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Congenital/ Infantile Fibrosarcoma of the Hand: A Multimodality Therapeutic Approach Aimed At Limb Salvage. Sabino Zani MD, Christine Finck MD, Steven Nelson, Alan Babigian MD. Connecticut Children’s Medical Center Hartford, CT University of Connecticut Farmington, CT Characterized by an abundance of uniform spindle shape cells arranged in bundles and fascicles, congenital or infantile fibrosarcoma morphologically resembles that of adult fibrosarcoma. This is a very rare tumor that occurs most commonly in the extremity and has a local recurrence rate of up to 32%, with metastatic rates of 8%. Treatment options range from wide local excision with or without adjuvant chemotherapy to limb amputation. Tumor size and extension into surrounding tissues can make wide local excision complicated. The addition of neoadjuvant chemotherapy offers the potential to reduce tumor size allowing for a greater success at limb salvage. We present a case of a 3 month old boy born with a large mass on the dorsum of his right hand. Initial biopsy was consistent with infantile fibrosarcoma. Neoadjuvant chemotherapy consisted of Vincristine, Cytoxan, and Dactinomycin. Radical excision of the infantile fibrosarcoma was achieved with primary closure using a dorsal forearm rotation flap for coverage. The patient has since healed well and maintains good function in the affected hand. At one year postoperative, there is no evidence of recurrence.
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