Can the MRI signal of aggressive fibromatosis be used to predict its behavior?
Introduction
Aggressive fibromatosis is a soft-tissue tumor composed of normal fibroblastic cells proliferating in an abundant fibrous stroma: it exhibits high invasiveness locally but does not metastasize.
Local aggressiveness is associated with a high-recurrence rate after surgery. Accurate diagnosis and a valid surgical approach are fundamental for the patient's follow-up. This tumor is very challenging for radiologists and clinicians, because its biologic behavior is variable and there is no consensus as to what is the best therapy [1], [2].
The aim of this study was to analyze and correlate signal and size features of aggressive fibromatosis on MRI in order to predict their future behavior and to select the best medical or surgical treatment.
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Materials and methods
From March 1985 to December 2005, 125 patients with histological-proven aggressive fibromatosis were seen in our Institute (Radiation Medicine and/or Surgery Departments). Patient's sex and age at presentation, tumor type (primary or recurrent), treatment and outcome were obtained from the hospital electronic patient record system and from Internal Archives. The records of all patients were retrospectively reviewed to determine those who had had an MR examination. Among 125 patients in total,
Results
The 47 nodular tumors were located in the upper extremity (n = 10: shoulder, 7; upper arm, 1; elbow, 1; forearm, 1); lower extremity (n = 18: thigh, 4; knee, 3; calf, 10; foot, 1), the abdominal/thoracic wall (n = 9), the pelvis/buttock (n = 9), and the neck (n = 1).
The results of our series with therapy are presented in Table 1, those without therapy in Table 2.
The rates of variations in size for lesions with therapy or without therapy according to the specified categories (decrease, stability and
Discussion
Aggressive fibromatosis is a benign tumor, characterized by the proliferation of fibrous tissue that disrupts the adjacent intermuscular and soft-tissue planes. It is also called musculo-aponeurotic fibromatosis, desmoid-type proliferation and desmoid tumor. The term “desmoid” is derived from Greek and means a band-like or tendon-like lesion [1], [2], [4].
This lesion accounts for about 0.03% of all neoplasms and less than 3% of soft-tissue tumors [1]. The most common age of incidence is between
Conclusion
Fibromatoses are soft-tissue tumors with an extremely high variability in signal and size. Their behavior cannot be predicted based on their initial MRI signal.
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