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Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk.

Fiore, Marco; Coppola, Sara; Cannell, Amanda J; Colombo, Chiara; Bertagnolli, Monica M; George, Suzanne; Le Cesne, Axel; Gladdy, Rebecca A; Casali, Paolo G; Swallow, Carol J; Gronchi, Alessandro; Bonvalot, Sylvie; Raut, Chandrajit P.
Ann Surg; 259(5): 973-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24477160

BACKGROUND:

Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking.

OBJECTIVE:

To investigate the possible relationship between DF and pregnancy.

PATIENTS AND METHODS:

A cohort of women with DF and pregnancy was identified from 4 sarcoma centers.Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed.

RESULTS:

Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery.

CONCLUSIONS:

Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.
Selo DaSilva