Subscapularis Fibromatosis as a Cause of Winged Scapula. Case Report and Literature Review
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Published:
Aug 17, 2023
Keywords:
Winged scapula, desmoid tumor, treatment
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Abstract
Winged scapula is usually caused by neurological injuries to both the spinal nerve and the long thoracic nerve. Its presence as a result of a ventral scapular tumor makes initial diagnosis difficult. We present the case of a young woman with limited external shoulder rotation, no known traumatic history, and images consistent with a soft tissue lesion dependent on subscapular muscle aponeurosis, which was confirmed by biopsy as a desmoid tumor. Although it is a benign, self-limiting tumor, it has an alarmingly high rate of relapse after resection, so many treatments are available, and many teams choose to closely monitor the patient’s prognostic factors and functional limitations, obtaining satisfactory outcomes and, in some series, superior to those of surgical treatment.
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How to Cite
González López, M., Delfino Carrillo, R. A., Arviza-Lorenzo, P. C., Madrid de la Serna, C., & Escribano Rueda, L. C. (2023). Subscapularis Fibromatosis as a Cause of Winged Scapula. Case Report and Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 444-450. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1674
Section
Case Presentations
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References
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refractory desmoid tumors. N Engl J Med 2018;379(25):2417-28. https://doi.org/10.1056/NEJMoa1805052
17. Kasper B. Systemic treatment approaches for sporadic desmoid-type fibromatosis: scarce evidence and recommendations. Oncol Res Treat 2015;38(5):244-8. https://doi.org/10.1159/000381909
18. Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003;14(2):181-90. https://doi.org/10.1093/annonc/mdg064
19. Fiore M, Rimareix F, Mariani L, Domont J, Collini P, Le Péchoux C, et al. Desmoid-type fibromatosis: a front-line
conservative approach to select patients for surgical treatment. Ann Surg Oncol 2009;16(9):2587-93. https://doi.org/10.1245/s10434-009-0586-2
20. Waddell WR, Kirsch WM. Testolactone, sulindac, warfarin, and vitamin K1 for unresectable desmoid tumors. Am J Surg 1991;161(4):416-21. https://doi.org/10.1016/0002-9610(91)91102-o
21. Ruspi L, Cananzi FCM, Sicoli F, Samà L, Renne SL, Marrari A, et al. Event-free survival in desmoid-type fibromatosis (DTF): A pre-post comparison of upfront surgery versus wait-and-see approach. Eur J Surg Oncol
2021;47(5):1196-1200. https://doiorg/10.1016/j.ejso.2020.08.009
22. Penel N, Le Cesne A, Bui BN, Perol D, Brain EG, Ray-Coquard I, et al. Imatinib for progressive and recurrent
aggressive fibromatosis (desmoid tumors): an FNCLCC/French Sarcoma Group phase II trial with a long-term
follow-up. Ann Oncol 2011;22(2):452-7. https://doi.org/10.1093/annonc/mdq341
23. Amary MF, Pauwels P, Meulemans E, Roemen GM, Islam L, Idowu B, et al. Detection of beta-catenin mutations in paraffin-embedded sporadic desmoid-type fibromatosis by mutation-specific restriction enzyme digestion (MSRED): an ancillary diagnostic tool. Am J Surg Pathol 2007;31(9):1299-309. https://doi.org/10.1097/PAS.0b013e31802f581a
review of management, current guidance and unanswered questions. Eur J Surg Oncol 2016;42(7):1071-83.
https://doi.org/10.1016/j.ejso.2016.02.012
2. Giarola M, Wells D, Mondini P, Pilotti S, Sala P, Azzarelli A, et al. Mutations of adenomatous polyposis coli (APC)
gene are uncommon in sporadic desmoid tumours. Br J Cancer 1998;78(5):582-7. https://doi.org/10.1038/bjc.1998.544
3. Nieuwenhuis MH, Casparie M, Mathus-Vliegen LM, Dekkers OM, Hogendoorn PC, Vasen HF. A nation-wide
study comparing sporadic and familial adenomatous polyposis-related desmoid-type fibromatoses. Int J Cancer
2011;129(1):256-61. https://doi.org/10.1002/ijc.25664
4. Singh Sikka R, Vora M. Desmoid tumor of the subscapularis presenting as isolated loss of external rotation of the shoulder. J Bone Joint Surg Am 2004;86(1):159-64. https://doi.org/10.2106/00004623-200401000-00026
5. Rock M, Pritchard D. Extra-abdominal desmoid tumors. J Bone Joint Surg Am 1984;66(9):1369-74. PMID: 6501332
6. Pignatti G, Barbanti-Bròdano G, Ferrari D, Gherlinzoni F, Bertoni F, Bacchini P, et al. Extraabdominal desmoid
tumor. Clin Orthop Relat Res 2000;375(375):207-13. PMID: 10853171
7. Mankin HJ, Hornicek FJ, Springfield DS. Extra-abdominal desmoid tumors: a report of 234 cases. J Surg Oncol
2010;102(5):380-4. https://doi.org/10.1002/jso.21433
8. Nuyttens JJ, Rust PF, Thomas CR Jr, Turrisi AT 3rd. Surgery versus radiation therapy for patients with aggressive
fibromatosis or desmoid tumors: A comparative review of 22 articles. Cancer 2000;88(7):1517-23. PMID: 10738207
9. Fontanesi J, Mott MP, Kraut MJ, Lucas DP, Miller PR. The role of postoperative irradiation in the treatment of
locally recurrent incompletely resected extra-abdominal desmoid tumors. Sarcoma 2004;8(2-3):83-6.
