Abnormal Presentation of Aggressive Fibromatosis After Radiotherapy for Keloids: Case Report and Brief Literature Review

Keloids, dermal fibroproliferative lesions, often occur secondary to skin injury and extend beyond the margins of the original lesion. Aggressive fibromatosis (AF) is a rare condition arising from fibroblasts and is characterized clinically as a nonmetastasizing but locally invasive tumor. In this work, we present the case of a patient who developed AF in the chest 3 years after surgery and postoperative radiotherapy for keloids. A 15-year-old female patient who underwent surgery and postoperative radiotherapy for keloids presented with AF in the chest 3 years after intervention. Physical examination revealed a fan-shaped scar on the manubrium sterni with a radius of 7 cm, as well as a 9 (L) × 2-cm (W) longitudinal reddish and irregularly surfaced scar arising from previous incisions. By comparing this case with similar cases reported previously, we infer that a history of exposure to radiation is the main factor that contributes to the development of AF in patients suffering from keloid scars. We also discussed the clinical characteristics of AF and treatment options and suggest factors that should be considered when using radiotherapy in patients with keloids.To our knowledge, this is the first reported case of AF developing in a patient after radiotherapy for keloids. Radiotherapy may be a causal factor of AF.

Here we report a case of 33 year-old woman with a 4-cm solid mass detected in her left adnexal area. She had previously undergone a laparoscopic surgery for endometriosis at age 29, and had been using combined oral contraceptives (COC) to prevent recurrence. The mass was diagnosed as a uterine fibroid on the basis of ultrasonography and MRI scans. GnRH agonist therapy for 3M resulted in shrinkage of the tumor. Using a second laparoscopy, we identified a tumor originating from the sigmoid colon. The pathological diagnosis was desmoid tumor. Gynecologists should consider the occurrence of desmoid tumor in patients who have been using COC and undergone previous surgeries.

In a young 29-year-old Caucasian woman who was diagnosed with a retromammary desmoid tumor infiltrating deeply into the anterior thoracic wall, surgery was considered excessively mutilating, and observation was recommended. The lesion progressed, however, and caused debilitating pain, despite nonsteroidal anti-inflammatory medication. Subcutaneous injections of human interferon-alpha (Multiferon) resulted in reduced growth kinetics but had to be terminated because of development of symptomatic pneumonitis. Frequently used oncological treatment was withheld because of the toxicity profile, and the patient was instead included in a phase I study investigating transdermal intratumoral injection of LTX-315, an oncolytic peptide that induces anticancer immune responses (ClinicalTrials.gov, NCT01986426). A marked increase of CD8+ tumor-infiltrating T cells in the lesion was complemented by upregulation of immune gene signature (including effector T-cell, T-helper type 1 cell, chemokine, and cytokine genes). These changes were followed by gradual symptom relief and long-term disease stabilization, indicating clinical benefit. LTX-315 was well tolerated until termination in week 16 after a serious allergic reaction. Local application of immunotherapy, minimizing systemic side effects, represents a novel treatment modality in desmoid tumors that should be tested in further clinical trials.

A total of 68 patients with Desmoid tumors (DTs) of the neck region with or without postoperative RT between 1/2008 and 12/2017 were included. They were individually matched for factors including age, gender, tumor size and margin status with a cohort of patients who underwent operative without postoperative RT. For the study, 34 patients and 34 matched control subjects were identified. The two groups did not differ in terms of age (p?=?0.810), gender (p?=?0.328), tumor size (p?=?0.803) and margin status (p?=?0.799). Patients who received surgery plus RT had a significantly higher 3?year event-free survival (EFS) than those who received surgery alone (74.6% vs. 13.3%, P?<?0.001). Factors including postoperative RT and margin status were independent factors of EFS. The values of P were <0.001 and 0.003 and the hazard ratios (95% confidence interval) were 11.929 (4.732–30.072) and 0.299 (0.133–0.671), respectively. None of the patients treated with RT developed serious complications. According to our results, postoperative radiotherapy is an effective treatment in desmoid tumors of the neck. Multi-institutional and prospective studies are warranted to further validate our findings.

Overall, 39 of a total of 79 patients underwent an MRI follow-up scan after resection of primary aggressive fibromatosis (AF) for a minimum of 1 year. The recurrent tumor was examined for contrast agent behavior, appearance, and extent in MRI. The patients were divided into two groups: younger and older than 25 years of age. The median recurrence-free follow-up interval was 49 months. Sixteen patients had no recurrence, and in 15 patients the suspicion was later withdrawn. Recurrences occurred in eight patients (21%), thus a high sensitivity but a moderate specificity (0.561) for the MRI scan. Recurrences occurred significantly more often during the first 9 months of the follow-up scan and especially in patients < 25 years of age. There was no significance in the appearance of AF, with a fascicular character the most common feature of recurrent AF. The primary tumors were altogether significantly smaller than recurrent AF. Muscle edema occurred significantly more often in patients with recurrences than in patients without them. The status of resection (R0–2) had no impact on recurrent AF. We showed that MRI follow-up scans result in a high sensitivity but a moderate specificity for the detection of recurrent AF because the distinction between recurrent AF and posttherapeutic changes is often difficult. Further studies are needed to investigate the radiologic features of recurrent AF and risk factors detected on MRI.

This study reports on the case of a 30-year-old female patient with the retroperitoneal fibromatosis that had a history of uterine leiomyoma. During the operation, the ovarian arteries and veins were separated according to what was found during the procedure. A postoperative examination demonstrated good function and morphology of the ovary. A thorough review of academic journals combined with our collection of clinical data was conducted, which confirmed the double blood supply source to the ovaries. As a result of this exploration, a new surgical method is being proposed that is designed to protect the ovaries. By conducting this new procedure, the patientÂ’s disease was not only halted and ultimately cured, but results demonstrate that the method was also able to retain the shape and function of the ovary. The postoperative satisfaction of the patient was significantly improved.