Sobani et al. Journal of Medical Case Reports 2011, 5:244 http://www.jmedicalcasereports.com/content/5/1/244 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Successful management of aggressive fibromatosis of the neck using wide surgical excision: a case report Zain A Sobani1*, Montasir Junaid2* and Mumtaz J Khan2 Abstract Introduction: Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. Case presentation: We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis. Conclusion: Due to the rarity of the condition no guidelines are available on the indications and extent of each modality. Due to its aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, we suggest that aggressive surgery is a viable management option and may be successfully used as a single modality treatment. Introduction Aggressive fibromatosis (AF) is a benign tumor, thought to arise from deep musculoaponeurotic structures [1], characterized by local invasion and recurrence that can occur anywhere in the body. It has rarely been reported in the head and neck region, with 179 cases documented between 1968 and 2008. Due to the tendency of AF to invade local structures and recur, a multi-modality management strategy is usually employed. However due to its rarity in the head and neck, no guidelines are available on the indications and extent of each modality. Here we report a case of AF of the neck successfully managed by wide surgical exci- sion; with no signs of recurrence 22 months after surgery. Case presentation A 39-year-old Pakistani man had presented to our Gen- eral Surgery clinic with a two-month history of a lump * Correspondence: zsobani@gmail.com; montsj@gmail.com 1Medical College, Aga Khan University, Stadium Road, Karachi, Pakistan 2Division of Otolaryngology, Head & Neck Surgery, Aga Khan University, Stadium Road, Karachi Pakistan Full list of author information is available at the end of the article on the right side of his neck. There were no associated symptoms. There was no history of tobacco or irritant use. On physical examination a fixed mass, 4 cm in size, was palpated in right level III. It was not associated with any changes in the overlying skin. An examination of his upper aerodigestive tract was unremarkable. The mass was excised by a general surgeon. Histopathologi- cal analysis demonstrated spindle-shaped cells with no identifiable nuclear pleomorphism or mitotic activity. The cells stained positive for anti-smooth muscle actin (ASMA), favoring a smooth muscle origin. The mass, however, recurred within a period of one month and continued to increase in size, limiting his neck movement to the right side. On presentation to our Head and Neck Surgery clinic, a hard, well demar- cated, non-tender and non-mobile mass of about 5 × 8 cm was noticed in the posterior triangle. A computed tomography (CT) scan of his neck showed a large soft tissue mass in his right posterior neck, measuring about 6.5 × 4.7 cm in its greatest dimension, involving both his anterior and posterior sca- lene muscles and closely abutting the right lobe of his thyroid gland. On the anterior side it extended up to his © 2011 Sobani et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.