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Desmoid Tumors of the Foot: A Retrospective Study of Four Patients

Hans R. Dürr
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Laura Wirth
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Andrea Baur-Melnyk
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Thomas Knösel
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Falk Roeder
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Volkmar Jansson
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Alexander Klein
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Background

Desmoid-type fibromatosis (DF) is an aggressive (myo)fibroblastic neoplasm with an infiltrative growth pattern and a tendency for local recurrence. It is rarely seen at the foot. The aim of this retrospective study was to analyze clinical presentation, therapy, and outcomes in a consecutive series of four patients with DF at the foot.

Methods

From 1994 to 2014, four patients had been surgically treated. The resection margin was marginal or even intralesional in all. One patient already had local recurrence at first presentation. The end point was either local recurrence or progression of residual disease.

Results

The mean patient age was 27 years. In one patient, marginal excision healed the disease. In another patient, local recurrence after marginal resection necessitated distal phalanx amputation. Two other patients showed stable disease after either adjuvant radiotherapy or treatment with nonsteroidal anti-inflammatory drugs and tamoxifen.

Conclusions

If surgery is necessary, operative margins are less important than keeping function for the patient. Radiotherapy might be an option to avoid major amputation. The role of adjuvant radiotherapy is controversially discussed. A watchful wait-and-see policy seems to be justified by the published data but may be difficult for DF at the foot.

Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine, and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

Institute of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

Institute of Pathology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

Corresponding author: Hans R. Dürr, MD, PhD, Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine, and Rehabilitation, University Hospital LMU Munich, Marchioninistr. 15, Munich, Bavaria 81377, Germany. (E-mail: hans_roland.duerr@med.uni-muenchen.de)