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Xu K, Zhao QK, Liu JS, Zhou DH, Chen YL, Zhu XY, Su M, Huang KQ, Du W, Zhao HY. Misdiagnosis of ligamentoid fibromatosis of the small mesenteric: A case report. World J Clin Cases 2020; 8:5758-5764. [PMID: 33344571 PMCID: PMC7716297 DOI: 10.12998/wjcc.v8.i22.5758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ligamentoid fibromatosis is a rare borderline tumor that occurs in the muscles, fascia, and aponeurosis. It is a kind of soft tissue tumor of fibrous origin, also known as invasive fibromatosis, desmoid fibroma, neurofibromatosis, etc. The tumor is between benign and malignant tumors and rarely has distant metastasis. Its characteristics are mainly local invasion, destruction and growth and easy recurrence. The World Health Organization defines it as a fibroblast cloning value-added lesion originating from deep soft tissue, which causes local invasion and growth leading to tissue reconstruction, extrusion and destruction of important structures and organs. The incidence rate accounts for 0.03% of all tumors and less than 3% of all soft tissue tumors. Definite diagnosis mainly depends on postoperative pathology. Surgical resection is still the main way to treat the disease, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence.
CASE SUMMARY The patient is a 57-year-old female. One week ago, she accidentally found a mass in the left upper abdomen while lying flat. There was no abdominal pain and abdominal distention, no fever, no black stool and blood in the stool and no nausea and vomiting. She had a 10-year history of glaucoma on the left side, underwent hysterectomy for uterine fibroids 5 years ago, had no hypertension, heart disease, diabetes, hepatitis or tuberculosis, had no history of smoking and had been drinking for 20 years.
CONCLUSION Accurate preoperative diagnosis is difficult, surgical resection is the main treatment, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence. The prognosis is still good, and the risk of recurrence of secondary surgery is greatly increased.
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Affiliation(s)
- Kai Xu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Qi-Kang Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Jing-Shan Liu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Dong-Hai Zhou
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xing-Yi Zhu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Ming Su
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Kun-Quan Huang
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Wen Du
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Hong-Yu Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
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Sugoor P, Gupta A, Patkar S, Rekhi B, Goel M. Sporadic Retroperitoneal Fibrosis: a Gentle Giant. Indian J Surg Oncol 2018; 9:71-73. [PMID: 29563740 DOI: 10.1007/s13193-017-0710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Fibromatosis covers a broad spectrum of benign fibrous tissue proliferation and is characterized by slow growing, locally infiltrative growth pattern with a high propensity for local recurrence. We report on a case of multicentric fibromatosis originating from the retroperitoneal space and submandibular triangle, in an 18-year-old lady. Computed tomography revealed a retroperitoneal abdominopelvic tumor extending from the left sub-diaphragmatic space to the pelvic inlet which had enveloped the solid viscera in the left upper quadrant with a displaced celiac axis. She also had a recurrent resectable fibromatosis in left submandibular gland. Histopathological evaluation revealed fibromatosis. Preoperatively, Vinblastin-, Methotrexate-, Tamoxifen-based systemic chemotherapy was offered for 12 weeks in an attempt to downsize the mass. An en bloc complete resection of tumor with multi-visceral resection was performed to achieve negative margins and since then, the patient has remained asymptomatic without any signs of tumor recurrence during the 12th month follow-up visit. Complete resection with negative margins is the treatment of choice and majority of the lesions are amenable for surgical resections. Adjuvant therapy using non-steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for un-resectable or recurrent cases.
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Affiliation(s)
- Pavan Sugoor
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Amit Gupta
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Shraddha Patkar
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Bharat Rekhi
- 2Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Mahesh Goel
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India.,3Gastrointestinal and HPB Surgery, Department of Surgical Oncology, Tata Memorial Center, Parel, Mumbai, 400012 India
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Abstract
The normal peritoneal structures, including the mesenteries and the omenta, are only a few cell layers thick and are visible on imaging based upon the tissues (e.g., fat) and structures (e.g., blood vessels and lymph nodes) contained within them. These structures become more visible and change in appearance when involved by pathological processes. In this pictorial essay, we discuss the normal anatomy of the various abdominopelvic peritoneal structures and illustrate numerous developmental and acquired diagnoses that involve these structures in the pediatric and young adult population.
