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Tanishima T, Kurokawa R, Sone M, Nakai Y, Kusumoto M. Radiological features of pancreatic desmoid-type fibromatosis: a case series and systematic review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04570-8. [PMID: 39278889 DOI: 10.1007/s00261-024-04570-8] [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: 07/18/2024] [Revised: 08/09/2024] [Accepted: 09/03/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE This retrospective study aimed to investigate the radiological features of pancreatic desmoid-type fibromatosis (PDF) and systematically review the previous publications and two new cases. METHODS We searched PubMed, Cochrane Library, and Web of Science Core Collection and included 31 patients with pathologically proven PDFs with analyzable preoperative computed tomography (CT) and magnetic resonance imaging, including two patients from our institution and 29 patients from 28 publications. Two board-certified radiologists reviewed all images. RESULTS The median age of the patients was 39 years, with a male dominance observed (male, 54.8% vs. female, 45.2%). Abdominal pain was the most frequent symptom, occurring in 58.1% of cases. Surgical resection was performed in all cases of PDFs, resulting in a recurrence rate of 8.3% (2/24). The tumors were most commonly located in the pancreatic tail (23/31, 74.2%). In terms of morphology, a "solid" shape was most prevalent (14/31, 45.2%), followed by a "solid and cystic" shape (9/31, 29.0%) and a "cystic" shape (8/31, 25.8%). Characteristic radiological features included heterogeneous enhancement of the solid portion of the tumors on CT scans (13/20, 65%), moderate-to-weak enhancement in the late phase on CT (16/17, 94.1%), and a presence of cystic components in the tumors (17/31, 54.8%). In 16.1% (5/31) of PDFs, the cystic component was pathologically confirmed to be a dilated pancreatic duct. CONCLUSION We summarized the clinical and imaging characteristics of PDF. Although the incidence may not be high, cystic components suggesting a dilated pancreatic duct within the tumor are unique imaging features in PDF.
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Affiliation(s)
- Tomoya Tanishima
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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2
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Litchinko A, Brasset C, Tihy M, Amram ML, Ris F. Large Desmoid Tumor of the Pancreas: A Report of a Rare Case and Review of the Literature. Am J Case Rep 2022; 23:e937324. [PMID: 36378606 PMCID: PMC9676065 DOI: 10.12659/ajcr.937324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Desmoid tumor (DT), also known as aggressive fibromatosis or desmoid-type fibromatosis, is a rare disease. It can occur in anyone at any age, and is more likely to appear in female patients. DTs are sometimes associated with familial adenomatous polyposis and rare syndromes such as Gardner syndrome. Arising from specific cells, fibroblasts, they tend to develop in patients with a history of abdominal surgery and rarely produce metastases. CASE REPORT We present a case of a 41-year-old man who was referred for abdominal discomfort with no digestive or general symptoms. An abdominal CT scan revealed a mass in the left hypochondrium, corresponding to an intraperitoneal tumor extending to left colon. Based on MRI, we suspected a gastrointestinal stromal tumor. Colonoscopy showed no intraluminal tumor in the colon. A PET-CT scan revealed tumor hypermetabolism and no metastases. The mass was diagnosed as a DT after percutaneous biopsy. Six weeks after diagnosis and as the tumor continued increasing despite pharmacological treatment, the patient underwent surgical pancreatic tail resection with splenectomy and left colonic segmentectomy. Histological examination revealed a 7.047-g DT with severe infiltration of pancreatic parenchyma and transmural colic barrier, with no high-grade differentiation and negative resection margins. The postoperative recovery was uneventful, and we proposed surveillance with MRI. CONCLUSIONS The DT was surgically removed and patient remains under MRI surveillance. Other reported management approaches consist of radiotherapy, tyrosine kinase inhibitors, anti-hormonal therapies/non-steroidal anti-inflammatory drugs, chemotherapy, or close surveillance only. This is, to our knowledge, the largest and heaviest DT reported in the modern literature.
