Locally aggressive de novo spinal fibromatosis: case report and review of the literature

Abstract

Fibromatosis is a benign lesion, which originates from proliferating fibroblasts. Although fibromatosis is a benign tumor, it is locally aggressive and invasive. Spinal presentation of fibromatosis is very rare, and case reports are the only source of the clinical knowledge. Herein, we describe the oldest patient having spinal fibromatosis with de novo occurrence and aggressive nature. A 68-year-old female patient admitted to our outpatient clinic with low back pain and neurological claudication. On lumbar spine magnetic resonance imaging, she had spinal canal stenosis with a concomitant lesion in the left longissimus muscle. We did our best to resect the tumor, entirely. The pathology result was consistent with spindle cell lesion. The lesion recurred 6 months after the primary surgery. In the second surgery, we did en bloc resection. Pathology and immunohistochemical analysis results were consistent with fibromatosis. After the second surgery, she had adjuvant radiotherapy. There was nothing other than radionecrosis in the operation site, still after 2 years. In conclusion, radiological work-up is usually insufficient to make fibromatosis diagnosis and whole pathological specimen should be carefully evaluated to achieve the accurate diagnosis. Spinal fibromatosis is very rare and its treatment methods have not universally been conceptualized. However, adjuvant therapies are necessary after en bloc resection.KeywOrds: Fibromatosis, Lumbar spine, Radiotherapy, Surgery ÖZ Fibromatozis, fibroblastların çoğalması sonrası oluşan bening bir lezyondur. Fibromatozis, bening olmasına rağmen, lokal olarak agresifdir ve invazif bir seyir seyreder. Spinal fibromatozis çok nadirdir ve literatürde sadece olgu sunumları bulunmaktadır. Yazıda, de novo oluşan ve agresif bir klinik tabloya sahip olan, literatürdeki en yaşlı hasta sunuldu. Altmış sekiz yaşında kadın bir hasta kliniğimize bel ağrısı ve nörojenik kladikasyon ile başvurdu. Lomber MR incelemesinde, spinal dar kanal ile beraber, sol paraspinal alanda, longissimus kasının içinde kitle lezyonu saptandı. Mümkün olan en geniş cerrahi eksizyon uygulandı. Patoloji sonucu iğsi hücreli lezyon olarak geldi. Altı ay sonra, lezyon nüksetti. İkinci ameliyatta, en blok rezeksiyon yapıldı. Patoloji ve immünohistokimyasal çalışmalar patolojiyi fibromatozis olarak sonuçlandırdı. İkinci ameliyattan sonra hasta adjuvan radyoterapi aldı. Hastanın 2 yıllık takibinde radyonekroz dışında ek patoloji saptanmadı. Radyolojik çalışmalar fibromatozis tanısı konulmasında yetersiz olabiliyor; bu sebeple patolojik preparat detaylı olarak incelenmelidir. Spinal fibromatozis çok nadirdir ve hâlâ genel kabul görmüş standart bir tedavisi yoktur. Ancak; en blok cerrahiden sonra adjuvan tedaviler gerekmektedir.

Extra-abdominal Desmoid Tumor Mimicking Cervical Spine Schwannoma

“…Spontaneous formation is rare overall, but accounts for the majority of DTs [ 5 ]. As of 2015, only 14 cases of DTs localized to the spine have been reported, mostly occurring in the thoracic region [ 7 ]. Spinal DTs have also been observed in patients following posterior spinal instrumentation placement [ 4 ].…”

Paraspinal Desmoid Tumor in a Pediatric Patient with No Surgical History: A Case Report

“…Only 25 known cases of paraspinal desmoid tumors have been reported, among which only 6 were in pediatric patients (►Table 1). [10][11][12][13][14]16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Desmoid tumors typically occur in the abdomen or extremities with surgery often being an antecedent. 2,4 The tumor's slow growing, benign course in our case is typical of desmoid tumor.…”

“…Only 25 known cases of paraspinal desmoid tumors have been reported, among which only 6 were in pediatric patients ( Table 1 ). 10 11 12 13 14 16 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 …”