DESMOID TUMOURS OF THE AXILLARY REGION: SEVEN CASES

Abstract

Purpose: Desmoid tumours are uncommon in the axillary region. We report the clinical course in seven patients operated for desmoid tumours of the axillary region.

Material and methods: Our series included two women and five men. Mean age was 52 years (39–60). One tumour was in the trapesium, two were in the retroplexic, two in the axillary fossa, one in the deltoid and one in the upper part of the arm. Biopsy and magnetic resonance imaging were obtained in all patients. Surgical margins were in healthy tissue in five cases; resection was limited to intratumoural tissue in one. The axillary nerve had to be sacrificed in two patients, the spinal nerve in one and the medial nerve in one. Chemotherapy was given to one patient prior to surgery.

Results: Mean follow-up was 51 months (23.2–162.1). Five patients experienced at least one relapse requiring one or two complementary procedures. Among the relapse cases, one patient required resection of the median nerve with bypass of the humeral artery. No amputations were necessary and the brachial plexus was not sacrificed. Four patients were given one to five adjuvant chemotherapy courses. Two were given radiotherapy. Shoulder motion was preserved in two patients, moderately reduced in five. Elbow and finger mobility was compromised due to the medial epicondylar site of the tumour in one patient whose median nerve had to be sacrificed.

Discussion: Even though the surgical margins were in healthy tissue, the risk of relapse was high in our patients as in other series reported in the literature. The course does however stabilise after several episodes of recurrence, an observation reported in the literature and confirmed in our patients. In case of brachial plexus involvement, several authors advocate preservation of upper limb function despite incomplete tumour resection, proposing postoperative radiotherapy.

Conclusion: Desmoid tumours of the axillary region seriously compromise upper limb function. Surgical resection should be as complete as possible but without sacrificing upper limb function.