Nuchal-type fibroma - A clinicopathologic study of 52 cases

BACKGROUND. Nuchal-type fibroma (NTF) usually arises in the posterior aspec t of the neck. Previously published reports describe only II cases and prov ide limited clinicopathologic information. METHODS. Fifty-two examples of NTF from 50 patients were analyzed from the fries of the Soft Tissue Registries of the Armed Forces Institute of Pathol ogy in Washington, DC, and the Faculty Hospital in Pilsen, Czech Republic. RESULTS. The age of the patients ranged from 3 to 79 years (mean, 40 years) . There were 41 males and 9 females. Thirty-six NTFs were located in the po sterior neck: region and 16 were from extranuchal sites. Two patients had h ad lesions excised from both a nuchal and an extranuchal location. The mean greatest tumor dimension nas 3.2 cm. Microscopically, all examples had a s uperficial (subcutaneous and sometimes dermal) component and consisted of p aucicellular, thick bundles of lobulated collagen fibers with inconspicuous fibroblasts. Entrapped adipose tissue and traumatic neuromalike nerve prol iferations were typically present. Skeletal muscle infiltration was also se en in a minority of cases. Eleven of 25 patients (44%) for whom clinical in formation was available reportedly had diabetes. Gardner's syndrome was doc umented in one patient and was possibly present in two additional individua ls. During follow-up, five patients had local recurrences, but none of the recurrences were destructive and ail were ultimately controlled by local re excision. CONCLUSIONS. NTF is a rare, tumorlike accumulation of collagen that often a ffects the posterior neck region but can also occur in a number of other si tes. The process has a strong association with diabetes and also appears to be linked to Gardner's syndrome. Local recurrence probably reflects the pe rsistence of local or systemic factors related to its pathogenesis. Cancer 1999;85:156-63, (C) 1999 American Cancer Society.