Gastrointestinal Stromal Tumour

          

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                                                Atypical Fibroxanthoma

             Dr Sampurna Roy MD

 
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 May 2007

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Fibromatosis colli (FC), also known as 'sternocleidomastoid tumour of infancy', is a benign spindle cell lesion of the sternocleidomastoid muscle. It is often associated with torticollis due to contraction of the sternocleidomastoid muscle.

Although the pathogenesis of this lesion is not clear, it is probably related to birth trauma (breech or forceps delivery). Injury leads to secondary pressure necrosis and fibrosis within the muscle. In the early stage the mass may grow rapidly. Later the growth slows and ultimately ceases.  After a period of 1 to 2 years it  begins to regress . About  2/3rd of the cases resolve spontaneously.

Age:  Most cases show no abnormality at birth but manifest between the 2nd and 4th week of life.  Fibromatosis colli affects male patients slightly more often than female patients.

Site:  The lesion presents as a firm soft-tissue mass in the lower one-third of the sternocleidomastoid muscle. The disease is usually unilateral  (slightly more common on the right side) and affects both the sternal and clavicular heads of the muscle. Bilateral involvement is rare.  

Gross:  The mass may be excised at an early stage. Macroscopically it is a small firm mass (2-3 cm in diameter), with a greyish white, glistening cut surface . The lesion blends with the surrounding smooth muscle.

Microscopic features: IMAGE1     IMAGE2

1. There is replacement of muscle fibres by hyalinized fibrous tissue.
2. Throughout the lesion there are  scattered residual muscle fibres which shows prominent degenerative and reactive changes (atrophy, swelling, loss of cross striations). There is little cellular pleomorphism or mitotic activty.

Differential diagnosis: Myositis ossificans progressiva ; Desmoid type fibromatosis: (Unlike fibromatosis colli damaged muscle fibres are not present in fibromatosis.)

 
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Further reading:  Enzinger and Weiss's Soft Tissue Tumors

Imaging of musculoskeletal fibromatosis. Radiographics. 2001;21(3):585-600

Infantile fibromatosis of the sternocleidomastoid muscle mimicking muscular torticollis.J Pediatr Surg. 2004 Sep;39(9):1424-5

Fibromatosis colli in infants. A cytologic study of eight cases.Acta Cytol. 2003 May-Jun;47(3):359-62.

Diagnosis of fibromatosis colli by fine-needle aspiration.Diagn Cytopathol.2000 ;23 (5):338-42.

                      

Diagnosis of fibromatosis colli by fine needle aspiration (FNA) cytology. Cytopathology. 1999 ;10(1):25-9.

Fibromatosis colli. The utility of fine-needle aspiration in diagnosis. Arch Otolaryngol Head Neck Surg. 1997 Mar;123(3):301-4.

Fibroblastic-myofibroblastic tumors in children and adolescents: a clinicopathologic study of 108 examples in 103 patients.Pediatr Pathol. 1991 Jul-Aug;11(4):569-88.

Superficial fibrous tumors in childhood. J Cutan Pathol. 1981 Oct;8(5):321-34.

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Nodular fasciitis ; Proliferative fasciitis ; Proliferative myositis ; Ischaemic fasciitis ; Elastofibroma; Fibrous Hamartoma of Infancy ;Infantile Myofibromatosis/ Myofibroma ; Juvenile hyaline fibromatosis ;Inclusion  Body Fibromatosis ; Calcifying aponeurotic fibroma ; Fibromatosis colli ;Fibroma of tendon sheath ; Desmoplastic fibroblastoma (collagenous fibroma) ;Storiform Collagenoma (sclerotic fibroma) ; Giant Cell CollagenomaPleomorphic Fibroma; Angiomyofibroblastoma; Dermatomyofibroma; Cellular Angiofibroma; Giant Cell Angiofibroma; Fibromatosis; Lipofibromatosis; Solitary fibrous tumour; [Hemangiopericytoma  including Lipomatous Hemangiopericytoma]; Inflammatory myofibroblastic tumour; Low grade myofibroblastic sarcoma; Myxoinflammatory fibroblastic sarcoma; Infantile fibrosarcoma ; Adult fibrosarcoma ; Myxofibrosarcoma; Low grade fibromyxoid sarcoma; Hyalinizing Spindle Cell Tumour with Giant Rosettes; Sclerosing epithelioid fibrosarcoma;

Soft Tissue Pathology;

Myxoid Tumours of Soft Tissue Classification of Soft Tissue Tumour;  Gross examination of soft tissue specimen ;  A practical approach to histopathological reporting of soft tissue tumours Grading of soft tissue tumours ; Lipomatous tumours ;Neural tumours ; Myogenic tumours ;Vascular tumours ; Fibroblastic/ Myofibroblastic tumours ; Myofibroblastic tumours ;  Fibrohistiocytic tumours ; ChondroOsseous tumours ; Soft TissueTumours of Uncertain Differentiation ; Notochordal Tumour -Chordoma ;Extra-adrenal Paraganglioma ; Gastrointestinal Stromal Tumour ;