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Pujol-Cano N, Bianchi A, Pagan-Pomar A, Ramos-Asensio R, Martínez-Ortega MA, Martinez-Corcoles JA, Gonzalez-Argente XF. Giant mesenteric fibromatosis associated with non-Hodgkin lymphoma. A case report and literature review. Acta Chir Belg 2022; 122:204-210. [PMID: 32644849 DOI: 10.1080/00015458.2020.1794334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- N. Pujol-Cano
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A. Bianchi
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A. Pagan-Pomar
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - R. Ramos-Asensio
- Department of Pathological Anatomy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M. A. Martínez-Ortega
- Department of Pathological Anatomy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - X. F. Gonzalez-Argente
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Kuwabara H, Katayanagi S, Koganezawa I, Nakagawa M, Katsumata K, Tsuchida A, Kawachi S. Sporadic intra-abdominal desmoid tumor with a very unusual onset: two case reports. J Med Case Rep 2021; 15:457. [PMID: 34526110 PMCID: PMC8444561 DOI: 10.1186/s13256-021-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background Intra-abdominal desmoid tumors are rare soft tissue tumors that arise mainly in the mesentery and pelvis. Their etiology may include genetic mutations, estrogen-associated changes after childbirth, and mechanical factors such as a history of abdominal surgery. However, there are cases of intra-abdominal desmoid tumors that develop in the absence of such causes. Since they are rare, diagnosis is often difficult based on clinical findings. We encountered two cases of patients with sporadic intra-abdominal desmoid tumors with a very unusual onset and contrasting features. Case presentation The first patient was a 51-year-old asian man who presented with sudden onset of abdominal pain. He was referred to our department because of a giant tumor detected on abdominal ultrasonography. Imaging revealed a 19-cm tumor with internal tumoral hemorrhage; however, no definitive diagnosis was made. Tumor resection was performed for diagnostic and therapeutic purposes. The second patient was a 41-year-old asian man, and right hydronephrosis was detected on abdominal ultrasonography during a periodic medical checkup. We diagnosed invasion of the primary mesenteric tumor into the right ureter using diagnostic imaging and performed ileocecal resection with partial right ureteral resection for a definitive diagnosis and therapeutic purposes. Although the tumors of both patients had developed from the ileal mesentery, the tumors were substantially different from each other based on their imaging findings, macroscopic morphology, and progression pattern. Meanwhile, they showed similar pathological characteristics. Both consisted of bundles of collagen fibrils of spindle-shaped fibroblasts with low cell atypia. Moreover, they were diagnosed as desmoid tumors using positive immunohistochemical staining for β-catenin. Conclusions Neither patient had susceptibility factors for desmoid tumors, and to our knowledge, there have been very few reports to date of intra-abdominal desmoid tumors that were diagnosed because of acute abdominal pain caused by tumoral hemorrhage or asymptomatic obstructive uropathy. Furthermore, it is clinically interesting that the two patients showed contrasting progression patterns and imaging findings. Intra-abdominal desmoid tumors are rare and may present with various symptoms and findings similar to those observed in our patients. Diagnosis therefore requires experience and knowledge that is not bound by preconceptions.
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Affiliation(s)
- Hiroshi Kuwabara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan. .,Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan.
| | - Sou Katayanagi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Itsuki Koganezawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku Ward, Tokyo, 160-0012, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
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Iranpour M, Dabiri S, Khodarahmi A, Bagheri F. A Giant Solid-Cystic Mesenteric Fibromatosis with Unusual Synchronous Skin Fibromatosis. Arch Iran Med 2021; 24:326-329. [PMID: 34196193 DOI: 10.34172/aim.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/10/2021] [Indexed: 11/09/2022]
Abstract
Mesenteric fibromatosis (MF) is a rare, locally aggressive tumor without distant metastasis, which has a high recurrence rate. Based on its location, it is classified as intra-abdominal, from abdominal wall, and extra-abdominal. The incidence of cystic-solid, retroperitoneal tumors is very low in comparison to other MF forms. Intra-abdominal MFs are asymptomatic in early stages, but their symptoms appear late in the tumor course. There is no specific imaging finding since radiological diagnosis is mostly impossible. Thus, diagnosis is made histopathologically. Nowadays, there is no consensus about its treatment although surgical resection is widely used. In the present study, a very rare case of cystic-solid retroperitoneal MF associated with separate synchronous skin tumors is reported.
