Fibromatoses of the extremities: Clinicopathologic study of 36 cases

Background and Objectives: Fibromatoses of the extremities are rare and oft en recalcitrant to treatment. We evaluated the clinical and pathologic feat ures of a group of extremity fibromatoses treated by surgical excision with or without adjuvant therapy to determine if any clinical or pathologic par ameters were predictive of clinical outcome. Methods: Thirty-six extremity fibromatoses were evaluated. A number of clin ical and histologic features were correlated with risk of local recurrence. Results: The cohort included 19 females and 17 males with ages ranging from 11-72 years (mean: 35 years), with 12 tumors of the upper and 24 tumors of the lower extremity. Tumors ranged in size from 1.5-15.5 cm (mean: 7.5 cm) . Histologically, 26 were infiltrative, 3 had pushing borders and 7 had bot h. Mitotic counts ranged from 0-5/50 high-power fields (mean: 0.74). Surgic al margins were positive in 22 cases. Seventeen patients were treated with postoperative adjuvant therapy including radiation therapy and tamoxifen. F ollow-up information was available in 34 cases (from 1-202 months; mean: 83 months). Nineteen patients (56%) had recurrences, including II with multip le recurrences (range to first recurrence: 5-61 months; mean 23 months). Se venty-one percent of patients with a positive surgical margin and clinical follow-up had a local recurrence, compared to 31% with a negative surgical margin (P < 0.05). None of the other clinical or histologic parameters corr elated with the risk for local recurrence. Conclusions: Local control in fibromatoses of the extremities remains probl ematic. Aside from positive surgical margins, none of the other clinical or histologic parameters evaluated in this study were useful in predicting th e risk of local recurrence. (C) 2000 Wiley-Liss, Inc.