Aggressive Desmoid Fibromatosis of the Neck after Total Thyroidectomy

Abstract

A 21-year-old woman underwent total thyroidectomy. Three years later, she noticed a neck mass and increasing discomfort in her neck. A computed tomography (CT) scan showed a mass near the site of the previous thyroidectomy, on the right. Fine-needle-aspiration cytology tests were nondiagnostic.The patient underwent surgery, during which a paralaryngeal mass was found firmly attached to the surrounding structures and impossible to dissect. Frozen section biopsy was negative for malignancy; a biopsy was taken for permanent section, and the wound was closed. The histologic diagnosis was desmoid tumor.During the following weeks, the patient's symptoms rapidly worsened and she was referred to our department, complaining of severe swallowing difficulty. She was not hoarse and had no pain.Physical examination revealed a firm, palpable neck mass fixated on the right ( figure 1, A). Laryngeal endoscopy showed normal vocal fold movement and a projection of the posterior pharyngeal wall. Magnetic resonance imaging (MRI) revealed an 11-cm mass extending from the right to the left sternocleidomastoid (SCM) muscles ( figure 1, B). Surgery was scheduled, with the goal to resect as much tumor as possible and to refer the patient for postoperative radiotherapy. Figure 1. A: Photo shows the appearance of the neck, with enlargement of the right side and obliteration of the space between the sternocleidomastoid muscle and the larynx. The scar of the previous thyroidectomy is visible. B: T2-weighted MRI of the neck reveals the tumor occupying the space between the larynx and the spine and extending between the large vessels on both sides. The right carotid is enclosed within the tumor. HEAD AND NECK CLINIC