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デスモイド型線維腫症は,局所浸潤性は強いが遠隔転移をしない線維芽細胞増殖性の軟部腫瘍である。発生要因として,外傷や手術などの物理的因子,エストロゲンなどの内分泌因子,catenin beta 1(CTNNB1)遺伝子やadenomatous polyposis coil(APC)遺伝子の変異が関与する。発生部位は腹壁が約半数を占め,その他,肩,大腿などで,前縦隔での発生はまれである。今回我々は,前縦隔に発生したデスモイド型線維腫症を経験したため,文献的考察を加えて報告する。
A man in his 60s presented with dyspnea and was found to have a massive 24 cm anterior mediastinal mass on imaging. Computed tomography revealed a lobulated mass compressing the heart posteriorly with heterogeneous enhancement. Magnetic resonance imaging demonstrated T1-weighted isointensity with T2-weighted hyperintensity and restricted diffusion in hemorrhagic areas. Following CT-guided biopsy suggesting fibrous tumor, surgical resection via clamshell thoracotomy was performed, yielding a 2.65 kg tumor. Histopathology revealed spindle cell proliferation with collagen deposition and positive nuclear β-catenin immunostaining, confirming desmoid-type fibromatosis. Despite microscopically positive margins, adjuvant radiotherapy(60 Gy/30 fractions)was administered. The patient remains recurrence-free. Anterior mediastinal desmoid-type fibromatosis should be considered in differential diagnosis of mediastinal masses.

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