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Pleș L, Ricu A, Stoica B, Păun S. Giant mesenteric fibromatosis – A case report. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2017. [DOI: 10.25083/2559.5555.21.5459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mesenteric fibromatosis or intra-abdominal desmoids tumor is a rare clinical entity. It is a locally aggressive tumor but not metastasizing proliferation. We report a case of a 27-year-old woman with no significant medical and a previous cesarean section, admitted for abdominal pain. The CT abdominal evaluation revealed subserosal uterine fibroid. The patient underwent an elective laparotomy and a mass measuring 20/15/15 cm in diameter to the medial wall of the cecum was discovered. Complete removal was accomplished with right hemicolectomy. Histopathological examination reported mesenteric fibromatosis. Postoperatively, patient was well and 6 month follow-up showed good recovery. Moreover the next month she became pregnant and the pregnancy and birth were uneventful.
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Campara Z, Spasic A, Aleksic P, Milev B. An Aggressive Retroperitoneal Fibromatosis. Med Arch 2016; 70:154-7. [PMID: 27147794 PMCID: PMC4851536 DOI: 10.5455/medarh.2016.70.154-157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Aggressive fibromatosis (AF) is a heterogeneous group of mesenchymal tumors that have locally infiltrative growth and a tendency to relapse. The clinical picture is often conditioned by the obstruction of the ureter or small intestine. Diagnosis is based on clinical, radiological and histological parameters. A case report: We report a case of male patient, aged 35 years, with the retroperitoneal fibromatosis. He reported to the physician because of frequent urination with the feeling of pressure and pain. Computed tomography revealed the tumor mass on the front wall of the bladder with diameter of 70mm with signs of infiltration of the musculature of the anterior abdominal wall. Endoscopic transurethral biopsy showed proliferative lesion binders by type of fibromatosis. The tumor was surgically removed in a classical way. The patient feels well and has no recurrence thirty-six months after the operative procedure. Conclusion: The complete tumor resection is the therapeutic choice for the primary tumor as well as for a relapse.
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Affiliation(s)
- Zoran Campara
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | | | - Predrag Aleksic
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | - Bosko Milev
- Department of Abdominal Surgery, Military Medical Academy, Belgrade, Serbia
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Muccino E, Gentile G, Mantero S, Marchesi M, Rancati A, Zoja R. The medico-legal observation of an aggressive urogenital fibromatosis with isolated development not related to any traumatic event. Forensic Sci Int 2016; 260:e1-e6. [PMID: 26786144 DOI: 10.1016/j.forsciint.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/26/2015] [Accepted: 01/02/2016] [Indexed: 11/29/2022]
Abstract
Desmoid tumor is a fibroproliferative neoplasm with an intermediate malignancy and it can be localized in every bodily district: some locations are considered exceptional, like the urogenital localization. The Author point out a rare case of giant idiopathic scrotal fibromatosis that was found during an autopsy. A widower, that lived alone in poor hygienic conditions, was found dead in his house. The Judicial Authority ordered the autopsy, that was performed two days later at the Medico-Legal Section of Milan University. External examinations revealed only the considerable dimension of the scrotum (cm 24 × 41). The cause of death was fixed in a cardiac tamponade due to a natural heart laceration localized in correspondence of a transmural infarction. The toxicological exam resulted negative, while the histopathological and immunohistochemical analysis qualify the scrotal mass as a desmoids tumor. Due to the absence of predisposing conditions and of fibroproliferative infiltration in bladder and retroperitoneal space, the neoplasm was configured as an idiopathic desmoid tumor. The presented case gives the reason for the discussion concerning medico-legal aspects that are typical of rare neoplasms.
