Hi, a few more interesting comments regarding this case:
Lesion is locally infiltrative, histopathology can only be guessed at. Patient is not that old.
Anecdotal reports of deterioration following Bx of desmoid are just that, could just be coincidence.
I refer such a patient to a sarcoma (not general oncology) surgeon for complete excision as they know the consequence of incomplete resection.
Given unknown histopathology I would also do whole body FDG PET prior to Bx/ excision.
If this lesion behaves like it looks (aggressive), the patient gets one chance at cure.
We have been doing cryo ablation for some of these and so far we’ve got really good results. Especially for these that surgeons do not want to operate for different reasons. This could be a potential case for cryo since there is no vital structure around it.
Treatment strategies for fibromatosis has really changed in the last decade – several desmoid working groups have published white papers/consensus statements. When I was at the University, tyrosine kinase inhibitors were being used with excellent results for cases that failed “active observation.” But I know that medical treatment (various forms of chemotherapy) is now becoming the first line treatment for aggressive cases (rather than surgery +/- radiation).
I’m not sure what the current recommendations are for biopsy or not – at the hospital I think we used to biopsy them because the oncologists wanted to map out their genetic mutations, but I’m not sure if that was for research purposes or whether that was to guide therapy.
Hilary
On Wed, Jan 4, 2023 at 2:10 PM hilary umans <hilary.umans> wrote:
History is Chronic Right Hip Pain, referred by a NP from what appears to be a community clinic.XRs were reported normal from June 22.
Looks awfully cicatricial, superficial to the fascia, but may be breaching the fascia of the external oblique.
Avidly enhances….don’t think it goes to bone.
I’m thinking along the lines of Desmoid, don’t know what to include in the DDx or if we can exclude malignancy.
Will recommend orthopedic oncologic consultation and biopsy, but want to know your thoughts on this.
