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2010, Volume 26, Number 3, Page(s) 243-244
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DOI: 10.5146/tjpath.2010.01031 |
Fine Needle Aspiration Cytology of Fibromatosis Colli |
Indranil CHAKRABARTI , Arghya BANDYOPAHYAY, Bidyut Krishna GOSWAMI |
Department of Pathology, North Bengal Medical College, WEST BENGAL, INDIA |
Keywords: Fibromatosis colli, Fine needle aspiration, Cytology |
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Fibromatosis colli, also known as sternomastoid tumor, is considered
a rare benign lesion of infancy of uncertain etiology and pathogenesis.
Usually a self-limiting condition, diagnosis of this lesion by less
invasive techniques is important to avoid an unnecessary surgical
procedure. We report a case of a one-month-old male infant who
presented with a firm 3 cm swelling on the left side of the neck.
Fine needle aspiration was performed and the cytological features
were suggestive of fibromatosis colli. Fibromatosis colli has to be
differentiated from various congenital, inflammatory and neoplastic
conditions that can occur in a similar location. Fine needle aspiration
cytology appears to be a cheap, rapid, less invasive and fairly accurate
diagnostic aid for excluding other causes and detection of this type of
lesion. Identification of these lesions is important as they are usually
self-eliminating with some cases requiring conservative management
and rarely surgical intervention. |
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Fibromatosis colli or sternomastoid tumor is a rare benign
type of fibromatosis occurring in infants, many of them
presenting with congenital torticollis. Usually appearing
within the first two months of life, the tumor is of uncertain
pathogenesis but is of benign nature. Usually these lesions
require no surgical intervention as such, unless there is
need for correction of torticollis. A history of perinatal
trauma is often sited as a possible cause of this tumor 1.
A fusiform swelling is usually noted in the sternomastoid
region in an infant which causes a diagnostic dilemma
to the clinician. Fine needle aspiration cytology (FNAC)
provides a rapid, cheap, less invasive diagnosis and helps
to exclude other causes of neck swelling in an infant such
as lymphadenopathy, various benign and malignant tumors
as well as congenital cysts and thus avoids unnecessary
invasive surgical intervention. |
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Abstract
Introduction
Case Presentation
Disscussion
References
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A one-month-old male infant presented to the outpatient
clinic with a round, firm swelling 3 cm in diameter, in
the left anterior triangle of neck just anterior to the left
sternocleidomastoid muscle. The overlying skin was normal.
The mother had noticed the swelling one to two weeks after
birth. The child had been delivered with the help of forceps
due to breech presentation. Ultrasonography revealed
a fusiform enlargement of sternocleidomastoid muscle
with heterogenous echotexture. No lymphadenopathy
calcification or cystic changes were noted.
FNAC was done with a 23-gauge needle fitted to a 10 ml
syringe. The aspirate was stained with Hematoxylin and
Eosin (H& E) and May-Grunwald-Giemsa (MGG) stains.
Microscopy revealed the presence of plump as well as normal
fibroblasts along with atrophic muscle cells (Figure 1). A
characteristic finding was the presence of multinucleated
regenerating muscle cells. The background was hemorrhagic
with no evidence of necrosis or inflammation (Figure
2A, B). A diagnosis of sternomastoid tumor of infancy or
fibromatosis colli was made.p
Click Here to Zoom |
Figure 1: Microphotograph showing clusters of fibroblasts (thin arrow) and regenerating muscle fibers (thick arrow). Few isolated fibrocytes seen scattered in the hemorrhagic background (MGG; x200). Inset showing regenerating muscle fiber (MGG; x1000 imm. oil). |
Click Here to Zoom |
Figure 2: (A) Microphotograph showing atrophic muscle fiber (arrow head) and regenerating muscle fiber (arrow) (H&E, x400) (B) Microphotograph showing regenerating muscle fiber (H&E x1000 imm. oil). |
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Abstract
Introduction
Case Presentation
Disscussion
References
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Fibromatosis colli (FC) or sternomastoid tumor of infancy
consists of benign proliferation of fibroblasts along
with atrophic and regenerating muscle cells occurring
in neonates, being more frequent in males 2. The
pathophysiology is not clear, but is felt to be related to
prenatal and antenatal events and particularly a birth injury
associated with difficult or assisted deliveries, including
forceps deliveries 2,3. Birth injury resulting in ischemia
may be a likely cause but the growth can be a cause rather
than effect of abnormal labor1. The present case also had
a forceps-assisted delivery for breech presentation and
presented with a left-sided neck mass. Fibromatosis colli
may be associated with other congenital defects like club
foot, congenital dislocation of hip etc. However, no other
congenital birth defect was detected in our case. FNAC
provides an economical, rapid and less-invasive procedure
for diagnosis and to exclude other causes of neonatal
neck swellings such as abscess, lymphadenitis, hematoma
congenital lesions like cystic hygroma, branchial cleft cyst
thyroglossal duct cyst, hemangiomas, teratomas, dermoid
cysts or neoplastic lesions like lipomas, rhabdomyosarcoma
fibrosarcoma, neuroblastoma and lymphoma 3.
Other forms of infantile fibromatosis are differentiated
from fibromatosis colli on the basis of various clinical and
cytological features like collagen fragments and spindly
nuclei 4. Nodular fasciitis is differentiated by pleomorphism
of proliferating fibroblasts and myofibroblasts with ovoid or
kidney-shaped nuclei, often binucleated and multinucleated
cells with myxoid background and few inflammatory cells
5.
Kurtycz et al. 2 reported the cytological features of ten
cases while Zaharopoulos et al. 6 described seven cases
of fibromatosis colli. FNAC provides a diagnosis of this
disease with considerable ease and recognition of this entity
is important as newer nonsurgical treatment procedures
result in regression of 90% cases of fibromatosis colli 7
thus avoiding unnecessary surgical intervention. |
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Abstract
Introduction
Case Presentation
Discussion
References
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1) Goldblum JR, Weiss SW: Fibrous tumors of infancy and childhood. In: Goldblum JR, Weiss SW. (Eds): Enzinger and Weiss’s Soft Tissue Tumors. 4th ed., St Louis, Mosby, 2001, 273-275
2) Kurtycz DF, Logroņo R, Hoerl HD, Heatley DG: Diagnosis of fibromatosis colli by fine-needle aspiration. Diagn Cytopathol 2000, 23: 338-342
3) Sharma S, Mishra K, Khanna G: Fibromatosis colli in infants. A cytologic study of eight cases. Acta Cytol 2003, 47: 359-362
4) Rajalakshmi V, Selvambigai G, Jaiganesh: Cytomorphology of fibromatosis colli. J Cytol 2009, 26:41-42
5) Dahl I, Akerman M: Nodular fasciitis a correlative cytologic and histologic study of 13 cases. Acta Cytol 1981, 25:215-223
6) Zaharopoulos P, Wong JY: Fine-needle aspiration cytology in fibromatoses. Diagn Cytopathol 2006, 8:73-78
7) Coffin CM, Dehner LP: The soft tissues. In: Stocker JT, Dehner LP. (Eds): Pediatric pathology. 2nd ed., Philadelphia, Lippincott Williams and Wilkins, 2002, 1181 |
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Abstract
Introduction
Case Presentation
Discussion
References
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