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Affiliation(s)
- Alexis Litchinko
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Camille Brasset
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Matthieu Tihy
- Clinical Pathology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | - Frederic Ris
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland,Corresponding Author: Frederic Ris, e-mail:
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Clarke-Brodber AL, Hartley CP, Ahmed F, Thangaiah JJ, Tiegs-Heiden C, Hagen CE. Desmoid fibromatosis involving the pancreas: A retrospective case series with clinical, cytopathologic and radiologic correlation. Ann Diagn Pathol 2022; 60:152015. [DOI: 10.1016/j.anndiagpath.2022.152015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/17/2022] [Indexed: 11/01/2022]
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Prete F, Rotelli M, Stella A, Calculli G, Sgaramella LI, Amati A, Resta N, Testini M, Gurrado A. Intraabdominal sporadic desmoid tumors and inflammation: an updated literature review and presentation and insights on pathogenesis of synchronous sporadic mesenteric desmoid tumors occurring after surgery for necrotizing pancreatitis. Clin Exp Med 2022:10.1007/s10238-022-00849-6. [PMID: 35913675 DOI: 10.1007/s10238-022-00849-6] [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: 03/05/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
Sporadic intra-abdominal desmoid tumors are rare and known to potentially occur after trauma including previous surgery, although knowledge of the underlying pathogenetic mechanism is still limited. We reviewed the recent literature on sporadic intraabdominal desmoids and inflammation as we investigated the mutational and epigenetic makeup of a case of multiple synchronous mesenterial desmoids occurring after necrotizing pancreatitis. A 62-year-old man had four mesenteric masses up to 4.8 cm diameter detected on CT eighteen months after laparotomy for peripancreatic collections from necrotizing pancreatitis. All tumors were excised and diagnosed as mesenteric desmoids. DNA from peripheral blood was tested for a multigene panel. The tumour DNA was screened for three most frequent β-catenin gene mutations T41A, S45F and S45P. Expression levels of miR-21-3p and miR-197-3-p were compared between the desmoid tumors and other wild-type sporadic desmoids. The T41A CTNNB1 mutation was present in all four desmoid tumors. miR-21-3p and miR-197-3p were respectively upregulated and down-regulated in the mutated sporadic mesenteric desmoids, with respect to wild-type lesions. The patient is free from recurrence 34 months post-surgery. The literature review did not show similar studies. To our knowledge, this is the first study to interrogate genetic and epigenetic signature of multiple intraabdominal desmoids to investigate potential association with abdominal inflammation following surgery for necrotizing pancreatitis. We found mutational and epigenetic features that hint at potential activation of inflammation pathways within the desmoid tumor.
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Affiliation(s)
- Francesco Prete
- Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy.
| | - MariaTeresa Rotelli
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Alessandro Stella
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Giovanna Calculli
- Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Lucia Ilaria Sgaramella
- Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Antonio Amati
- Division of Pathology, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Nicoletta Resta
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mario Testini
- Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Angela Gurrado
- Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy
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5
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Park CG, Lee YN, Kim WY. Desmoid type fibromatosis of the distal pancreas: A case report. Ann Hepatobiliary Pancreat Surg 2021; 25:276-282. [PMID: 34053932 PMCID: PMC8180399 DOI: 10.14701/ahbps.2021.25.2.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/09/2020] [Indexed: 11/17/2022] Open
Abstract
A 23-year-old Korean female presented epigastric pain of two-months’ duration. She had a laparoscopic ovarian cyst excision 8 months previously. Clinical examination was normal. An abdominal computed tomogram (CT) demonstrated a 10-cm solid mass in the distal pancreas, with signs of splenic artery and vein occlusion, gastric and transverse colon invasion. Operative findings showed a mass involving distal pancreas, invasive to the posterior wall of the antrum of the stomach and transverse colon and 4th portion of the duodenum without lymph node involvement. The surgery consisted of a distal pancreatectomy, splenectomy and combined partial resection of the stomach, transverse colon and 4th portion of the duodenum. The immunohistochemistry and histopathological features were consistent with a confirmed diagnosis of intra-abdominal desmoid type fibromatosis (DTF). The prognosis of pancreatic DTF is not known and she showed no recurrence or distant metastasis during a 3 year follow-up. Herein we report a rare case with an isolated, sporadic, and non-trauma-related DTF, located at the pancreatic body and tail.
