Computed tomographic presentation of mesenteric fibromatosis

Giant mesenteric fibromatosis associated with non-Hodgkin lymphoma. A case report and literature review

BACKGROUND

Mesenteric fibromatosis is a benign locally-aggressive mesenchymal neoplasm that lacks the potential for metastasis. It is related to Gardner's Syndrome, previous trauma, abdominal surgery, and prolonged intake of oestrogen. Differentially diagnosing this from similar tumours is crucial in order for establishing the appropriate treatment and only immunohistochemical features can be used for a definitive diagnosis. Although medical therapies play a role in the treatment of mesenteric fibromatosis, surgical resection is the gold-standard procedure.

METHODS

Our case study is a 40-year-old male with a concomitant diagnosis of non-Hodgkin lymphoma and mesenteric fibromatosis, not associated with any of the risk factors mentioned above. We performed CT and PET scans and observed a vascularised and well-defined mesenteric centre-abdominal hypermetabolic solid mass in contact with the gastric body, duodenum, body and tail of the pancreas, transverse colon, and spleen. An ultrasound-guided tru-cut biopsy revealed features suggestive of mesenteric fibromatosis.

RESULTS

An elective laparotomy was carried out and a giant mass, arising from mesentery, was excised, including a partial gastrectomy and segmental resection of the transverse colon. Distal pancreatectomy, small bowel resection and successive splenectomy were performed due to a large hypertensive component. The postoperative period was uneventful. The histopathology of the surgical pieces was compatible with intra-abdominal desmoid fibromatosis.

CONCLUSION

As far as we know from the literature, this is the largest mesenteric fibromatosis tumour ever to be excised. We also noticed that this is the first reported case of the concomitant presence of mesenteric fibromatosis and non-Hodgkin lymphoma that is not related to any of the described risk factors. Further research is needed to establish what type of association this presentation may indicate.

Rare acute abdominal condition caused by mesenteric fibromatosis perforation: A case report

RATIONALE

Mesenteric fibromatosis is a rare benign neoplasm with a tendency to spread and recur locally, without metastasis. It may present with a wide spectrum of clinical features; however, onset as a perforation is extremely rare.

PATIENT CONCERNS

The present patient was an 18-year-old female with a 10-hour history of increasing abdominal pain that arose suddenly with nausea and vomiting. She had experienced an appendectomy 2 years before this admission.

DIAGNOSES

A gastrointestinal perforation was initially suspected on the basis of complaints and physical examination. The patient was thoroughly investigated for further diagnosis. Computed tomography showed a large well-defined intra-abdominal mass measuring 7.1 × 6.7 × 5.9 cm in the right lower quadrant, with adjacent small intestine compression and free intraperitoneal air. Then, the patient underwent a laparotomy. Finally, postoperative pathology and immunohistochemistry confirmed mesenteric fibromatosis, with a consecutive perforation from ileum to the bottom of tumor.

INTERVENTIONS

The patient has been treated by a resection of the mass with the adhesive small intestine, without chemotherapy or radiotherapy postoperatively.

OUTCOMES

The patient had an uneventful postoperative recovery. Three months after surgery, the patient reviewed the colonoscopy, no intestinal polyps were noted. The present case has been followed up for 17 months without tumor recurrence.

LESSONS

Our case illustrates another possible cause of acute abdominal pain. Although rare, treating physicians should maintain a high suspicion index while managing a patient with an abdominal mass and pain. Close follow-up is essential because of the high incidence of local tumor recurrence.

Incidental Finding and Management of Mesenteric Fibromatosis

Patient: Male, 45

Final Diagnosis: Mesenteric fibromatosis

Symptoms: —

Medication: —

Clinical Procedure: Surgical removal of the mesenteric fibromatosis

Specialty: Surgery

A giant mesenteric desmoid tumor revealed by acute pulmonary embolism due to compression of the inferior vena cava

Patient: Male, 69

Final Diagnosis: Mesenteric desmoid tumor

Symptoms: —

Medication: —

Clinical Procedure: —

Specialty: Surgery

Mesenteric fibromatosis presenting as a diagnostic dilemma: a rare differential diagnosis of right iliac fossa mass in an eleven year old-a rare case report

An eleven-year-old boy presented with a mass in the right iliac fossa for the last 21 days associated with pain, fever, anorexia, and nausea. The patient was thoroughly investigated and contrast-enhanced CT abdomen revealed a well-defined mass in the region of right iliac fossa. Exploratory laparotomy was done and a mass measuring 10 cm in diameter arising from mesentery of proximal ileum and adherent with the wall of ileum was seen. Resection and anastomosis were done. Histopathological examination showed mesenteric fibromatosis. Postoperatively, patient was well and 3-month followup showed normal recovery.

Giant mesenteric fibromatosis: Report of a case and review of the literature

Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. This paper presents a 35-year-old female complaining of vague abdominal pain of 2 mo duration. Her computed tomography scan and magnetic resonance imaging revealed a pelvi-abdominal heterogenous mass with significant displacement of the small bowel and urinary bladder. She underwent surgical excision of the mass with resection and anastomosis of the involved loop of the small intestine. Histological examination confirmed mesenteric fibromatosis without infiltration of the bowel. The patient remained well during the 6 mo follow-up.

Spontaneous isolated mesenteric fibromatosis: sonographic and computed tomographic findings with pathologic correlation

Eight cases of spontaneous isolated mesenteric fibromatosis (SIMF) were retrospectively reviewed. Clinical presentations included palpable abdominal mass (n = 6), abdominal pain (n = 4), gastrointestinal bleeding (n = 2) and acute abdomen (n = 1). On sonography and computed tomography (CT), eight SIMFs (size range 3 to 24 cm, mean 14.8 cm) were categorized into four morphologic patterns: well-defined inhomogeneous, well-defined homogeneous, well-defined cystic or infiltrative mesenteric mass patterns. Well-defined inhomogeneous SIMF (n = 3) was correlated with the histopathologic finding of bundles of fibroblasts with unevenly intermingled hyaline and/or myxoid degeneration areas, whereas well-defined homogeneous SIMF (n = 2) showed scarce degenerative changes. Well-defined cystic SIMF (n = 2) were ascribed to the presence of large areas of myxoid and cystic degenerations. One SIMF presented as an infiltrative mesenteric mass and the patient died 10 months after diagnosis. Both cases of cystic SIMFs showed tumor recurrences and one patient died after 84 months. The other five patients were cured by radical tumor resection. In summary, sonography, similar to CT, is also useful for evaluating SIMF with protean morphologic features, ascribing to the underlying histopathologic changes with varied degrees of hyaline, myxoid or cystic degenerations.

Giant Mesenteric Fibromatosis Presenting as Small Bowel Obstruction

Mesenteric fibromatosis is a proliferative fibroblastic neoplasia of the small intestine mesentery that may occur as a unique or multiple formation. Mesenteric fibromatosis is a rare, locally aggressive neoplasm and may present with abdominal discomfort, abdominal pain, weight loss, or symptoms of ureteral obstruction, mesenteric ischemia, or intestinal obstruction. It is of the utmost importance to distinguish mesenteric fibromatosis from gastrointestinal stromal tumors. Histopathology accurately differentiates between these two distinct entities. The preferred treatment is local surgical excision with a margin of uninvolved tissue. The involvement of important structures like the superior mesenteric artery and the superior mesenteric vein may pose a challenge during resection, but these tumors can be excised and the vessels repaired primarily.