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Affiliation(s)
- Maryam Iranpour
- Department of Pathology, Pathology and Stem Cell Research Center, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahriar Dabiri
- Department of Pathology, Pathology and Stem Cell Research Center, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Khodarahmi
- Department of General Surgery, Pathology and Stem Cell Research Center, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Bagheri
- Department of Pathology, Pathology and Stem Cell Research Center, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Abstract
BACKGROUND Colonic volvulus, a condition in which a colonic segment partially twists around its base, is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. However, volvulus of the transverse colon is the rarest type of large intestinal volvulus. Moreover, the occurrence of transverse colonic volvulus secondary to a benign tumor originating from outside the intestine has never been reported. We hereby report a case of transverse colonic volvulus caused by mesenteric fibromatosis. CASE PRESENTATION A 53-year-old female with a history of rheumatoid arthritis and thyroid tumor presented with abdominal pain for 1 day. Abdominal computed tomography revealed intestinal torsion at the hepatic flexure. Twisted and obstructed mucosa of the transverse colon was observed during colonoscopy, but no tumor invasion of the mucosal surface was detected. A solid mass of a mesenteric origin with involvement of the transverse colon was observed during surgery. The mass was diagnosed surgically as transverse colonic volvulus induced by a mesenteric tumor. Hence, the patient underwent a right hemicolectomy. Histopathological results indicated mesenteric desmoid-type fibromatosis. The postoperative recovery was uneventful, and the patient was discharged 8 days after surgery. CONCLUSIONS Although mesenteric fibromatosis is rare, this disease should be considered when managing transverse colonic volvulus resulting from nonmucosal tumors.
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Affiliation(s)
- Akihiro Yoshida
- Department of Gastroenterology, Fuchu Hospital, Izumi, Japan.
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan.
| | | | - Naoki Hosaka
- Department of Pathology, Fuchu Hospital, Izumi, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
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El-Helou E, Alimoradi M, Sabra H, Naccour J, Zaarour M, Haddad MM, Bitar H. A giant mesenteric fibromatosis adherent to the appendix and colonic wall, case report. Int J Surg Case Rep 2020; 77:638-642. [PMID: 33395863 PMCID: PMC7708862 DOI: 10.1016/j.ijscr.2020.11.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
MF is a rare tumor, derived from the mesenchymal tissue. The gold standard in diagnosis is the final pathology result confirmed by immunohistochemistry examining. The definitive treatment is surgical resection when possible. New approach “wait-and-see”, is getting more popular. This is the first documented case adherent to the wall and arising from the mesentery of the ascending colon and appendix.
Background Mesenteric fibromatosis, is a rare neoplasm arising usually from the bowel mesentery, with intermediate behavior and local invasion potential. They can be sporadic or related to multiple factors contributions. They usually presents as an asymptomatic growth of intraabdominal mass, and can reach a large diameter before symptoms appearance. Surgical excision is the definitive treatment when achievable. Case presentation In this case we present a case of 34 years old gentleman, presenting for painless abdominal distension, and found to have a giant mesenteric fibromatosis of 23 cm diameter and 4.5 kg arising from the appendix and colonic mesentery. Treated surgically, and was free of recurrence after 1 year follow up. Conclusion We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal mass.
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Affiliation(s)
- Etienne El-Helou
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Mersad Alimoradi
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Hassan Sabra
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Jessica Naccour
- Emergency Medicine Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Mariana Zaarour
- Anatomic Pathology Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Marwan M Haddad
- Radiology Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
| | - Henri Bitar
- General Surgery Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
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6
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Deshpande A, Tamhane A, Deshpande YS, Pagey R, Pangarkar M. Ball in the Wall: Mesenteric Fibromatosis-a Rare Case Report. Indian J Surg Oncol 2020; 11:73-77. [PMID: 33082700 PMCID: PMC7534782 DOI: 10.1007/s13193-020-01070-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/01/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Mesenteric fibromatosis-desmoid tumor of mesentery is a rare benign soft tissue tumor of mesentery. On CT, it mimics gastrointestinal stromal tumor (GIST). Case Report A 44-year-old female with small intestinal mass, preoperatively diagnosed radiologically and pathologically as GIST. Conclusion Mesenteric fibromatosis is a rare tumor often mistaken for GIST. Histopathology and immunohistochemistry is the key as management of both the tumors differs.