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Affiliation(s)
- Chan Gyun Park
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Yu Ni Lee
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Woo Young Kim
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
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6
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Pancreatic cystic desmoid tumor following metastatic colon cancer surgery: A case report. Radiol Case Rep 2020; 15:2063-2066. [PMID: 32944101 PMCID: PMC7481488 DOI: 10.1016/j.radcr.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023] Open
Abstract
Desmoid tumors are rare, benign, and locally aggressive neoplasms that stem from connective tissue that have high rates of recurrence after surgery. Intra-abdominal desmoid-type fibromatosis can arise in 2 forms: sporadic or hereditary (associated with familial adenomatous polyposis and Gardner syndrome). The diagnosis of desmoid-type tumors is based on imaging modalities and histopathological examination. The primary treatment is resection surgery. We report a 64-year-old male with a distal pancreatic desmoid tumor. We focus on tumor management by the application of radiological modalities and pathological analysis.
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7
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Takinami M, Matsubayashi H, Ishiwatari H, Uesaka K, Okamura Y, Sasaki K, Ohike N, Hirabayashi K, Ono H. An Intra-abdominal Solid-cystic Desmoid That Emerged after Distal Gastrectomy. Intern Med 2019; 58:3525-3529. [PMID: 31839672 PMCID: PMC6949453 DOI: 10.2169/internalmedicine.3252-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Desmoid is a locally aggressive fibroblastic neoplasm, typically showing a heterogeneous solid mass, and its pathogenesis is multifactorial, including surgical scars. We herein report a rare case of an intra-abdominal desmoid, consisting of solid and cystic components covered with epithelial linings, that emerged after distal gastrectomy. The preoperative diagnosis was inconclusive, so laparotomy was performed. Histopathology of the solid component showed proliferating spindle cells, which were positive for beta-catenin in their nuclei. Clinicians need to bear in mind that desmoids can appear in a solid-cystic form, and immunostaining of beta-catenin should be applied for tumors that emerge around postoperative wounds.
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Affiliation(s)
| | | | | | - Katsuhiko Uesaka
- Division of Hepato-pancreaticobiliary Surgery, Shizuoka Cancer Center, Japan
| | - Yukiyasu Okamura
- Division of Hepato-pancreaticobiliary Surgery, Shizuoka Cancer Center, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Japan
| | - Nobuyuki Ohike
- 1st Department of Pathology, Showa University School of Medicine, Japan
| | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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8
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Pancreatic desmoid tumor: A rare case with radiologic-pathologic correlation. Radiol Case Rep 2018; 13:1079-1083. [PMID: 30228848 PMCID: PMC6137398 DOI: 10.1016/j.radcr.2018.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/26/2022] Open
Abstract
A 39-year-old female patient was referred to our tertiary oncologic center for additional investigations relating to a suspect pancreatic tail lesion. An abdominal computed tomography scan and magnetic resonance imaging scan showed a solid lesion demonstrating progressive enhancement. Complete resection was obtained and the final diagnosis was that of a desmoid tumor of the pancreas, an exceptionally rare tumor demonstrating overlap with other solid and cystic lesions of the pancreas [1]. Therefore, it is important to recognize the essential role of pathology, particularly immunohistochemistry, in identifying this tumor. The high rate of postsurgical recurrence should prompt repeated follow-ups considering the potential aggressive nature of desmoid tumors.
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9
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Jafri SF, Obaisi O, Vergara GG, Cates J, Singh J, Feeback J, Yandrapu H. Desmoid type fibromatosis: A case report with an unusual etiology. World J Gastrointest Oncol 2017; 9:385-389. [PMID: 28979721 PMCID: PMC5605339 DOI: 10.4251/wjgo.v9.i9.385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023] Open
Abstract
Desmoid type fibromatosis (DTF) is a rare, locally invasive, non-metastasizing soft tissue tumor. We report an interesting case of DTF involving the pancreatic head of a 54-year-old woman. She presented with intermittent dysphagia and significant weight loss within a 3-mo period. Laboratory findings showed mild elevation of transaminases, significant elevation of alkaline phosphatase and direct hyperbilirubinemia, indicating obstructive jaundice. Computerized tomography of the abdomen revealed a mass in the head of the pancreas, dilated common bile duct, and dilated pancreatic duct. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound showed a large hypoechoic mass in the head of the pancreas causing extrahepatic biliary obstruction and pancreatic ductal dilation. The patient underwent a successful partial pancreatico-duodenectomy and cholecystectomy. She received no additional therapy after surgery, and liver function tests were normalized within nine days after surgery. Currently, surgical resection is the recommended first line treatment. The patient will be followed for any recurrence.
