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

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.

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.

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.

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.