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Kurtus Dafford, Daniel Kim, Adriane Nelson, and David Kline

Object

Desmoid tumors are fibrous, slow-growing, nonmalignant tumors with a low potential for metastasis. These lesions show a high propensity for infiltrative growth with local invasion.

Methods

The authors undertook a retrospective study of 15 desmoid tumors in 11 women and four men (ranging in age from 32 to 67 years; median 48 years) treated at their institution. This study included further resection for recurrent tumors in nine of 15 patients (60%).

Results

There were 13 patients (86%) with brachial plexus lesions, one patient (7%) with a lumbar plexus lesion, and one (7%) with a peroneal nerve lesion. There was a female predominance in the study group of 2.75:1. Four patients (27%) reported improvement in pain status, six (40%) reported no change from their preoperative pain levels, and five (33%) reported worsened pain symptoms. There was tumor recurrence in two patients (13%) leading to further surgical intervention.

Conclusions

This case series included many recurrent desmoid tumors of the brachial plexus. Most of these lesions were relatively large tumors, predominantly involved with the plexal elements adding to the challenge of the resection. Currently, function-sparing excision is considered the optimal treatment for desmoid tumors arising in extraabdominal sites. Adjunctive radiation or brachytherapy is reserved for a patient with further recurrence in whom resection would be disfiguring or in whom the disease is more refractory.

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Kurtus Dafford, Daniel Kim, Natasha Reid, and David Kline

Object

Pelvic plexus tumors are unusual entities. These lesions often reach significant size prior to clinical presentation due to vague lower extremity or other symptoms refractory to exhaustive workup and the potential space of the retroperitoneum.

Methods

The authors retrospectively reviewed the charts of 44 patients who presented to Louisiana State University Health Sciences Center with pelvic plexus tumors. All such patients were included in the present study if there was at least 12 months of follow-up. Clinical evaluations were examined, including typical clinical presentation, imaging studies, and other preoperative evaluations. These tumors include 38 peripheral neural sheath tumors (86%), two malignant neural sheath tumors (5%), and four nonneural sheath tumors (9%). The authors also examined the relation of pelvic neural sheath tumors to neurofibromatosis Type 1 (NF1).

Results

Histopathological examination confirmed 18 solitary neurofibromas (41%), 12 NF1-associated neurofibromas (27%), eight schwannomas (18%), two malignant nerve sheath tumors (5%), and four other nonneural sheath tumors (9%). The other nonneural sheath tumors consisted of one each of desmoid, ganglioma, lipoma, and an unspecified calcified mass.

Conclusions

The optimal treatment for retroperitoneal lesions remains operative excision with adjunctive therapy specific to the lesion encountered.