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Affiliation(s)
- Syed Faisal Jafri
- Gastroenterology, Research Medical Center, Kansas City, MO 64132, United States
| | - Obada Obaisi
- School of Medicine, University of Missouri in Kansas City, Kansas City, MO 64108, United States
| | - Gerardo G Vergara
- Pathology, Research Medical Center, Kansas City, MO 64132, United States
| | - Joe Cates
- General and Vascular Surgery, Research Medical Center, Kansas City, MO 64132, United States
| | - Jaswinder Singh
- Hematology/Oncology, Research Medical Center, Kansas City, MO 64132, United States
| | - Jennifer Feeback
- Division Director of Clinical Research, Research Medical Center, Kansas City, MO 64132, United States
| | - Harathi Yandrapu
- Internal Medicine Department of Research Medical Center and Research Department of Kansas City Veterans Affairs Medical Center, Kansas City, MO 64132, United States
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10
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Wang YC, Wong JU. Complete remission of pancreatic head desmoid tumor treated by COX-2 inhibitor-a case report. World J Surg Oncol 2016; 14:190. [PMID: 27450394 PMCID: PMC4957301 DOI: 10.1186/s12957-016-0944-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Desmoid tumors (DTs) are non-metastatic, locally aggressive neoplasms with high postoperative recurrence rates. The pancreas is an extremely rare location for DTs. The local control of DTs is challenging. Surgery and radiotherapy are currently the principal treatment modalities for DTs; however, some resections might not be radical, and radiotherapy has several drawbacks. Therefore, many studies have been focusing on the molecular pathways involved in DTs in order to develop molecular-targeted therapies or chemotherapy. Cyclooxygenase-2 (COX-2) has been demonstrated to play a role in the growth of DTs, and the pharmacologic blockade of COX resulted in decreased cell proliferation in desmoid cell cultures in vitro. Case presentation Herein, we report a 57-year-old woman who presented with recurrent epigastric pain and weight loss. An abdominal computed tomography scan showed an approximately 10-cm mass over the pancreatic head region and dilatation of the pancreatic duct. Tumor biopsy and bypass surgery were performed. A DT was confirmed on pathologic analysis. After resection, we prescribed treatment with the COX-2 inhibitor celecoxib. The patient showed complete remission and there was no local recurrence or distant metastasis within the 24-month follow-up period. Conclusions The outcome of this case study is encouraging, and long-term follow-up studies are required to establish the effect of treatment with celecoxib on the prognosis of DTs.
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Affiliation(s)
- Yu-Chieh Wang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Jia-Uei Wong
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.
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11
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Pancreatic desmoid-type fibromatosis with beta-catenin gene mutation-Report of a case and review of the literature. Pathol Res Pract 2016; 212:484-9. [PMID: 26907785 DOI: 10.1016/j.prp.2016.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 11/21/2022]
Abstract
We experienced a rare case of pancreatic desmoid-type fibromatosis (DTF) in a 75-year-old Japanese woman. She was asymptomatic but routine examination including ultrasonography revealed a mass in the abdomen. For precise examination, she was referred to the regional hospital. Computed tomography showed that the mass was protruding anteriorly from the left-sided pancreas. Because of the enlargement of the mass lesion, distal pancreatectomy with splenectomy was performed after about 3 months. Macroscopically, the mass was encapsulated and approximately 8cm in diameter. Histological examination revealed that spindle or blunt stellate cells were proliferating in parallel or storiform fashion with myxoid and fibrous background. The tumor cells did not show prominent atypia and mitoses were rarely seen, suggesting that the tumor was low grade or borderline. Immunohistochemistry showed obvious nuclear staining of beta-catenin. Furthermore, analysis of beta-catenin gene revealed that the tumor had a typical missense mutation of threonine to alanine at colon 41 (T41A) in exon 3. These findings confirmed the pathological diagnosis of DTF of the pancreas. To the best of our knowledge, 18 cases of pancreatic DTF have been reported in the English literature and beta-catenin gene mutation had been examined in only one case among them. Thus, our case is the 19th pancreatic DTF and the second case with confirmed beta-catenin gene mutation.
