Nodular fasciitis: case report / Fasciíte nodular: relato de caso

ABSTRACT Nodular fasciitis (NF) is a rare fibroblast proliferation of unknown etiology, with benign, rapid clonal growth, from a superficial fascia to the subcutaneous tissue or an adjacent muscular layer. Also known as pseudosarcomatous fasciitis, this clinical syndrome is characterized as a solitary mass of hardened consistency, painless palpation and no gender preference. The definitive diagnosis is made by immunohistochemistry and surgery is the treatment of choice.

RESUMEN La fascitis nodular (FN) es una lesión proliferativa fibroblástica rara, de etiología desconocida, naturaleza benigna, crecimiento rápido y probablemente clonal, que se origina en una fascia superficial hacia el tejido subcutáneo o una camada muscular adyacente. También conocida como fascitis pseudosarcomatosa, este síndrome clínico se caracteriza por un tumor solitario de consistencia endurecida, ligero dolor a la palpación y sin predilección por sexo. Su diagnóstico definitivo se hace por inmunohistoquímica, y el tratamiento de elección es el quirúrgico.

RESUMO A fasciíte nodular (FN) é uma lesão proliferativa fibroblástica rara, de etiologia desconhecida, caráter benigno, crescimento rápido e provavelmente clonal, que se origina a partir de uma fáscia superficial para o tecido subcutâneo ou uma camada muscular adjacente. Também conhecida como fasciíte pseudossarcomatosa, esta síndrome clínica caracteriza-se por uma massa solitária de consistência endurecida, pouco dolorosa à palpação e sem predileção por gênero. O diagnóstico definitivo é feito por imuno-histoquímica, e o tratamento de escolha é o cirúrgico.

Alternative surgical approaches for aggressive angiomyxoma at different sites in the pelvic cavity.

Aggressive angiomyxoma, a rare soft tissue benign neoplasm, predominantly occurs in the female pelvic peritoneum and perineum region during reproductive age. It is slow growing, locally infiltrative, and has a high risk of local recurrence and the neoplastic character of blood vessels. The standard treatment is surgery. We report three unusual aggressive angiomyxoma cases. The first case was a pedunculated mass of the left labium major; the second, a left perineal mass that infiltrated into the paravesical area via the obturator foramen; and the third, a big mass in the retroperitoneal cavity, found that growing aggressive angiomyxoma looked like lava expulsion in the pelvic area. After a thorough examination and full radiologic workup, we performed surgical excision in each patient via different approaches. Histopathologic findings were consistent with diagnosis of aggressive angiomyxoma. To date, no relapse has been observed.

Triple locations of elastofibroma dorsi: First case report and review.

INTRODUCTION: Elastofibroma is a rare benign fibroelastic tumor. CASE: We report a case of a 44-year-old woman, operated 4 months ago for a left infrascapular desmoid tumor and presented for bilateral mass of the left suprascapular and right infrascapular regions which were surgically resected. The diagnosis of elastofibroma was made and also confirmed for the left infrascapular desmoid tumor. Six months later, she presented an asymptomatic left infrascapular recurrence. Monitoring was continued and the patient is still asymptomatic after 24 months. DISCUSSION: We highlight the importance of imaging features understanding in order to avoid misdiagnosis and unnecessary surgical resection.

Alternative surgical approaches for aggressive angiomyxoma at different sites in the pelvic cavity

Aggressive angiomyxoma, a rare soft tissue benign neoplasm, predominantly occurs in the female pelvic peritoneum and perineum region during reproductive age. It is slow growing, locally infiltrative, and has a high risk of local recurrence and the neoplastic character of blood vessels. The standard treatment is surgery. We report three unusual aggressive angiomyxoma cases. The first case was a pedunculated mass of the left labium major; the second, a left perineal mass that infiltrated into the paravesical area via the obturator foramen; and the third, a big mass in the retroperitoneal cavity, found that growing aggressive angiomyxoma looked like lava expulsion in the pelvic area. After a thorough examination and full radiologic workup, we performed surgical excision in each patient via different approaches. Histopathologic findings were consistent with diagnosis of aggressive angiomyxoma. To date, no relapse has been observed.

Dermatofibroma of the face: a clinicopathologic study of 20 cases.

INTRODUCTION: Dermatofibroma is one of the most common benign skin tumors. It typically develops on the lower limbs between the third and fifth decade of life and is more common in women. Clinical diagnosis is often straightforward. Dermatofibromas are associated with a very low rate of local recurrence following excision. OBJECTIVES: To describe the clinical and histologic features of dermatofibroma of the face based on our experience. MATERIALS AND METHODS: Descriptive retrospective study of the clinicopathologic features of dermatofibromas of the face diagnosed at the dermatology department of Hospital General Universitario de Valencia between 1990 and 2012. RESULTS: Twenty cases of dermatofibroma of the face (1.11% of all dermatofibromas diagnosed) were studied. The age at onset varied widely, from 28 to 84 years. The mean age at onset was 57.15 years and the median was 54 years. There were 11 women and 9 men. Mean follow-up was 83 months and there were no local recurrences. All the tumors were confined to the papillary and reticular dermis and the storiform pattern was the most common growth pattern observed. CONCLUSIONS: This study of facial dermatofibromas diagnosed at our hospital over a period of 22 years suggests that the face is an uncommon site but that dermatofibromas in this location behave similarly to those occurring elsewhere on the body.

Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities.

INTRODUCTION AND OBJECTIVE: Neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas. METHODS: A retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m(2)) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months. RESULTS: The five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5%, 46.7% and 58.3%, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3% and 41.2%, respectively. Severe wound complications were observed in 41.8% of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7% (14/19) of the patients eligible to receive it. CONCLUSIONS: In this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.

Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities

INTRODUCTION AND OBJECTIVE: Neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas. METHODS: A retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m²) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months. RESULTS: The five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5 percent, 46.7 percent and 58.3 percent, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3 percent and 41.2 percent, respectively. Severe wound complications were observed in 41.8 percent of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7 percent (14/19) of the patients eligible to receive it. CONCLUSIONS: In this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.