Desmoplastic Fibroma of the Distal Femur in a Young Man: A Rare Case Report
Original Article | Volume 6 | Issue 3 | JBST September – December 2020 | Page 2-4 | Suresh Babu, Abhishek Vaish, Raju Vaishya DOI: 10.13107/jbst.2020.v06i03.30
Author: Suresh Babu, Abhishek Vaish, Raju Vaishya
Department of Orthopaedics and Joint Replacement Surgery, Indrparastha Apollo Hospitals, New Delhi, India.
Address of Correspondence
Dr. Suresh Babu,
Department of Orthopaedics and Joint Replacement Surgery, Indrparastha Apollo Hospitals, Sarita Vihar, New Delhi – 110 076, India.
Introduction: Lytic lesions in the distal femur in a mature skeleton though a common presentation for various tumors, desmoplastic fibroma (DFB) of bone is a rare occurrence. Review of the literature shows its incidence of 0.06% to 0.3%. In the majority of reported cases, the diagnosis has been obtained on histopathological examination. Treatment varies from aggressive curettage to amputations. We describe a novel surgical technique for dealing such lesions.
Case Report: A 24-year-old male presented with swelling around with DFB the left distal femur presented with pain for 4 months which progressed in severity and led to inability to bear weight. On clinical examination, he had a tender discrete swelling over the medial aspect of the left distal femur. Radiographic examination showed an eccentric lytic lesion in the metaphyseoepiphyseal region of the left distal femur. An extended curettage using phenol (10%) as adjuvant therapy was performed. The cavity was packed with bone cement and the distal femur was fixed by spanning the lytic lesion with a distal femoral locking plate. At months follow-up, he reported complete resolution of symptoms, and on examination, he had pain free and full range of motion, without any signs of recurrence.
Conclusion: An effort should be made to obtain a pre-operative histopathological diagnosis of the tumor type. In cases of equivocal findings, a diagnosis of DFB of the bone should be considered. Extended curettage, phenol ablation, and bone cement with plate augmentation offer an effective treatment modality in the treatment of DFB.
Keywords: Desmoplastic fibroma, benign bone tumors, surgery, knee, femur.
1. Campanacci M. Desmoid fibroma. In: Bone and Soft Tissue Tumors: Clinical Features, Imaging, Pathology and Treatment. Wien: Springer-Verlag; 1999. p. 143-8.
2. Campanacci L. Desmoid fibroma. In: Diagnosis of Musculoskeletal Tumors and Tumor-like Conditions. Berlin, Germany: Springer; 2019. p. 61-3.
3. Mazabraud A. Desmoid fibroma. In: Pathology of bone tumours. Springer, Berlin, Heidelberg; 1998;14:167-72 https://doi.org/10.1007/978-3-642-95839-7_14.
4. Kalil RK. Desmoplastic fibroma of bone. In: Tumors and Tumor-Like Lesions of Bone. Berlin, Germany: Springer; 2020. p. 451-7.
5. Inwards CY, Unni KK, Beabout JW, Sim FH. Desmoplastic ﬁbroma of bone. Cancer 1991;68:1978-83.
6. Gebhardt MC, Campbell CJ, Schiller AL, Mankin HJ. Desmoplastic ﬁbroma of bone: A report of eight cases and review of the literature. J Bone Joint Surg Am 1985;67:732-47.
7. Gao S, Cai Q, Yao W, Wang J, Zhang P, Wang X. Desmoplastic (collagenous) fibroma of the femur: A case report and review of the literature. Oncol Lett 2013;6:1285-8.
8. Gong LH, Liu WF, Ding Y, Geng YH, Sun XQ, Huang XY. Diagnosis and differential diagnosis of desmoplastic fibroblastoma by clinical, radiological, and histopathological analyses. Chin Med J 2018;131:32-6.
9. Crim JR, Gold RH, Mirra JM, Eckardt JJ, Bassett LW. Desmoplastic fibroma of bone: Radiographic analysis. Radiology 1989;172:827-32.
10. Xu Y, Wang Y, Yan J, Bai X, Xing G. Desmoplastic fibroma of the femur with atypical image findings: A case report. Medicine 2018;97:e13787.
11. Kang HS, Ahn JM, Kang Y. Radiographic findings. In: Oncologic Imaging: Bone Tumors. Berlin, Germany: Springer; 2017. p. 273-307.
12. Tanwar YS, Kharbanda Y, Rastogi R, Singh R. Desmoplastic fibroma of bone: A case series and review of literature. Indian J Surg Oncol 2018;9:585-91.
13. Nishida J, Tajima K, Abe M, Honda M, Inomata Y, Shimamura T, et al. Desmoplastic fibroma. Aggressive curettage as a surgical alternative for treatment. Clin Orthop Relat Res 1995;320:142-8.
14. Taconis WK, Schütte HE, van der Heul RO. Desmoplastic fibroma of bone: A report of 18 cases. Skeletal Radiol 1994;23:283-8.
15. Bohm P, Krober S, Greschniok A, Laniado M, Kaiserling E. Desmoplastic fibroma of the bone. A report of two patients, review of the literature, and therapeutic implications. Cancer 1996;78:1011-23.
16. Takazawa K, Tsuchiya H, Yamamoto N, Nonomura A, Suzuki M, Taki J, et al. Osteosarcoma arising from desmoplastic fibroma treated 16 years earlier: A case report. J Orthop Sci 2003;8:864-8.
17. Abdelwahab IF, Klein MJ, Hermann G, Steiner GC, Yang DC. Osteosarcoma arising in a desmoplastic ﬁbroma of the proximal tibia. AJR Am J Roentgenol 2002;178:613-5.
|How to Cite this article: Babu S, Vaishya A, Vaishya R | Desmoplastic Fibroma of the Distal Femur in a Young Man: A Rare Case Report. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2020; 6(3): 2-4.|