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12
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Abstract
Desmoid tumors, also known as desmoid-type fibromatoses or aggressive fibromatoses, are clonal fibroblastic proliferations that arise in the deep soft tissues. They are characterized by infiltrative growth, a tendency toward local recurrence and the inability to metastasize. We present a case of a 63-year-old woman who complained of abdominal pain, and a contrast-enhanced computed tomography scan revealed a well-circumscribed tumor in the pancreatic tail, measuring 5.1 cm. A left-sided, spleen-preserving pancreatic resection was performed, and pathological analysis showed a mesenchymal tumor. The diagnosis of a pancreatic desmoid tumor was made based on the characteristic morphology and the immune phenotype of the tumor. The English-language literature on pancreatic desmoid tumors was reviewed. In total, 16 previous cases were identified.
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Affiliation(s)
- Roxana Gerleman
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
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13
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Słowik-Moczydłowska Ż, Rogulski R, Piotrowska A, Małdyk J, Kluge P, Kamiński A. Desmoid tumor of the pancreas: a case report. J Med Case Rep 2015; 9:104. [PMID: 25943401 PMCID: PMC4437747 DOI: 10.1186/s13256-015-0591-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/08/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Desmoid tumor is a rare, benign, usually asymptomatic fibromatous lesion. The etiology is unknown and the diagnosis is based on histopathological examination. The treatment is complete resection of the tumor. Pancreatic desmoid tumor is extremely rare. In the literature there have been only 11 cases described, most of them as solid or solid-cystic masses. We report the case of a patient with an isolated cystic pancreatic desmoid tumor that is, to the best of our knowledge, the second reported case. Case presentation A 13-year old Caucasian boy presented with recurrent pain of two months’ duration in the left hypochondrium of his abdomen. An ultrasound examination and computed tomography scan revealed the presence of a cystic mass located in his splenic hilum, tightly adjacent to the pancreatic tail. A splenic cyst was suspected. Operative findings showed a 10x10cm cystic mass tightly connected to the pancreatic tail and left colonic flexure, adherent to the spleen, splenic vein and artery. Distal splenopancreatectomy with en bloc resection of the left colonic flexure was performed. Histological analysis confirmed that the resection was complete. The mass had infiltrated the pancreatic parenchyma. All tumor cells were positive for anti-beta-catenin staining characteristic for desmoid tumor. No abnormalities in the spleen and colon were found. Conclusions Isolated sporadic pancreatic desmoid tumor with cyst formation is extremely rare and its diagnosis can be difficult, especially because of uncharacteristic symptoms and radiological findings, as in our patient. This case report should be of interest not only to surgeons, as the treatment of choice is radical resection, but also gastroenterologists, considering it is in close relation with familial adenomatous polyposis, and oncologists as the reason for differentiation with other pancreatic tumors.
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Affiliation(s)
- Żaneta Słowik-Moczydłowska
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Robert Rogulski
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Anna Piotrowska
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
| | - Przemysław Kluge
- Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland.
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland.
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14
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Jia C, Tian B, Dai C, Wang X, Bu X, Xu F. Idiopathic desmoid-type fibromatosis of the pancreatic head: case report and literature review. World J Surg Oncol 2014; 12:103. [PMID: 24755337 PMCID: PMC4032157 DOI: 10.1186/1477-7819-12-103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/07/2014] [Indexed: 12/17/2022] Open
Abstract
Desmoid-type fibromatosis (DTF) is an uncommon nonmetastatic fibrous neoplasm. Sporadic intraperitoneal DTF is rarely described in current literature. We herein report a case of DTF of unknown cause involving the pancreatic head. A 41-year-old man presented with recurrent epigastric pain and weight loss. An abdominal computed tomography scan showed a well-delineated solid cystic mass inside the pancreatic head. Pylorus-preserving pancreaticoduodenectomy was performed due to the patient's debilitating symptoms and suspected malignancy. The pathological examination revealed massive fibroblastic proliferation arising from the musculoaponeurotic tissues, consistent with a diagnosis of DTF. Immunohistochemical phenotyping determined positive immunoreactivity to vimentin and β-catenin, but negative immunoreactivity to smooth muscle actin, CD117, CD34, or S-100, confirming the diagnosis of DTF. No local recurrence or distant metastasis was found during a 24-month follow-up. Radical resection is recommended as first-line treatment for pancreatic DTF. Long-term follow-up studies are required to establish the prognosis of pancreatic DTF.
