Nuchal-type Fibroma Induced by Repetitive Trauma from Weightlifting: Case Report and Comprehensive Review of Literature

Abstract

A nuchal-type fibroma (NTF) is a rare, benign, subcutaneous nodule that most frequently occurs in the posterior neck along the midline. It is characterized histologically by bundles of thick collagen fibers confined to the dermis and subcutaneous tissue of the posterior neck. Few trauma-related NTF cases have been published. We present a biopsy-proven case of NTF that is likely to have developed as a result of weightlifting activity in the gym, including repetitive trauma to the area of the lesion during the exercise known as the "barbell back squat." During this exercise, a heavy barbell was repeatedly rested on the patient's vertebral prominence at the level of C7/T1, the location where the NTF developed. Our 25-year old patient reported that he had been doing this exercise on a weekly basis for about 10 years. We believe that repetitive trauma at this location from specific weightlifting exercises may attribute to the incidence of NTF. A description of key magnetic resonance imaging characteristics and the surgical pathology of this case are provided, along with a review of current literature on trauma-related NTFs.

Fig. 1.

Posterolateral view of mass.

Fig. 2.

MRI T1 sagittal flair.

Fig. 3.

Low-power H&E-stained section showing paucicellular lesion composed of abundant thick collagen bundles surrounding and entrapping fat spaces.

Fig. 4.

Higher power H&E-stained section showing entrapped blood vessels and a nerve.

Fig. 5.

One-day postoperative photograph.

Fig. 6.

One-month postoperative photograph.

Fig. 7.

Animation of barbell back squat. Used with permission.