Introduction: Congenital infantile fibrosarcoma (CIF) is a rare soft tissue tumor, typically diagnosed at birth or during the first few months of life. In contrast to the adult form, it has a more favorable prognosis, despite sometimes misleading clinical and radiological features. Treatment usually involves complete surgical excision, but neoadjuvant or exclusive chemotherapy may be considered a therapeutic option, particularly when the tumor is located in areas where surgery would cause significant mutilation.
Methods: We report the case of a male newborn, born on March 9, 2022, presenting with a congenital and progressively enlarging swelling of the left forearm. Initial imaging suggested a hemangioma on Doppler ultrasound, while MRI findings were indicative of fibrosarcoma. The diagnosis of congenital infantile fibrosarcoma was confirmed by biopsy and histopathological examination. Although the multidisciplinary tumor board initially recommended amputation, a review of the literature guided the therapeutic decision toward exclusive chemotherapy using the VAC protocol (first cycle) and IVA protocol (second cycle), followed by a course of cyclophosphamide, vincristine, and doxorubicin.
Results: At 12 months, a marked reduction in tumor size was observed. At 24 months, a small, stable residual mass without any suspicious tumor activity remained. After three years of follow-up, the patient showed no recurrence, had satisfactory functional development of the upper limb, and exhibited no significant clinical sequelae.
Conclusion: This case demonstrates that an exclusively chemotherapeutic, limb-sparing approach can avoid major amputation while achieving complete control of congenital infantile fibrosarcoma. Continued clinical and radiological monitoring is essential to ensure the absence of recurrence. This therapeutic strategy may represent a valuable alternative for infants with fibrosarcomas located in anatomically critical sites.