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Affiliation(s)
- Abhinav Deshpande
- National Cancer Institute,Nagpur, 25, Outer Hingna Ring Road, Mouza-Jamtha, Nagpur,, 441108 Maharashtra India
| | - Ankita Tamhane
- National Cancer Institute,Nagpur, 25, Outer Hingna Ring Road, Mouza-Jamtha, Nagpur,, 441108 Maharashtra India
| | | | - Radhika Pagey
- National Cancer Institute,Nagpur, 25, Outer Hingna Ring Road, Mouza-Jamtha, Nagpur,, 441108 Maharashtra India
| | - Meena Pangarkar
- National Cancer Institute,Nagpur, 25, Outer Hingna Ring Road, Mouza-Jamtha, Nagpur,, 441108 Maharashtra India
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7
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Xu Y, Duan Z, Hu W, Zhu K, You J, Abe M, Chen P, Zhang Q, Zong L. Huge mesenteric fibromatosis presenting with intestinal perforation and acute diffuse peritonitis: a case report. Transl Cancer Res 2020; 9:5674-5678. [PMID: 35117931 PMCID: PMC8797417 DOI: 10.21037/tcr-19-1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
Abstract
Mesenteric fibromatosis is a locally invasive myofibroblastic proliferation and rarely metastasize to other organs. Hollow organ perforation and acute diffuse peritonitis caused by mesenteric fibromatosis rarely occurred. Here we report a case of huge mesenteric fibromatosis who complained a paroxysmal epigastric pain, and CT scan showed a huge mass, pneumoperitoneum and ascites. An urgent laparotomy showed an intro-abdominal mass and perforation locating at the jejunum. Postoperative histology confirmed it to be mesenteric fibromatosis. With one-year follow-up, the patient had no recurrence. We wish to share our treating experience of this interesting case because it did not belong to a typical type but presenting with acute diffuse peritonitis, and total resection and R0 margin is a key to treat acute case. This atypical one has not been reported in the literature till now.
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Affiliation(s)
- Yingying Xu
- Department of General Surgery, Yizhen People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Zongkui Duan
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Wenqing Hu
- Department of General Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, China
| | - Kaixuan Zhu
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jun You
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo Hospital, Tokyo, Japan
| | - Ping Chen
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qinyuan Zhang
- Department of Gastrointestinal Surgery, The First People's Hospital of Dali City, Dali, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of General Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, China.,Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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8
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Cai HJ, Wang H, Cao N, Wang W, Sun XX, Huang B. Peutz-Jeghers syndrome with mesenteric fibromatosis: A case report and review of literature. World J Clin Cases 2020; 8:577-586. [PMID: 32110669 PMCID: PMC7031834 DOI: 10.12998/wjcc.v8.i3.577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) and mesenteric fibromatosis (MF) are rare diseases, and PJS accompanying MF has not been previously reported. Here, we report a case of a 36-year-old man with both PJS and MF, who underwent total colectomy and MF surgical excision without regular follow-up. Two years later, he sought treatment for recurrent acute abdominal pain. Emergency computed tomography showed multiple soft tissue masses in the abdominal and pelvic cavity, and adhesions in the small bowel and peritoneum. Partial intestinal resection and excision of the recurrent MF were performed to relieve the symptoms.
CASE SUMMARY A 36-year-old male patient underwent total colectomy for PJS with MF. No regular reexamination was performed after the operation. Two years later, due to intestinal obstruction caused by MF enveloping part of the small intestine and peritoneum, the patient came to our hospital for treatment. Extensive recurrence was observed in the abdomen and pelvic cavity. The MF had invaded the small intestine and could not be relieved intraoperatively. Finally, partial bowel resection, proximal stoma, and intravenous nutrition were performed to maintain life.
CONCLUSION Regular detection is the primary way to prevent deterioration from PJS. Although MF is a benign tumor, it has characteristics of invasive growth and ready recurrence. Therefore, close follow-up of both the history of MF and gastrointestinal surgery are advisable. Early detection and early treatment are the main means of improving patient prognosis.
