A 46-year-old man was referred to our department due to chronic chest pain. A computed tomography showed an exophytic image arising from 5th rib that was projected on the middle lobule. The patient underwent an exploratory videothoracoscopic because we couldn't discard lung compromise. A corneal-like lesion emerging from the inner side of the 5th rib was revealed. Complete video-assited resection was done. Histopathology examination revealed a desmoplastic fibroblastoma. To our knowledge this is the first case of desmoplastic fibroblastoma arising from a rib and the second case published in all literature of chest wall involvement.

Desmoplastic fibroblastoma is a benign soft tissue tumor of indolent nature. It is more prevalent in males in their fourth to sixth decades of life and typically presents in the upper extremities, feet, and back. Other, uncommon locations have been reported as well, including the oral cavity and retroperitoneum. Histological examination demonstrates bland spindle cells in a dense collagenous stroma. The tumor neither recurs nor metastasizes. In this report, we discuss a case of a female patient who presented with symptoms concerning for intra-abdominal sepsis and was subsequently diagnosed with an intraperitoneal desmoplastic fibroblastoma. There is no evidence that this condition has been previously reported in the literature in the English language. The lesion was excised during laparoscopy and the patient showed no evidence of recurrence on magnetic resonance elastography (MRE) imaging 12 months later.

Rib desmoplastic fibroblastoma: Video-assisted resection.

A Rare Case of Intraperitoneal Desmoplastic Fibroblastoma

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.

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Rib desmoplastic fibroblastoma: Video-assisted resection.

Citations

A Rare Case of Intraperitoneal Desmoplastic Fibroblastoma

An extremely rare case of desmoplastic fibroblastoma exhibiting rapid growth in the chest wall: a case report

Tumor de rápido crecimiento en el primer dedo del pie derecho

Rapidly Growing Tumor on the Left Big Toe.