Innovative treatment for huge nuchal desmoid tumour: A case report with a 2-year follow-up

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Abstract

Background: The desmoid tumour is a monoclonal neoplasm originating from musculoaponeurotic tissues. It is benign in histological presentations and yet its locally invasive behaviour could lead to dire consequences such as disfigurement, functional impairment or even mortality. Surgical resection, radiotherapy, chemotherapy, hormonal therapy, non-steroidal anti-inflammatory drugs and even a wait-and-see policy, either alone or in combination, were advocated as treatment modalities. We experienced an extremely difficult case who had a huge nuchal desmoid tumour measuring 45 x 35 x 20 cm in dimension with extension to the anterior neck and thoracic paraspinal area. Its intimacy with the carotid artery, jugular vein and brachial plexus made margin-free resection infeasible. Moreover, the tumour burden was so immense that the patient was plunged into profound hypoproteinaemic, septic and anaemic status, with severe pain, bleeding and odour that mandated prompt and daring management. Methods: In an effort to prevent uncontrollable tumour bleeding, we embarked on a series of strategic measures, including pre-surgical embolisation, innovative tourniquet technique, a novel method of ligature deployment, staged tumour excision and adjunct methods, such as ethanol injection and irradiation therapy. Results: The huge nuchal desmoid tumour was successfully excised under the planned strategies. The patient went through a number of complications such as sepsis, acute respiratory distress and renal failure. Fortunately, she eventually survived and exhibited no evidences of tumour relapse at 2 years' follow-up. She has resumed daily activity independently without noticeable functional deficit. Conclusion: We believe that multimodality strategies and innovative surgical techniques are the key to success in managing such a difficult case.

Original languageEnglish
Pages (from-to)e622-e626
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume63
Issue number8
DOIs
Publication statusPublished - 2010 Aug 1

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Aggressive Fibromatosis
Neoplasms
Therapeutics
Hemorrhage
Tourniquets
Brachial Plexus
Jugular Veins
Tumor Burden
Carotid Arteries
Respiratory Insufficiency
Renal Insufficiency
Ligation
Sepsis
Anti-Inflammatory Agents
Ethanol
Neck
Radiotherapy
Thorax
Recurrence
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

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title = "Innovative treatment for huge nuchal desmoid tumour: A case report with a 2-year follow-up",
abstract = "Background: The desmoid tumour is a monoclonal neoplasm originating from musculoaponeurotic tissues. It is benign in histological presentations and yet its locally invasive behaviour could lead to dire consequences such as disfigurement, functional impairment or even mortality. Surgical resection, radiotherapy, chemotherapy, hormonal therapy, non-steroidal anti-inflammatory drugs and even a wait-and-see policy, either alone or in combination, were advocated as treatment modalities. We experienced an extremely difficult case who had a huge nuchal desmoid tumour measuring 45 x 35 x 20 cm in dimension with extension to the anterior neck and thoracic paraspinal area. Its intimacy with the carotid artery, jugular vein and brachial plexus made margin-free resection infeasible. Moreover, the tumour burden was so immense that the patient was plunged into profound hypoproteinaemic, septic and anaemic status, with severe pain, bleeding and odour that mandated prompt and daring management. Methods: In an effort to prevent uncontrollable tumour bleeding, we embarked on a series of strategic measures, including pre-surgical embolisation, innovative tourniquet technique, a novel method of ligature deployment, staged tumour excision and adjunct methods, such as ethanol injection and irradiation therapy. Results: The huge nuchal desmoid tumour was successfully excised under the planned strategies. The patient went through a number of complications such as sepsis, acute respiratory distress and renal failure. Fortunately, she eventually survived and exhibited no evidences of tumour relapse at 2 years' follow-up. She has resumed daily activity independently without noticeable functional deficit. Conclusion: We believe that multimodality strategies and innovative surgical techniques are the key to success in managing such a difficult case.",
author = "Lee, {Yao Chou} and Lee, {Jing Wei}",
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T1 - Innovative treatment for huge nuchal desmoid tumour

T2 - A case report with a 2-year follow-up

AU - Lee, Yao Chou

AU - Lee, Jing Wei

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N2 - Background: The desmoid tumour is a monoclonal neoplasm originating from musculoaponeurotic tissues. It is benign in histological presentations and yet its locally invasive behaviour could lead to dire consequences such as disfigurement, functional impairment or even mortality. Surgical resection, radiotherapy, chemotherapy, hormonal therapy, non-steroidal anti-inflammatory drugs and even a wait-and-see policy, either alone or in combination, were advocated as treatment modalities. We experienced an extremely difficult case who had a huge nuchal desmoid tumour measuring 45 x 35 x 20 cm in dimension with extension to the anterior neck and thoracic paraspinal area. Its intimacy with the carotid artery, jugular vein and brachial plexus made margin-free resection infeasible. Moreover, the tumour burden was so immense that the patient was plunged into profound hypoproteinaemic, septic and anaemic status, with severe pain, bleeding and odour that mandated prompt and daring management. Methods: In an effort to prevent uncontrollable tumour bleeding, we embarked on a series of strategic measures, including pre-surgical embolisation, innovative tourniquet technique, a novel method of ligature deployment, staged tumour excision and adjunct methods, such as ethanol injection and irradiation therapy. Results: The huge nuchal desmoid tumour was successfully excised under the planned strategies. The patient went through a number of complications such as sepsis, acute respiratory distress and renal failure. Fortunately, she eventually survived and exhibited no evidences of tumour relapse at 2 years' follow-up. She has resumed daily activity independently without noticeable functional deficit. Conclusion: We believe that multimodality strategies and innovative surgical techniques are the key to success in managing such a difficult case.

AB - Background: The desmoid tumour is a monoclonal neoplasm originating from musculoaponeurotic tissues. It is benign in histological presentations and yet its locally invasive behaviour could lead to dire consequences such as disfigurement, functional impairment or even mortality. Surgical resection, radiotherapy, chemotherapy, hormonal therapy, non-steroidal anti-inflammatory drugs and even a wait-and-see policy, either alone or in combination, were advocated as treatment modalities. We experienced an extremely difficult case who had a huge nuchal desmoid tumour measuring 45 x 35 x 20 cm in dimension with extension to the anterior neck and thoracic paraspinal area. Its intimacy with the carotid artery, jugular vein and brachial plexus made margin-free resection infeasible. Moreover, the tumour burden was so immense that the patient was plunged into profound hypoproteinaemic, septic and anaemic status, with severe pain, bleeding and odour that mandated prompt and daring management. Methods: In an effort to prevent uncontrollable tumour bleeding, we embarked on a series of strategic measures, including pre-surgical embolisation, innovative tourniquet technique, a novel method of ligature deployment, staged tumour excision and adjunct methods, such as ethanol injection and irradiation therapy. Results: The huge nuchal desmoid tumour was successfully excised under the planned strategies. The patient went through a number of complications such as sepsis, acute respiratory distress and renal failure. Fortunately, she eventually survived and exhibited no evidences of tumour relapse at 2 years' follow-up. She has resumed daily activity independently without noticeable functional deficit. Conclusion: We believe that multimodality strategies and innovative surgical techniques are the key to success in managing such a difficult case.

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