NUCHAL-TYPE FIBROMA: A CASE REPORT
Scibetta Nunzia , Marasà Lorenzo
C.O.U. of Pathologic Anatomy, ARNAS-Civico Hospital,
Palermo, Italy.
Nuchal-type fibroma (NTF) is a rare, tumorlike
proliferation typically located in the subcutaneous
tissues of the posterior neck and interscapular
regions of patients between ages 25 and 60 years.
The lesion has a low recurrence following excision,
not metastatize and has a strong association with
diabetes and Gardner’s syndrome.
Materials and methods
A 72-year old man presented with a mass in the
posterior neck region. It was locally excised.
Gardner’s syndrome and diabetes mellitus has not
been documented.
Specimens had been fixed in 4% formaldehyde
and embedded in paraplast.
Sections 4 micron thick were stained with H&E
and Van Gieson stain.
Immunohistochemistry was performed.
Results
The poorly circumscribed, whitish, subcutaneous,
2 cm in the greatest diameter excised mass ,
microscopically was paucicellular and composed of
thick, irregularly arranged bundles of collagen, and
scattered fibroblast, with island of trapped adipose
tissues , and a localized proliferation of nerve
twigs, similar to that seen in traumatic neuroma.
A delicate network of elastic fibres is observed
between the collagen fibres.
The fibroblast-like cells were positive for vimentin
and CD34, negative for actin, desmin, S100, GFAP.
H&E x 100
Van Gieson staining x 200
NTF contain thick, haphazardly arranged collagen fibers
H&E x 100
S100 protein x100
Irregularly arranged bundles of collagen with scattered island of
trapped adipose tissue and small nerves with haphazardly arranged
fascicles
S100 protein x200
S100 protein x400
Entrapped peripheral nerve exhibiting a splayed appearance
similar to that of traumatic neuroma
Entrapped peripheral nerve exhibiting a splayed appearance similar to
that of traumatic neuroma (S100 protein, x 400)
Conclusions
NTFs , typically present in the posterior neck region,
appear to represent a localized accentuation of the
collagenous connective tissue that normally resides
in these sites.
NTF represents a peculiar, non neoplastic tumorlike
reactive process and should be distinguished from
other fibrous tumors and tumor like conditions,
especially the desmoids-type fibromatosis,
circumscribed storiform collagenoma,
collagenous fibroma , lipoma.
Local recurrence probably reflects the persistence of
local or systemic factor related to its pathogenesis.
References
 Allen
PW : Nuchal-type fibroma appearance in a
desmoid fibromatosis. Am J Surg Pathol 2001, 25: 828829.
 Dawes LC, La Hei ER, Tobias V, Kern I, Stening W :
Nuchal fibroma should be recognized as a new extracolonic manifestation of Gardner-variant familial adenomatous polyposis. Aust N Z J Surg 2000, 70: 824-826.
 Michal M, Fetsch JF, Hes O, Miettinen M : Nuchal-type
fibroma: a clinicopathologic study of 52 cases. Cancer
1999, 85 :156-163.