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Affiliation(s)
- Changjun Jia
- Department of General Surgery, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
| | - Baoling Tian
- Department of Pathology, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
| | - Chaoliu Dai
- Department of General Surgery, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
| | - Xinlu Wang
- Department of Ultrasound Medicine, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
| | - Xianmin Bu
- Department of General Surgery, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
| | - Feng Xu
- Department of General Surgery, Shengjing Hospital, China Medical University, 36 Sanhao Street, Shenyang 110004, China
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15
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Xu B, Zhu LH, Wu JG, Wang XF, Matro E, Ni JJ. Pancreatic solid cystic desmoid tumor: Case report and literature review. World J Gastroenterol 2013; 19:8793-8798. [PMID: 24379602 PMCID: PMC3870530 DOI: 10.3748/wjg.v19.i46.8793] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumors (DTs) are nonmetastatic, locally aggressive neoplasms with a high rate of postoperative recurrence. Pancreatic DTs are especially rare; only a few cases have been reported to date. This paper describes a case of a sporadic cystic DT of the pancreas managed successfully with central pancreatectomy, with no signs of recurrence 40 mo after surgery. According to the literature, this is the first reported case in China of a pancreatic DT presenting as a solid cystic lesion, as well as the first pancreatic DT managed with central pancreatectomy and pancreaticogastrostomy. We report the case for its rarity and emphasize disease management by concerted application of clinical, pathological, radiological and immunohistochemical analyses.
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Sporadic intra-abdominal desmoid: a rare presentation as a hepatic mass. Case Rep Pathol 2012; 2012:245671. [PMID: 23091764 PMCID: PMC3471414 DOI: 10.1155/2012/245671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/05/2012] [Indexed: 12/27/2022] Open
Abstract
We report an unusual presentation of a sporadic intra-abdominal desmoid tumour, possibly arising from the diaphragm, masquerading as a hepatic mass in a young female without any history of surgery or trauma. Histopathology ruled out a hepatic origin of the tumour as was inferred from pre- and intraoperative evaluation. Immunohistochemistry showed positivity of lesional fibroblastic cells for β-catenin and negativity for CD34, CD117, EMA, SMA, desmin, vimentin, cytokeratin, and ALK1 thereby confirming the diagnosis of a desmoid tumour. There exist only a few reports in the literature on desmoids related to the diaphragm, but only one on a diaphragmatic desmoid that is possibly primary.
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Abstract
Desmoid tumors are rare neoplasms. They occur mostly in females in their reproductive age and may present with pelvic pain and intestinal obstruction. These connective tissue neoplasms are because of uncontrolled proliferation of differentiated myofibroblasts. The cells may synthesize vast amounts of collagen fibers in response to various stimuli. We describe a case of a pelvic desmoid tumor simulating a uterine leiomyoma recurrence. We review the literature on the epidemiology and the treatment options for desmoid tumors and suggest a strong index of suspicion when a new pelvic mass arises in an adult with previous pelvic surgery. We advise a planned multidisciplinary treatment approach at the first hint of the diagnosis of desmoid tumor.
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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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Elguezabal Rodriguez A, Gené Hijós M, Caro Tarragó A, Martínez González S. [Intra-abdominal desmoid tumor mimicking a pancreatic tumor in a patient with familial colonic polyposis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:406-10. [PMID: 21571398 DOI: 10.1016/j.gastrohep.2011.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Fibromatosis consists of a benign fibroblastic proliferation with local infiltrative growth. Two types are recognized: a superficial and a deep form, also known as desmoid tumor. The latter may occur sporadically or in association with familial adenomatous polyposis and Gardner's syndrome. Pancreatic presentation is exceptional and only eight cases have been described in the literature. CASE REPORT We report the case of a 29-year-old woman with a history of familial colonic polyposis and two pancreatic lesions. In the surgical specimen, two poorly defined pancreatic lesions were observed with infiltration of neighboring organs. Histologically, the lesions corresponded to mesenchymal proliferation with a fusocellular pattern without cytological atypica, which were diagnosed as desmoid tumors. DISCUSSION The etiology of fibromatosis is unknown. In patients with familial colonic polyposis, the most common localization of desmoid tumor is intra-abdominal. Pancreatic presentation is unusual, requiring differential diagnosis with other pancreatic neoplasms.
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