Desmoplastic Fibroma of Proximal Tibia Mimicking Malignant Tumor
Keywords:
Desmoplastic Fibroma, mimicking malignant tumor, proximal tibia bone tumorAbstract
Introduction:
Desmoplastic Fibroma is one of the most uncommon bone tumors found in only approximately 0.1% of all primary bone tumors and 0.3% of benign bone tumors. This benign bone tumor composed of spindle cells with minimal cytological atypia andabundant collagen production, but locally aggressive. It occurs most often in the first three decades of life and in long tubular bones, mandible, and pelvis. Surgical resection with a wide margin has been advocated for the treatment.
Methods:
We present a rare case of Desmoplastic Fibroma in an 18year old female with a progressive mass on her right popliteal for the last 1 year. The large and hard consistency of the mass and increased in lactate dehydrogenase (LDH) serum level along with infiltration into the soft tissue characteristics shown in the magnetic resonance imaging (MRI) increased the suspicion of it as a malignant bone tumor. Fine Needle Aspiration Biopsy (FNAB) results were inconclusive, so we performed histopathology examination with core biopsy. All data were discussed in the Clinico-pathological-conference and the conclusion was chondromyxoid fibroma. In accordance with this conclusion, we, therefore, planned to perform marginal excision, followed by curettage to preserve proximal tibia bone and inserted a bone graft completed with internal fixation with plate and screw.
Results:
Intraoperatively, we found lobulated solid mass extended distally to the posterior compartment of cruris. The tumor was then resected completely and curettage was conducted to the intramedullary mass. We sent the tumor mass to the Pathology Anatomy to confirm the diagnosis. After the next clinico-pathological-conference, it was concluded that the diagnosis was Desmoplastic Fibroma of proximal tibia. The first pathological result of the patient from core biopsy was chondromyxoid fibroma, but at the second pathological result from intraoperative biopsy was Desmoplastic Fibroma. Surgical treatment is the most effective method for Desmoplastic Fibroma. Curettage has been associated with local recurrence rate varying between 37% and 72%. One study reported that marginal resection could result in recurrence compared to wide excision and reconstruction, which showed no recurrence after 1-year follow-up.
Conclusion:
Desmoplastic Fibroma is not easy to diagnose because it is mimicking malignant bone tumor and should be established in CPC (Clinic-Pathologic Conference). Good surgical planning is very important to minimize complication and rates of recurrence.
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References
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