Ota Hideki, Ishida Hirotaka, Matsumoto Hidekazu, Ishiyama Tomoharu
Department of Surgery, Yamagata Prefecture Shinjo Hospital, 12-55 Wakaba Town, Shinjo, Yamagata, 996-0025, Japan.
Surg Case Rep. 2021 Apr 7;7(1):86. doi: 10.1186/s40792-021-01171-1.
Desmoplastic fibroblastoma is an uncommon, benign, fibrous tumor exhibiting infiltrative growth. Most of these tumors are small, slow-growing, and develop as subcutaneous lesions in the extremities. Cases of desmoplastic fibroblastoma in the chest wall are quite rare, and the preoperative diagnosis of such cases remains challenging as these tumors can mimic the characteristics of desmoid-type fibromatosis, which often occurs in the chest wall. We aimed to describe a rare case of desmoplastic fibroblastoma exhibiting rapid growth in the chest wall of a patient that was successfully treated with marginal excision only by diagnostic imaging before surgery.
A 79-year-old man was admitted to our hospital after experiencing right shoulder pain lasting for a few months. A 4 × 4 × 2 cm mass was incidentally detected at the right second rib two years prior. Chest computed tomography revealed a well-defined homogeneous mass with a muscle-like density along the right lateral chest wall, the size of which had increased to 12 × 10 × 4.5 cm in two years. Dynamic contrast-enhanced computed tomography revealed abundant vascularity at the periphery of the tumor. Magnetic resonance imaging revealed iso-intensity to muscle on T1-weighted images, slightly high intensity on T2-weighted images, and rim-like contrast enhancement at the periphery of the tumor, with uniform thickness on gadolinium-enhanced T1-weighted images with fat suppression. Rim-like contrast enhancement is an imaging feature that can distinguish cases of desmoplastic fibroblastoma from desmoid-type fibromatosis. We diagnosed the tumor as desmoplastic fibroblastoma by diagnostic imaging without tissue biopsy. Marginal excision with videoscopic assistance was performed through a small incision. The pathological diagnosis was desmoplastic fibroblastoma. The patient's postoperative course was uneventful, and his shoulder pain was relieved after the surgery.
Desmoplastic fibroblastoma in the chest wall is extremely rare, but should be considered in the differential diagnosis when desmoid-type fibromatosis is clinically suspected. Gadolinium-enhanced magnetic resonance imaging is helpful in confirming the differential diagnosis.
促结缔组织增生性纤维母细胞瘤是一种罕见的良性纤维性肿瘤，呈浸润性生长。这些肿瘤大多较小，生长缓慢，多表现为四肢的皮下病变。胸壁促结缔组织增生性纤维母细胞瘤病例相当罕见，此类病例的术前诊断仍具有挑战性，因为这些肿瘤可模仿硬纤维瘤病的特征，而硬纤维瘤病常发生于胸壁。我们旨在描述一例罕见的促结缔组织增生性纤维母细胞瘤，该肿瘤在一名患者的胸壁快速生长，术前仅通过诊断性影像学检查就成功进行了边缘切除。
一名79岁男性因右肩疼痛持续数月入院。两年前偶然在右侧第二肋骨处发现一个4×4×2 cm的肿块。胸部计算机断层扫描显示右侧胸壁外侧有一个边界清晰的均匀肿块，密度类似肌肉，其大小在两年内增至12×10×4.5 cm。动态对比增强计算机断层扫描显示肿瘤周边血管丰富。磁共振成像显示在T1加权图像上与肌肉等信号，在T2加权图像上略高信号，肿瘤周边呈环状对比增强，在脂肪抑制的钆增强T1加权图像上厚度均匀。环状对比增强是一种影像学特征，可将促结缔组织增生性纤维母细胞瘤病例与硬纤维瘤病区分开来。我们通过诊断性影像学检查而非组织活检将该肿瘤诊断为促结缔组织增生性纤维母细胞瘤。在电视辅助下通过小切口进行了边缘切除。病理诊断为促结缔组织增生性纤维母细胞瘤。患者术后恢复顺利，术后肩部疼痛缓解。
胸壁促结缔组织增生性纤维母细胞瘤极为罕见，但在临床怀疑硬纤维瘤病时应考虑在鉴别诊断中。钆增强磁共振成像有助于确诊鉴别诊断。
