E2013. Phenomenal Soft Tissue Mass, Itty Bitty Bone Erosions: Imaging Patterns of Head and Neck Desmoid Tumors
Authors
Matin Goldooz;
University of Mississippi Medical Center
Mina Qobadi;
University of Mississippi Medical Center
Charlotte Taylor;
University of Mississippi Medical Center
Background
Desmoid tumors (DTs), also called deep fibromatosis or desmoid-type fibromatosis, are rare tumors of musculoaponeurotic structures of the deep tissue. Although they are benign with no metastatic potential, they are highly invasive and locally aggressive with potential for recurrence. 7 - 15% of DTs occur in the head and neck. Differential diagnosis of DTs in head and neck includes malignant fibrous histiocytoma, sarcomas (rhabdomyosarcoma and fibrosarcoma), neurogenic tumors (neurofibromas and schwannomas), and metastasis. The clinical management of desmoid tumors varies from surgery and radiation therapy to more conservative treatment including chemotherapy or hormonal therapy. Diagnosing and treating desmoid tumor in the head and neck can be very challenging due to their complexity and proximity to vital structures, indicating the significant role of imaging in diagnosis and decision-making for effective treatment. Therefore, it is essential for radiologists to be familiar with the radiological features of desmoid tumors to differentiate these tumors, evaluate recurrence, and assess lesion resectability.
Educational Goals / Teaching Points
Review the head and neck manifestations of desmoid tumors. Illustrate the imaging features of desmoid tumors in the head and neck with underlying osseous changes. Discuss the differential diagnosis of desmoid tumor in the head and neck.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Histologically, DTs consist of different intralesional components including myxoid matrix, cellular stroma, and fibrous tissue, which results in different MR signal intensities. On MRI, DTs demonstrate heterogeneous appearance with variable signal on T2-weighted images, isointense signal on T1-weighted images, and moderate-to high enhancement in most lesions. About 21% of patients may demonstrate underlying osseous involvement with pressure erosion without extension into the medullary canal.
Conclusion
Head and neck DTs are rare, benign tumors which are highly invasive, locally aggressive and have potential for recurrence. They can present as complex soft tissue mass with moderate to high enhancement and underlying bone erosions in about 21% of patients. Differential diagnosis of soft tissue mass in head and neck is wide, however, DTs should be included in the differential diagnosis of any large head and neck soft tissue mass with relatively small localized underlying bone erosion and periosteal reaction. Therefore, a deeper understanding of radiological features of desmoid tumors is essential to differentiate these tumors, evaluate recurrence, and assess lesion resectability.
