Sobani et al. Journal of Medical Case Reports 2011, 5:244 http://www.jmedicalcasereports.com/content/5/1/244 Page 3 of 4 Figure 2 Axial (A) and sagittal (B) T1 MRI scans with contrast showing the mass. the recurrence free survival rate is 83.6% at five years [6], with figures going up to 88.5% for 10-year recur- rence free survival [7]. However, radiation therapy is associated with a high risk of complications, especially in the head and neck region, and in our opinion should only be considered in cases with residual disease or where surgery may signifi- cantly impair the functional capabilities of the patient. Although it is argued that chemotherapy is not effec- tive in benign tumors with low mitotic rates, cases of AF successfully treated with cytotoxic and non-cytotoxic chemotherapy are being reported. Sze et al. report sig- nificant tumor shrinkage with low dose methotrexate and vinblastine [1]. Another trial concluded that pegy- lated liposomal doxorubicin leads to tumor shrinkage and partial remission in some cases; or at least stops proliferation, leading to a stable disease state [8]. Melox- icam, a COX-2 inhibitor, has also been shown to be effective in controlling extra-abdominal AF [9]. Keeping these in mind, pharmacological therapy can be consid- ered for unresectable disease, or in cases where surgical and radiation therapy may lead to significant morbidity. Janis et al., in their review on pharmacological manage- ment of AF, concluded that although chemotherapy is effective against AF, larger trials are required to validate their results [10]. Sarcoma Alliance for Research through Collaboration (SARC) initiated a multi-center phase II trial on the efficacy of imatinib in AF and esti- mated progression-free survival was 94% and 88%, for two and four months respectively; whereas one year progression-free survival was 66% [11]. Recently radio frequency ablation has also been advo- cated by Ilaslan et al., with no recurrence noted after a mean follow-up of 30 months [12]. Early data from the Mayo Clinic, USA shows that percutaneous cryoablation may provide an alternative treatment for small to middle sized tumors [13]. However, both modalities have been recently tried on a limited number of patients and it is too early to comment on their application. Conclusion The rarity of AF in the head and neck means that no guidelines are currently available on the indications and extent of each modality. Due to the aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, the authors suggest that aggressive surgery is a viable management option for AF in the head and neck, and may be successfully used as a single modality treatment. However where functional preservation and aesthetics need to be taken into account, a multi-modality treatment plan involving chemotherapy and radiation therapy can be considered for its management. Figure 3 Coronal (A), axial (B) and sagittal (C) CT scans with contrast showing the mass measuring about 9.3 × 5.9 × 12 cm with areas of central necrosis. The carotid sheath is displaced anteriorly.