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Affiliation(s)
- Huai-Jie Cai
- The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Han Wang
- The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Nan Cao
- The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Wei Wang
- The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xi-Xi Sun
- The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Bin Huang
- Department of Ultrasound, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
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Nakanishi K, Shida D, Tsukamoto S, Ochiai H, Mazaki J, Taniguchi H, Kanemitsu Y. Multiple rapidly growing desmoid tumors that were difficult to distinguish from recurrence of rectal cancer. World J Surg Oncol. 2017;15:180. [PMID: 28974244 DOI: 10.1186/s12957-017-1248-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Background Intra-abdominal desmoid tumors are usually slow growing and solitary, but multifocal desmoid tumors develop on rare occasions. Diagnosing desmoid tumors before histological examination of a surgical biopsy is often difficult. In particular, if a patient has a prior history of malignancy, it may be difficult to differentiate between these lesions and disease recurrence or metastasis. Case presentation We present a rare case of multiple rapidly growing intra-abdominal desmoid tumors after surgical trauma, without familial adenomatous polyposis. A 51-year-old male underwent abdominal perineal resection with lateral lymph node dissection after neoadjuvant chemotherapy for lower rectal cancer. Follow-up computed tomography (CT), performed 6 months after primary surgery, showed a 20-mm solitary mass in the pelvic mesentery. Another CT scan, performed 3 months later, revealed that the mass had grown to 35 mm in size and that two new masses had formed. Based on imaging studies and his medical history, it was difficult to distinguish the desmoid tumors from recurrence of rectal cancer. Curative resection was chosen for therapeutic diagnosis. The pathological diagnosis was multiple mesenteric desmoid tumors. Conclusions Desmoid tumors should not be excluded as a differential diagnosis for intra-abdominal masses after intra-abdominal surgery, even in cases of rapidly growing multiple masses.
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Williams AD, Heightchew K, Siripirapu V. Diagnostic and therapeutic dilemmas in intra-abdominal desmoid tumors: A case report and literature review. Int J Surg Case Rep 2016; 26:150-3. [PMID: 27494372 PMCID: PMC4976140 DOI: 10.1016/j.ijscr.2016.07.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/25/2016] [Indexed: 01/29/2023] Open
Abstract
Desmoid tumors are benign but lead to morbidity and mortality due to mass effect. Histologically, desmoid tumors can masquerade as other neoplastic processes. Chemo- and radio-therapy are useful, but surgery is the cornerstone of therapy. The recurrence rate, even after treatment, is high.
Introduction Intra-abdominal desmoid tumors (DTs) are a rare and anatomically diverse group of locally-aggressive, benign neoplasms. They are often difficult to diagnose, even in patients who possess risk factors for the disease. Even after a diagnosis has been reached, the optimal therapy is often not well-defined. Presentation of case The case discussed of a 33-year old male with a giant intra-abdominal desmoid is an example of both the diagnostic and therapeutic dilemmas that arise when confronted with a patient with a DT. Initial confusion over diagnosis led to ineffective therapy, but once the correct diagnosis was made, the patient went on to definitive surgical resection. Discussion The differential diagnosis of DTs is broad, and the diagnosis is often delayed due to nonspecific presentations. Immunohistochemistry is crucial in the accurate histological diagnosis, which guides treatment. Chemotherapy and radiation have a role in the management of both primary and recurrent lesions, but surgical resection remains the cornerstone of treatment. Conclusion DTs present a clinical challenge in their diagnosis and management, and despite providing standard medical and surgical treatment, recurrence rates are high and continued surveillance is crucial.
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Affiliation(s)
- Austin D Williams
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Avenue, Wynnewood, PA 19096, USA.
| | - Kimberly Heightchew
- Department of Pathology, Lankenau Medical Center, 100 E Lancaster Avenue, Wynnewood, PA 19096, USA
| | - Veeraiah Siripirapu
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Avenue, Wynnewood, PA 19096, USA
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11
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Zilberman DE, Mor Y, Fridman E, Ramon J. Mesenteric Fibromatosis Mimicking Tumor Recurrence Following Radical Cystectomy and Bladder Replacement. Urol Case Rep 2016; 3:40-1. [PMID: 26793495 PMCID: PMC4714273 DOI: 10.1016/j.eucr.2014.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/25/2022] Open
Abstract
We report an unusual case of benign tumor mimicking tumor recurrence following radical cystectomy and bladder replacement for high grade urothelial carcinoma.
