Gardner Fibroma Presenting as a Suspected Encephalocele: A Case Report and Literature Review.

Gardner fibroma (GF) is a rare benign tumor of soft tissues, most frequently described in children and adolescents, and occasionally representing an early manifestation of familial adenomatous polyposis. We report a case of a 14-month-old infant with no relevant medical history who presented with a midline occipital mass. The lesion was well-epithelialized and non-fistulized, with no evidence of pus, cerebrospinal fluid leakage, or inflammation, and measured 7 × 7 × 8 cm. Neurological examination was normal. Computed tomography revealed a heterogeneous, hypodense soft tissue mass with punctate central calcifications. The patient underwent gross total resection; the tumor appeared white, solid, and cartilaginous, adherent to the dura with an underlying bone defect, but without significant vascularity. Histopathological analysis confirmed the diagnosis of Gardner fibroma. The postoperative course was uneventful. At two months of follow-up, the patient remained asymptomatic, except for delayed language development. This case may represent one of the first documented instances of cranial GF presenting as an encephalocele-like lesion. A review of the literature shows that GF typically arises in the paraspinal or shoulder regions, and its recognition in rare cranial sites is clinically significant, as it may represent the earliest manifestation of an inherited cancer predisposition syndrome. When assessing cranial masses, Gardner fibroma should be considered in the differential diagnosis alongside encephalocele and dermoid cyst. Complete surgical excision remains the treatment of choice to minimize recurrence.