AJR 2005; 184:1029-1030
© American Roentgen Ray Society
Pelvic Fibromatosis with Massive Ossification
Guo-Shu Huang,
Herng-Sheng Lee,
Chian-Her Lee and
Cheng-Yu Chen
Departments of Radiology, Pathology, and Orthopaedics National
Defense Medical Center Tri-Service General Hospital Taipei, Taiwan, Republic
of China
A 56-year-old woman presented with a 3- year history of right hip pain. She
had no history of trauma or of renal, metabolic, or systemic diseases. An
anteroposterior radiograph of the right hip showed a calcified or ossified
mass in the right lower pelvic cavity adjacent to the inner wall of the right
acetabulum (Fig. 1A). A
computed tomogram revealed a soft-tissue mass with internal calcified or
ossified plaques and nodules adjacent to the inner wall of the right
acetabulum, involving the iliopsoas muscle
(Fig. 1B). Infiltrative foci
were present at the margin of the soft-tissue mass. There was no evidence of
involvement of the adjacent right acetabulum and iliac bones. At that time,
the lesion was thought to be a parosteal or soft-tissue osteosarcoma,
pseudosarcomatous lesion of the soft-tissue part, nodular fasciitis or some
other benign or malignant fibrous tumor, or some other soft-tissue malignancy.
Histologic examination of specimens obtained from the surgically removed mass
revealed interlacing fascicles of spindle-shaped fibroblasts
(Fig. 1C) characteristic of
fibromatosis. A large area of mature bone formation within the lesion was
noted (Fig. 1D). Mitotic
figures and nucleic pleomorphism were not evident. Appropriately, the final
diagnosis was pelvic fibromatosis with ossification. A reccurrence prompted
repeated surgery 2 years later. This operation alleviated the symptoms, and no
recurrence had developed in a 5-year follow-up.
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Fig. 1A. —56-year-old woman with ossifying fibromatosis in the pelvis.
Anteroposterior radiograph of right hip shows densely ossified plaques
(arrows) in right lower pelvic cavity and adjacent to right
acetabulum.
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Fig. 1B. —56-year-old woman with ossifying fibromatosis in the pelvis.
Computed tomogram shows intrapelvic soft-tissue mass (arrows) with
internal dense ossification close to inner margin of right acetabulum. Note
involvement of right iliopsoas muscle.
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Fig. 1C. —56-year-old woman with ossifying fibromatosis in the pelvis.
Photomicrographs show interlacing fascicles of fibroblasts. No abnormal
mitosis or nucleic pleomorphism is noted (C). There is bone formation
in which osteocyte nuclei can be seen in small lacunae (arrows)
within calcified bone matrix (D). (H and E, x200)
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Fig. 1D. —56-year-old woman with ossifying fibromatosis in the pelvis.
Photomicrographs show interlacing fascicles of fibroblasts. No abnormal
mitosis or nucleic pleomorphism is noted (C). There is bone formation
in which osteocyte nuclei can be seen in small lacunae (arrows)
within calcified bone matrix (D). (H and E, x200)
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Fibromatosis (or desmoid tumor) is a benign proliferation of fibroblasts
that exhibits aggressively infiltrative growth
[1]. The incomplete resection
of the involved margin of the lesions may lead to a high incidence of
recurrence [1]. Pelvic
fibromatosis is rare, with only 31 cases having been described previously
[1]. It usually affects women.
Clinically, patients frequently have pain in and around the pelvic region that
can mimic gynecologic disorders. The location of the lesion inside the pelvis
and close to the right acetabulum leads to right hip pain, which, currently,
is confused with orthopedic or rheumatologic conditions.
Although dystrophic or psammomatous calcification in a desmoid tumor is
well documented [2],
ossification coincident with fibromatosis is extremely rare, with only two
cases having been described [3,
4]. In one case, a 70-year-old
woman displayed ossified fibromatosis of the breast. A dense plaque of
mineralization that was evident on mammography mimicked a carcinoma. The
second case involved the forearm of a 23-month-old boy. This case was
radiographically and histologically confused with myositis ossificans,
parosteal or soft-tissue osteosarcoma, and fasciitis.
The cause of ossification is unclear and has been postulated to be related
to the periosteal involvement of the lesion or a result of long-standing
dystrophic calcification or a tissue environment favorable to osteogenesis,
particularly in late fetal development and early infancy
[4].
The present case documents an uncommon pelvic fibromatosis with massive
ossification. Radiographic findings mimic parosteal or soft-tissue
osteosarcoma.
References
- Mariani A, Nascimento AG, Webb MJ, Sim FH, Podratz KC. Surgical
management of desmoid tumors of the female pelvis. J Am Coll
Surg 2000;191:175
-183[Medline]
- Lee Y-S, Sen BK. Dystrophic and psammomatous calcifications in a
desmoid tumor. Cancer 1985;55
: 84-90[Medline]
- Mayers MM, Evans P, MacVicar D. Case report: ossifying fibromatosis
of the breast. Clin Radiol1994; 49:211
-212[Medline]
- Fromowitz FB, Hurst LC, Nathan J, Badalamente M. Infantile (desmoid
type) fibromatosis with extensive ossification. Am J Surg
Pathol 1987;11:66
-75[Medline]
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