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Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Yoram Mor
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Edward Fridman
- Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; Tel-Aviv University, Sackler School of Medicine, Israel
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12
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D M, Ghalige HS, R S, Sharma MB, Singh TSC. Mesenteric fibromatosis (desmoid tumour) - a rare case report. J Clin Diagn Res 2015; 8:ND01-2. [PMID: 25584260 DOI: 10.7860/jcdr/2014/8520.5098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
Abstract
Mesenteric Fibromatosis (MF) is a proliferative fibroblastic lesion of small intestinal mesentery. It constitutes 8% of all desmoid tumours, which represent 0.03% of all neoplasm. It is histologically benign but may invade locally and recur after excision. It occurs sporadically or in association with Familial adenomatous polyposis (FAP) mutation as a component of Gardner's syndrome. The presenting features of MF are asymptomatic abdominal mass, abdominal discomfort or pain, bowel or ureteral obstruction, intestinal perforation, fistula, functional impairment of ileoanal anastomosis following colectomy in FAP cases. A 29-year-old male presented with a swelling on the right side of the umbilicus for six months and dull aching pain for two months. Fine needle aspiration cytology, ultrasonography, contrast enhanced computerized tomography findings were inconclusive. After Exploratory laparotomy, a mass approx 6x5x4 cm in ileal mesentery was identified and excised along with 20cm of ileum. End to end anastomosis was done and specimen was sent for histopathology which confirmed the diagnosis of MF. Considering the rarity of this tumour and difficulties in diagnostic and therapeutic ambit, we believe it is justified to describe this case which came to our observation.
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Affiliation(s)
- Mukut D
- Senior Resident, Department of Urology, NEIGRIHMS , Meghalaya, India
| | | | - Santhosh R
- Senior Resident, Department of Surgical Gastro-enterology, Jagjivan Ram Railway Hospital , Mumbai, India
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Sinukumar S, Gomes RM, Kumar RK, Desouza A, Saklani A. Sporadic giant mesenteric fibromatosis. Indian J Surg Oncol 2014; 5:242-5. [PMID: 25419076 DOI: 10.1007/s13193-014-0342-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/28/2014] [Indexed: 11/29/2022] Open
Abstract
Mesenteric fibromatosis is an uncommon tumour which is locally aggressive without any metastatic potential and can occur as a sporadic event or in association with familial adenomatous polyposis syndrome. Giant mesenteric fibromatosis is very rare and is a diagnostic and therapeutic challenge. This is a case report of a rare presentation of deep fibromatosis as a sporadic giant intrabdominal mesenteric tumour in a 29 year old male managed by surgical excision and definitive diagnosis made on the basis of immunohistochemical findings.
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Affiliation(s)
- Snita Sinukumar
- Unit of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, E Borges Road, Parel Mumbai, 400 012 India
| | - Rachel M Gomes
- Unit of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, E Borges Road, Parel Mumbai, 400 012 India
| | - Rajiv K Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Ashwin Desouza
- Unit of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, E Borges Road, Parel Mumbai, 400 012 India
| | - Avanish Saklani
- Unit of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital, E Borges Road, Parel Mumbai, 400 012 India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Abstract
Fibromatosis is a kind of spindle cell tumor which is characterized by the remarkable proliferation and invasive growth of fibrous tissue. It often arises from the abdominal wall or the extremities and rarely from the mesentery and abdominal organs. The patient was 35 year old female whose major complaints were an abdominal mass and pain. She underwent a right hemicolectomy after the tumor was confirmed by abdominal ultrasonography and computerized tomography. Hereby the pathophysiology, diagnosis and the treatment of the disease is discussed.
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16
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Jung SH, Paik CN, Jung JH, Lee KM, Chung WC, Yang JM. Simultaneous Colonic Obstruction and Hydroureteronephrosis due to Mesenteric Fibromatosis. Gut Liver 2010; 3:215-7. [PMID: 20431749 PMCID: PMC2852704 DOI: 10.5009/gnl.2009.3.3.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 05/07/2009] [Indexed: 11/04/2022] Open
Abstract
Mesenteric fibromatosis (MF) is a rare benign mesenchymal lesion that can occur throughout the gastrointestinal tract, especially small bowel. Its biological behavior is intermediate between benign fibrous tissue proliferation and malignant fibrosarcoma. In previously reported cases of MF, we could find colonic obstruction or ureter obstruction, but simultaneous involvement of colon and ureter was not able to be seen. We described a patient that presented with colonic obstruction and hydroureteronephrosis due to MF at sigmoid colon which mimicked submucosal tumor such as gastrointestinal tumor. This case resulted in a positive positron emission tomography scan suggesting malignant neoplasm, but beta-catenin positivity on immunohistochemical staining separated MF from gastrointestinal stromal tumor and sclerosing mesenteritis. The clinical course of the patient was improved after surgical resection.
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Affiliation(s)
- Sung Hoon Jung
- Department of Internal Medicine, College Medicine, The Catholic University of Korea, Seoul, Korea
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17
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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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