NUCHAL FIBROMA - A CLINICOPATHOLOGICAL STUDY OF 9 CASES

Nuchal fibroma apparently was first described in the second edition of Enzinger's and Weiss's text book in 1988. We have been unable to find any other accounts of this entity. We have reviewed the clinicopathol ogical features of nine nuchal fibromas, eight of which were referred in consultation. Eight patients were men; the ages ranged from 19 to 5 3 years (median, 43). Patients were first seen with solitary, unencaps ulated, subcutaneous swellings in the back of the neck or dorsal regio n measuring from 2.5 to 8 cm in maximum dimensions (median, 3.5). Macr oscopically, lesions were firm, fibrofatty masses. Histologically, the re were sheets of hypocellular dense collagen with interspersed mature fat, inconspicuous, small, thin-walled vessels, and entrapped nerve f ibers. The picture suggested a fibrolipoma, a lipomatosis, scar tissue , or even elastofibroma, but the small amount of elastic tissue presen t lacked the beaded, nodular appearance of elastofibroma. Follow-up in formation was available in seven cases. In follow-up times from 6 mont hs to 19 years (median, 6 years), one tumor was reexcised 4 months aft er an incisional biopsy and had not recurred 19 months later. None of the others recurred. The lack of a capsule, the entrapment of nerves, and the predilection for the nuchal or dorsal regions suggest that thi s hypocellular, benign, fibrofatty lesion is a distinct entity and not merely a lipoma.