# Desmoplastic Fibromas of the Bone: A Systematic Review of Clinical Presentation and Surgical Treatment

## TL;DR

This review summarizes 187 cases of desmoplastic fibroma, a rare bone tumor, showing that wide resections are better than curettage to reduce recurrence.

## Contribution

The study provides the largest systematic review of desmoplastic fibroma cases, comparing surgical outcomes and recurrence rates.

## Key findings

- Desmoplastic fibroma commonly affects the femur, mandible, and pelvis, with pain and swelling as typical symptoms.
- Curettage had a 38.5% local recurrence rate, while wide resections had only 11.6% recurrence.
- Pathological fractures occurred in 11% of cases, and the average age at diagnosis was 24.3 years.

## Abstract

Desmoplastic fibroma is a rare, benign, but locally aggressive bone tumor. First described in 1958, to date, only a limited number of cases are available, and little is known about the clinical presentation and outcomes of surgical treatment. Our review included 187 cases of desmoplastic fibroma treated with surgery. The most frequently involved bones were the femur, the mandible, and the pelvis. Pain and swelling were common findings. Pathological fractures occurred in 11% of cases. Bone resections (112) and curettage (70) were the most common surgical treatments. Curettage was associated with significantly higher local recurrence rates (38.5) compared to bone resections (11.6) during the post-operative follow-up.

Background: Bone desmoplastic fibroma (DF) is a rare, locally aggressive, benign tumor. Due to its low incidence, studies on the topic have been limited to case reports and a few case series. This review aims to summarize modern literature on bone DF and provide an overview of its clinical presentation and prognostic horizons after surgical treatment. Methods: We systematically searched for articles reporting on DFs treated surgically. Our research was conducted according to the PRISMA guidelines, including PubMed, Embase, and Scopus articles between 1958 and 2025. Lesions’ location and size, tumors’ symptoms, the surgical treatment of choice, and the recurrence rates at patients’ latest follow-up were recorded. Results: A total of 97 articles and 187 cases were included. The mean age was 24.3. There was no gender difference. The lower limb was the most common localization (87 cases; 47%), followed by the upper limb (48; 26%), mandible (27; 14%), spine (17; 9%), and other sites (8; 4%). Pain was detected in 73% of cases and swelling in 53%. Seventeen patients (11%) had pathological fractures. Focal resections and curettage were the most common surgical treatments. Thirty-eight cases (23%), most treated with intralesional curettage, had local recurrence after a mean follow-up of 63 months. Conclusions: Despite its low incidence, desmoplastic fibromas should be considered in the differential diagnosis of symptomatic osteolytic bone lesions. Although curettage can be considered as a reasonable solution for selected cases, wide resections are recommended when feasible to minimize the risk of local recurrence.