Abnormal Presentation of Aggressive Fibromatosis After Radiotherapy for Keloids

Abstract

Rationale Keloids, dermal fibroproliferative lesions, often occur secondary to skin injury and extend beyond the margins of the original lesion. Aggressive fibromatosis (AF) is a rare condition arising from fibroblasts and is characterized clinically as a nonmetastasizing but locally invasive tumor. In this work, we present the case of a patient who developed AF in the chest 3 years after surgery and postoperative radiotherapy for keloids. Patient Concerns A 15-year-old female patient who underwent surgery and postoperative radiotherapy for keloids presented with AF in the chest 3 years after intervention. Diagnoses and Outcomes Physical examination revealed a fan-shaped scar on the manubrium sterni with a radius of 7 cm, as well as a 9 (L) × 2-cm (W) longitudinal reddish and irregularly surfaced scar arising from previous incisions. By comparing this case with similar cases reported previously, we infer that a history of exposure to radiation is the main factor that contributes to the development of AF in patients suffering from keloid scars. We also discussed the clinical characteristics of AF and treatment options and suggest factors that should be considered when using radiotherapy in patients with keloids. Lessons To our knowledge, this is the first reported case of AF developing in a patient after radiotherapy for keloids. Radiotherapy may be a causal factor of AF.

Management of aggressive fibromatosis (Review)

“…In addition, taking into consideration that ~50% primary desmoids would recur and young age is indicative of a high chance of relapse, it is unwise to treat children with chemotherapy alone (21,140,141). Simultaneously, radiation is a clear carcinogenic factor, increasing risk of tumors, especially in children (48). Hence, children with desmoids should be treated synthetically with much caution, while surgery, chemotherapy or radiation is necessary.…”

“…According to the guidelines from the NCCN, radiotherapy is often a supplementary treatment indicated in cases of AF that present as large tumors or with positive margins (48). Nuyttens et al (49) noted that the local control rate of surgery combined with post-operational radiotherapy group was 75%, which is better compared with the exclusive surgery group while both margins are positive.…”

“…Moreover, the duration to achieve complete resolution may be as long as several months (50). Secondly, Chen et al (48) reported a desmoid tumor developed from radiation treatment for keloids, which indicated that radiotherapy may be a causal factor of AF. Thirdly, some studies cannot validate the efficacy of adjuvant radiotherapy for desmoids following incomplete surgical resection (51,52).…”

Advances in Skin Wound and Scar Repair by Polymer Scaffolds

“…Individual differences, the heterogeneous pressure distribution, joint movement, and skin surface irregularities will affect the treatment effect and even cause complications [11]. The existence of radioactive sources (doses ≥ 30 Gy) has sparked debate about the safety of radiation therapy, such as triggers fatal complications such as visceral injuries [12]. For pharmacological interventions, the combination of glucocorticoid triamcinolone acetonide and 5-fluorouracil is instrumental in mitigating the pain and itching of scar, accompanied by a lower recurrence rate and fewer side effects [13].…”