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Affiliation(s)
- Enrico Muccino
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Guendalina Gentile
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Stefano Mantero
- Centro Nazionale delle Ricerche-Istituto di Ricerca Genetica e Biomedica (IRGB)- Istituto Clinico Humanitas, Via Manzoni 113, 20089 Rozzano MI, Italy
| | - Matteo Marchesi
- Azienda Ospedaliera Papa Giovanni XXIII-Piazza OMS 1, 24127 Bergamo
| | - Alessandra Rancati
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute- Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano MI, Italy.
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Abstract
A 20-year-old woman with Gardner syndrome and intra-abdominal desmoid tumors presented with increasing abdominal pain. CT demonstrated a new area of central hypodensity in a presumed desmoid tumor, compressing the left ureter. Findings were suspicious for abscess or fistula to the ureter. Subsequent 99mTc-MAG3 renogram demonstrated persistent extraureteral radiotracer activity in the region of the tumor, confirming a desmoid tumor-ureteral fistula. Desmoid tumors are benign but locally aggressive fibrous neoplasms that can be sporadic or associated with familial adenomatous polyposis syndromes, specifically Gardner syndrome. Fistula formation to the ureter has been reported infrequently.
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Chung EM, Biko DM, Arzamendi AM, Meldrum JT, Stocker JT. Solid Tumors of the Peritoneum, Omentum, and Mesentery in Children: Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives. Radiographics 2015; 35:521-46. [DOI: 10.1148/rg.352140273] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Palladino E, Nsenda J, Siboni R, Lechner C. A giant mesenteric desmoid tumor revealed by acute pulmonary embolism due to compression of the inferior vena cava. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:374-7. [PMID: 25180474 PMCID: PMC4159246 DOI: 10.12659/ajcr.891044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patient: Male, 69 Final Diagnosis: Mesenteric desmoid tumor Symptoms: — Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Elisa Palladino
- Department of General and Digestive Surgery, Chalons en Champagne Hospital, Chalons en Champagne, France
| | - Joseph Nsenda
- Department of General and Digestive Surgery, Chalons en Champagne Hopsital, Chalons en Champagne, France
| | - Renaud Siboni
- Department of General and Digestive Surgery, Chalons en Champagne Hopsital, Chalons en Champagne, France
| | - Christian Lechner
- Department of General and Digestive Surgery, Chalons en Champagne Hopsital, Chalons en Champagne, France
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Shatnawei A, Habib M, Hamilton C, Steiger E, Kirby DF, Speerhas R, Quintini C. The Association Between Home Parenteral Nutrition and Patients With FAP‐Associated Intra‐Abdominal Desmoids. JPEN J Parenter Enteral Nutr 2013; 37:683-8. [DOI: 10.1177/0148607112471860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Abdullah Shatnawei
- Department of Gastroenterology and Hepatology, Digestive Disease Institute
| | - Monica Habib
- Center for Human Nutrition, Digestive Disease Institute
| | | | - Ezra Steiger
- Department of Hepato‐Pancreato‐Biliary & Transplant Surgery, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Donald F. Kirby
- Department of Gastroenterology and Hepatology, Digestive Disease Institute
| | | | - Cristiano Quintini
- Department of Hepato‐Pancreato‐Biliary & Transplant Surgery, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio
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Cho WC, Chen JYJ, Pai YC, Hsieh CL, Huang PW, Choi WM. Pancreatic mesenteric fibromatosis: A rare cause of epigastric pain with massive hemoperitoneum. J Acute Med 2012. [DOI: 10.1016/j.jacme.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Gari MKM, Guraya SY, Hussein AM, Hego MMN. Giant mesenteric fibromatosis: Report of a case and review of the literature. World J Gastrointest Surg 2012; 4:79-82. [PMID: 22530082 PMCID: PMC3332225 DOI: 10.4240/wjgs.v4.i3.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/11/2012] [Accepted: 02/20/2011] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mohammed Khalid Mirza Gari
- Mohammed Khalid Mirza Gari, Amir Mounir Hussein, Moustafa Mahmoud Nafady Hego, Department of Surgery, Imam Abdulrehman Bin Faisal Hospital, National Guard Health Affairs, Dammam 31412, Saudi Arabia
