A Rare Paraspinal Desmoid Tumour following Instrumented Scoliosis Correction in an Adolescent

“…Surgery, as a traumatic cause, has been described. There are 15 reported cases of paraspinal desmoid tumours following spine surgery [8][9][10][11][12][13].…”

Postoperative Recurrent Paraspinal Fibromatosis after Resection of Cervical Meningioma and Review of Literature

“…These tumors are histologically benign, however, can be locally aggressive and invasive with significantly high recurrence rates ranging from 24 to 77% depending on the patient's age, location of the tumor, and resection margins. 2,5 In our case, the risk factor was surgical trauma due to the resection of cervical meningioma. The incidence of pediatric meningioma is as low as 2.19% of whole-brain tumors.…”

“…These tumors are histologically benign, however, can be locally aggressive and invasive with significantly high recurrence rates ranging from 24 to 77% depending on the patient’s age, location of the tumor, and resection margins. 2 5 …”

“…It can just be incidental finding without any symptoms to start with, detected on imaging done for another disease, just like our case, or presenting symptom can be painless swelling and lump, limping or other difficulty using arms, hands, legs, and feet, and compromised joint or muscle mobility. 5 The intra-abdominal fibromatosis has entirely different presentation ranging from progressive abdominal pain to frank intestinal obstruction.…”

“… 8 9 Other less likely imaging possibilities include neurogenic tumor, postoperative infection, hematoma, and reactive process such as myositis ossificans. 3 5 …”