Cervical Gardner fibroma in a child: a case report

Background Gardner fibroma (GF) is a rare, benign collagenous soft-tissue lesion that occurs predominantly in children and adolescents and is often associated with germline Adenomatous Polyposis Coli (APC) pathogenic variants and familial adenomatous polyposis (FAP) as a sentinel mass. Neck/anterior cervical presentations are uncommon, and pediatric literature reports are limited. Case presentation A 6-year-old female presented with a painless, progressively enlarging anterior neck swelling of 3 months' duration, with a family history notable for an aunt who had an unspecified tumor. Clinical examination revealed a 3×2 cm left supraclavicular firm, mobile, irregular mass. Neck ultrasound demonstrated a 2.9×1.8 cm non-vascularized mass containing diffuse fine calcifications. Fine-needle aspiration cytology revealed a fluid background composed of few oval to spindle cells, suggestive of a spindle cell neoplasm. The patient underwent complete surgical excision of the mass. Histopathologic examination demonstrated a well-circumscribed, non-encapsulated, hypocellular lesion composed of densely hyalinized collagenous stroma with spindle-shaped fibroblasts containing scattered dystrophic calcification. There were no atypia, mitotic activity, or necrosis. The findings were consistent with a diagnosis of Gardner fibroma. Genetic testing was not performed due to resource limitations. The patient remains under active surveillance with no recurrence at 2 weeks postoperatively and at subsequent follow-up visits. Conclusions GF should be included in the differential diagnosis of pediatric anterior neck masses. Patients with confirmed GF should undergo genetic testing to rule out genetic forms of colonic polyposis.