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Shatnawei A, Hamilton C, Quintini C, Steiger E, Kirby DF. Use of home parenteral nutrition in patients with intra-abdominal desmoid tumors. Nutr Clin Pract 2010; 25:290-5. [PMID: 20581324 DOI: 10.1177/0884533610368706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fistulae, small bowel obstruction (SBO), and malabsorption are complications of intra-abdominal desmoid (IAD) tumors that require home parenteral nutrition (HPN). HPN outcomes in patients with IAD tumors have not been previously reported. The aim of this study was to compare some of the nutrition parameters and complications of HPN in patients with IAD with a control group of patients on HPN. METHODS This was a case-control study of patients and randomly selected controls who required HPN because of fistulae, SBO, or malabsorption and were managed by the Cleveland Clinic Nutrition Support Team between 1990 and 2008. Variables included demographics, indications, number of episodes, duration of HPN, number of admissions and complications related to HPN, and nutrition parameters. Univariable and multivariable logistic regression analyses were used. RESULTS Eighteen of 1615 HPN patients (1.1%) had IAD. For the study, 58 patients were included: 14 with IAD and 44 controls. Four IAD patients did not have complete medical records. IAD patients had longer duration of HPN (P = .015), were younger (P = .028), and were more likely to receive HPN for malabsorption (P < .001). Body mass index (BMI), serum albumin level, protein intake provided at the beginning of HPN, energy intake provided at the start and end of HPN, mortality, and complications were comparable between groups. At the end of HPN, IAD patients received significantly more protein and had lower serum albumin levels compared with controls. CONCLUSIONS HPN for IAD patients maintained BMI but did not increase serum albumin concentration despite receiving more protein than controls. IAD patients did not have increased HPN-related complications.
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Affiliation(s)
- Abdullah Shatnawei
- Center of Human Nutrition-Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A51, Cleveland, OH 44195, USA
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Choi JY, Kang KM, Kim BS, Kim TH. Mesenteric fibromatosis causing ureteral stenosis. Korean J Urol 2010; 51:501-4. [PMID: 20664786 PMCID: PMC2907502 DOI: 10.4111/kju.2010.51.7.501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/18/2010] [Indexed: 01/10/2023] Open
Abstract
Mesenteric fibromatosis is a rare benign disease characterized by proliferating fibrous tissue in the bowel mesentery. We report a case of aggressive mesenteric fibromatosis with ureteral stenosis arising in a 46-year-old woman who suffered from intermittent right abdominal pain. Computed tomography revealed a right retroperitoneal mass with right ureteral stenosis at the level of the right common iliac vessel. The mass was excised with resection of the affected segment of the ileum, ascending colon, and ureter, and end-to-end ureter anastomosis was performed. Pathological examination confirmed mesenteric fibromatosis.
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Affiliation(s)
- Jae Young Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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Guraya SY. Quiz. J Taibah Univ Med Sci 2010. [DOI: 10.1016/s1658-3612(10)70125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sun L, Wu H, Zhuang YZ, Guan YS. A rare case of pregnancy complicated by mesenteric mass: What does chylous ascites tell us? World J Gastroenterol 2007; 13:1632-5. [PMID: 17461463 PMCID: PMC4146913 DOI: 10.3748/wjg.v13.i10.1632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesenteric fibromatosis is a rare benign nonmetastatic neoplasm that appears as a sporadic lesion or occurs in patients with familial polyposis, while chylous ascites associated with aggressive mesenteric fibromatosis during pregnancy has never been reported thus far. Here we present the case of a 28-year old pregnant woman, in whom an aggressive mesenteric fibromatosis with chylous ascites was detected, involving the jejunum, superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and pancreas. One year after a successful surgical excision, the patient had no signs of recurrence. The authors report the case for its rarity and emphasize on combining clinicopathological, radiological and immunohistochemistry analysis for management of the disease.
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Affiliation(s)
- Long Sun
- Department of Minnan PET Center, First Hospital of Xiamen, Fujian Medical University, Xiamen 316003, Fujian Province, China
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