- Desmoplastic Fibroma
- Soft Tissue Menu
- refers to multiple fibrous benign tumors which are locally aggressive;
- these are more aggresive than solitary fibroma;
- these lesions often develope in the proximal limbs or the trunk;
- in abdomen, the tumor is called a desmoid tumors;
- in the foot, plantar fibromatosis is common;
- although generally superficial, tumors are locally invasive, frequently involving adjacent neurovascular structures;
- Non Operative Treatment:
- begins w/ construction of a well molded, padded shoe & orthosis;
- transference of weight away from prominent nodules is important;
- may require custom-made insoles;
- radiation therapy:
- may be used as an adjunct to surgical excision in treatment of aggressive fibromatosis;
- indications for surgical treatment:
- major indication for operative intervention is pain;
- when nodules become large and painful enough to be disabling while patient is standing or walking;
- plantar fibromatosis: operative treatment:
- these tumors may involve neurovascular structures as well as infiltrating surrounding muscle;
- care must be taken to place the incision away from wt-bearing region;
- use a longitudinal medial incision use longitudinal, s-shaped incision made on plantar surface of foot;
- incision can be made two centimeters posterior to head of first metatarsal, w/ extension posterolaterally, then posteromedially, & again posterolaterally,
finishing anterior to weight-bearing surface of calcaneus;
- total excision of the fascia is necessary to reduce the chance of recurrence;
- in some cases the skin will be heavily adherent to the mass, which then requires removal of a portion of the skin along with the mass;
- resection & recurrence:
- recurrence after incomplete excision is very common;
- consider wider excision - even if this will require STSG;
- use at least 2-cm margin of normal fascia proximal and distal to nodule;
- recurrance are difficult to distinguish from scarring of previous excisions, thus making excision even more hazardous;
- adjuvant radiation therapy reduces that recurrence rate after marginal or even after intracapsular excision;
- consider using of XRT as adjunct to surgical excision
Current Concepts Review. Plantar Fibromatosis.
Radiation therapy for aggressive fibromatosis. The Experience at the University of Florida.
Musculoaponeurotic fibromatosis. A report of 28 cases and review of the literature.
Chemotherapy for children with aggressive fibromatosis and Langerhans' cell histiocytosis.
Plantar fibromatosis: an immunohistochemical and ultrastructural study.