Myofibroblastic tumors are fibrous tissue tumors that originate from muscle, tendon, and fascia and are rich in collagen. It is a benign tumor composed of fibrous connective tissue. It is usually found in the subcutaneous area and is usually small, with clear margins and a smooth surface.
Incidence rate
The incidence of myofibroma is 1.37% of benign soft tissue tumors. Tumors can occur in any part of the large muscles of the body, with rectus abdominis muscle of the abdominal wall and the tendon membrane of the adjacent muscles being the most common, and are most common during pregnancy and late pregnancy. Outside of the abdominal wall, the tumors are more common in men and are more likely to be found in the scapula, femur and buttocks. The age of onset is 30 to 50 years, but it is not uncommon in children and adolescents. The cause of the disease is unknown and may be related to trauma, hormonal and genetic factors.
Pathology
Microscopically, the tumor contains abundant collagen fibers, and the lesion has no envelope and no boundary with the surrounding tissues. Few recurrent cases may show morphological changes of fibrosarcoma.
The tumor is located in deep tissues and has no obvious conscious symptoms or slight discomfort. The growth is slow. The shape is irregular or oval, and its length and diameter are in the same direction as the affected muscle fibers. The size of the tumor is related to the duration of the disease, ranging from several centimeters to more than ten centimeters in diameter. The circumference of the tumor is indistinct, the surface is smooth, no pressure pain, and the texture is tough like rubber. The tumor is relatively fixed in the longitudinal direction with the invading muscle, while it is slightly mobile in the lateral direction and does not adhere to the skin. Large tumors can affect the movement and compress the nerves.
Types
1.Yellow muscle fibroma: It is found in the dermis or subcutis of the upper arm of the trunk, often starting from a small papule after trauma or itching, with hard, unclear and noble edges.
2, bulging dermatofibrosarcoma: located in the dermis, protruding from the surface of the body, the surface skin is smooth and resembles a scar. It occurs in the trunk with low malignancy, with pseudo-envelope, and is prone to many recurrences after excision.
3, banded muscle fibroma: abdominal wall muscles due to trauma or postpartum injury reparative hyperplasia into no heart obvious envelope appropriate Monday surgical excision clinical
Symptoms
Slow growth of masses Generally metastasis without much money other symptoms too poor Mostly seen under the skin, no adhesions with the skin, with a certain degree of activity. Slow growth, generally small, the surface skin is normal Shunxin can be palpable subcutaneous smooth activity of round masses. There is no pressure pain, the boundary is clear, and the texture is hard. Few of them have malignant biological behavior and recur repeatedly, but rarely metastasize distantly. The recurrence rate is 25 to 57%. The recurrence time is mostly 1 month to 1 year after surgery, even up to 10 years or more, so this type of tumor is also called aggressive fibromatosis. Multiple recurrences can lead to more extensive lesion involvement and unstoppable growth, invading vital organs and endangering life.
Diagnosis
1.It can be seen in all parts of the body, large or small, with smooth surface or cephalic shape, which can be freely pushed and viewed.
2.It can also be seen with a tip, the enlargement can be up to several kilograms, more loosely hanging, soft to the touch, with pigmentation.
3, according to its tissue composition and nature, there are soft and hard two special types. Soft fibroids, also known as dermatomes, are mostly found on the face, neck and back of the chest, with tips, varying in size, soft and elastic. Hard fibroids are mostly found in women aged 20-40 years old, and are more common in the abdominal wall. It is a hard, painless, immobile mass with poorly defined boundaries with the surrounding tissues, growing slowly and infiltrating without envelope. It is easy to develop after excision and can become malignant.
4.Pathological section can determine the nature of the tumor.
Treatment
Early surgical excision and proper removal of the surrounding tissues are recommended to prevent recurrence of muscle fibroma. The scope of resection must have a certain breadth and depth. It should include the normal skin, muscle, tendon and other tissues around the tumor of 3-5 cm and certain normal tissues in the deep side.
If the tumor invades the periosteum or peritoneum, it should be removed together. If the tumor encircles important blood vessels and nerves, it should be sharply separated, and if necessary, vascular transplantation can be performed. The indications for amputation and hemipelvic amputation should be grasped seriously. Radiation therapy and hormone application can inhibit the growth of tumor in some cases, but it is generally considered not as the main treatment, but as palliative treatment for inoperable patients.
Extensive resection of tumor often results in local soft tissue loss and exposure of important tissues, which must be repaired by tissue grafting. Only by mastering the treatment of tissue grafting can we create conditions for surgical cure of tumor. Local muscle flap or muscle flap repair is the most ideal.
Its advantages are.
1, rich in blood flow, easy to be viable.
2. Easy to operate.
3. Immediate repair of the defect at one time.
4.Strong resistance to infection.
5.The tissue is rich, which can be a good liner and can play the role of cushioning.
6.The arc of rotation is large, which is easy to transfer in all directions, and if the island muscle flap is formed, it can reach 180° of transposition.