Aggressive Resection of Cervical Desmoid Tumor Invading the Paraspinal Muscles without Recurrence at Eight Year Followup: A Case Report and Review of the Literature

Abstract

Objective: To provide an overview of head, neck, and spine Desmoid Tumor (DT), to describe the case of a patient who underwent aggressive surgical resection of a large invasive cervical DT, and to analyze the DT literature. We discuss the importance of aggressive surgical margins in decreasing recurrence risk in head, neck, and spine DTs. Methods:A twenty-three-year-old female patient with history of a left cervical neurofibroma resection presented two years later with neck mass regrowth. The mass was aggressively resected, and occiput to T1 fusion was performed. Additionally, the head, neck, and spine DT literature was reviewed regarding surgical margin status and recurrence rate. A "N-1" Chi-squared test was used to compare proportions, between percentage of patients that experienced recurrence after gross total resection, and percentage of patients that experienced recurrence after subtotal resection, to determine statistical significance (p < 0.05).Results: Histologically, the lesion was shown to be a DT, with posterior paracervical spinal musculature invasion. The surgery was well tolerated with no complications. At eight years postoperative followup, the patient is doing well with no tumor recurrence. Nine studies were identified describing surgical margin status and recurrence rate of head, neck, and spine DT. When recurrence rates were compared in patients with grossly negative surgical margins and grossly positive surgical margins for head, neck, and spine DTs, two studies showed statistical significance (p < 0.05) for lower recurrence rate after gross total resection, and seven showed a trend toward lower recurrence rates in patients with gross total resection. Conclusion:DTs are difficult clinical entities to cure due to high recurrence rate after resection. Consistent with previous studies indicating that aggressive surgical margins are associated with a decreased risk of recurrence, we present a case report of a female patient who underwent aggressive resection of a large DT and remains tumor-free after eight years. Thus, we recommend aggressive surgical resection of head, neck, and spine DTs to minimize recurrence risk.

A Rare Paraspinal Desmoid Tumour following Instrumented Scoliosis Correction in an Adolescent

“…Surgery, as a traumatic cause, has been described. There are 15 reported cases of paraspinal desmoid tumours following spine surgery [8][9][10][11][12][13].…”