https://doi.org/10.1080/13577140410001710512
10. Nishida Y, Tsukushi S, Shido Y, Wasa J, Ishiguro N, Yamada Y. Successful treatment with meloxicam, a
cyclooxygenase-2 inhibitor, of patients with extra-abdominal desmoid tumors: a pilot study. J Clin Oncol 2010;28(6):e107-9. https://doi.org/10.1200/JCO.2009.25.5950
11. Mullen JT, DeLaney TF, Rosenberg AE, Le L, Iafrate AJ, Kobayashi W, et al. β-Catenin mutation status and
outcomes in sporadic desmoid tumors. Oncologist 2013;18(9):1043-9. https://doi.org/10.1634/theoncologist.2012-0449
12. Kasper B, Baumgarten C, Bonvalot S, Haas R, Haller F, Hohenberger P, et al. Desmoid Working Group.
Management of sporadic desmoid-type fibromatosis: a European consensus approach based on patients’ and
professionals’ expertise - a sarcoma patients EuroNet and European Organisation for Research and Treatment of
Cancer/Soft Tissue and Bone Sarcoma Group initiative. Eur J Cancer 2015;51(2):127-36. https://doi.org/10.1016/j.ejca.2014.11.005
13. Constantinidou A, Jones RL, Scurr M, Al-Muderis O, Judson I. Advanced aggressive fibromatosis: Effective
palliation with chemotherapy. Acta Oncol 2011;50(3):455-61. https://doi.org/10.3109/0284186X.2010.509105
14. Gennatas S, Chamberlain F, Smrke A, Stewart J, Hayes A, Roden L, et al. A Timely oral option: Single-agent
vinorelbine in desmoid tumors. Oncologist 2020;25(12):e2013-e2016. https://doi.org/10.1002/ONCO.13516
15. Gounder MM, Lefkowitz RA, Keohan ML, D’Adamo DR, Hameed M, Antonescu CR, et al. Activity of sorafenib
against desmoid tumor/deep fibromatosis. Clin Cancer Res 2011;17(12):4082-90. https://doi.org/10.1158/1078-0432.CCR-10-3322
16. Gounder MM, Mahoney MR, Van Tine BA, Ravi V, Attia S, Deshpande HA, et al. Sorafenib for advanced and
refractory desmoid tumors. N Engl J Med 2018;379(25):2417-28. https://doi.org/10.1056/NEJMoa1805052
17. Kasper B. Systemic treatment approaches for sporadic desmoid-type fibromatosis: scarce evidence and recommendations. Oncol Res Treat 2015;38(5):244-8. https://doi.org/10.1159/000381909
18. Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003;14(2):181-90. https://doi.org/10.1093/annonc/mdg064
19. Fiore M, Rimareix F, Mariani L, Domont J, Collini P, Le Péchoux C, et al. Desmoid-type fibromatosis: a front-line
conservative approach to select patients for surgical treatment. Ann Surg Oncol 2009;16(9):2587-93. https://doi.org/10.1245/s10434-009-0586-2
20. Waddell WR, Kirsch WM. Testolactone, sulindac, warfarin, and vitamin K1 for unresectable desmoid tumors. Am J Surg 1991;161(4):416-21. https://doi.org/10.1016/0002-9610(91)91102-o
21. Ruspi L, Cananzi FCM, Sicoli F, Samà L, Renne SL, Marrari A, et al. Event-free survival in desmoid-type fibromatosis (DTF): A pre-post comparison of upfront surgery versus wait-and-see approach. Eur J Surg Oncol
2021;47(5):1196-1200. https://doiorg/10.1016/j.ejso.2020.08.009
22. Penel N, Le Cesne A, Bui BN, Perol D, Brain EG, Ray-Coquard I, et al. Imatinib for progressive and recurrent
aggressive fibromatosis (desmoid tumors): an FNCLCC/French Sarcoma Group phase II trial with a long-term
follow-up. Ann Oncol 2011;22(2):452-7. https://doi.org/10.1093/annonc/mdq341
23. Amary MF, Pauwels P, Meulemans E, Roemen GM, Islam L, Idowu B, et al. Detection of beta-catenin mutations in paraffin-embedded sporadic desmoid-type fibromatosis by mutation-specific restriction enzyme digestion (MSRED): an ancillary diagnostic tool. Am J Surg Pathol 2007;31(9):1299-309. https://doi.org/10.1097/PAS.0b013e31802f581a