Intra-abdominal fibromatosis: differentiation from gastrointestinal stromal tumour based on biphasic contrast-enhanced CT findings

An intra-abdominal desmoid tumour: Case report

INTRODUCTION AND IMPORTANCE

Desmoid tumours typically arise in the abdomen and extremities. They are rare, originating from mesenchymal cells, with intra-abdominal desmoid tumours (DT) being even less common. While non-malignant and non-metastatic, they can be locally invasive, often necessitating surgical intervention for complete resection.

CASE PRESENTATION

We present the case of a 26-year-old woman referred to our emergency department with pelvic pain three months after cesarean delivery. Abdominal computed tomography revealed a 7 cm retro-uterine mass extending to the right colon, appendix, and cecum. Although MRI suggested an intra-mesenteric benign tumour, a definitive diagnosis was not established. Surgical excision was performed for both diagnostic and therapeutic purposes, revealing a 5.5 cm desmoid tumour infiltrating adipose and muscular tissue of the last ileal loop, with negative resection margins. Postoperative recovery was uneventful, and the patient is under CT surveillance.

CLINICAL DISCUSSION

Intra-abdominal DTs are exceedingly rare and can present with a spectrum of symptoms. Imaging findings may mimic other conditions, making diagnosis challenging. Surgical expertise is crucial for optimal management, with complete resection being the primary therapeutic approach.

CONCLUSION

In conclusion, intra-abdominal desmoid tumours are rare entities that pose diagnostic and therapeutic challenges. Surgeons experienced in handling such cases are essential for achieving favourable outcomes. Continued surveillance is necessary due to the potential for recurrence.

A Rare Case of Recurrent Intra-abdominal Desmoid-Type Fibromatosis

Desmoid-type fibromatosis is an uncommon fibroblastic or myofibroblastic tumour arising in deep soft tissues with no metastatic potential. This case report presents a 78-year-old male patient with an incidental finding of desmoid-type fibromatosis of the abdomen with recurrence within two years and required surgical interventions. Primarily, a computed tomography (CT) of the abdomen and pelvis showed an incidental finding of a large soft tissue mass in the right iliac fossa mesentery measuring 11 by 8.5 cm. The patient underwent a successful elective exploratory laparotomy and resection of the mass along with a small bowel. A final pathology revealed the mass to be a primary desmoid of the small bowel. Despite clear resection margins, the patient developed recurrence after 17 months, which was treated with surgical resection. His post-operative course was uneventful. The patient's clinical presentation, management, and diagnosis are discussed in this case report.

Can lymphovascular invasion be predicted by contrast-enhanced CT imaging features in patients with esophageal squamous cell carcinoma? A preliminary retrospective study

Background

To investigate the value of contrast-enhanced CT (CECT)-derived imaging features in predicting lymphovascular invasion (LVI) status in esophageal squamous cell carcinoma (ESCC) patients.

Methods

One hundred and ninety-seven patients with postoperative pathologically confirmed esophageal squamous cell carcinoma treated in our hospital between January 2017 and January 2019 were enrolled in our study, including fifty-nine patients with LVI and one hundred and thirty-eight patients without LVI. The CECT-derived imaging features of all patients were analyzed. The CECT-derived imaging features were divided into quantitative features and qualitative features. The quantitative features consisted of the CT attenuation value of the tumor (CTV_Tumor), the CT attenuation value of the normal esophageal wall (CTV_Normal), the CT attenuation value ratio of the tumor-to-normal esophageal wall (TNR), the CT attenuation value difference between the tumor and normal esophageal wall (ΔTN), the maximum thickness of the tumor measured by CECT (Thickness), the maximum length of the tumor measured by CECT (Length), and the gross tumor volume measured by CECT (GTV). The qualitative features consisted of an enhancement pattern, tumor margin, enlarged blood supply or drainage vessels to the tumor (EVFDT), and tumor necrosis. For the clinicopathological characteristics and CECT-derived imaging feature analysis, the chi-squared test was used for categorical variables, the Mann–Whitney U test was used for continuous variables with a nonnormal distribution, and the independent sample t-test was used for the continuous variables with a normal distribution. The trend test was used for ordinal variables. The association between LVI status and CECT-derived imaging features was analyzed by univariable logistic analysis, followed by multivariable logistic regression and receiver operating characteristic (ROC) curve analysis.

Results

The CTV_Tumor, TNR, ΔTN, Thickness, Length, and GTV in the group with LVI were higher than those in the group without LVI (P < 0.05). A higher proportion of patients with heterogeneous enhancement pattern, irregular tumor margin, EVFDT, and tumor necrosis were present in the group with LVI (P < 0.05). As revealed by the univariable logistic analysis, the CECT-derived imaging features, including CTV_Tumor, TNR, ΔTN and enhancement pattern, Thickness, Length, GTV, tumor margin, EVFDT, and tumor necrosis were associated with LVI status (P < 0.05). Only the TNR (OR 8.655; 95% CI 2.125–37.776), Thickness (OR 6.531; 95% CI 2.410–20.608), and tumor margin (OR 4.384; 95% CI 2.004–9.717) were independent risk factors for LVI in the multivariable logistic regression analysis. The ROC curve analysis incorporating the above three CECT-derived imaging features showed that the area under the curve obtained by the multivariable logistic regression model was 0.820 (95% CI 0.754–0.885).

Conclusion

The CECT-derived imaging features, including TNR, Thickness, tumor margin, and their combination, can be used as predictors of LVI status for patients with ESCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-022-00804-7.

Sporadic intra-abdominal desmoid tumor with a very unusual onset: two case reports

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.

Differentiation of intra-abdominal desmoid tumor from peritoneal seeding based on CT and/or 18F-FDG PET-CT in patients with history of cancer surgery

PURPOSE

To investigate differential imaging features of intra-abdominal desmoid tumors and peritoneal seeding in patients with history of cancer surgery.

METHODS

Thirty-two patients who had a single pathologically proven intra-peritoneal lesion that developed after cancer surgery were enrolled between January 2000 and June 2019. There were 16 desmoid tumors and 16 peritoneal seeding lesions. Portal phase CT and/or ¹⁸F-FDG PET findings were analyzed by two radiologists in consensus for the following items: location, size, shape, margin, contour, homogeneity, necrosis, adjacent organ invasion, calcification, intra-lesional fat, peritoneal infiltration, mass effect, and degree of enhancement. Hounsfield units (HU) and maximum standardized uptake values (SUV_max) of the lesions were measured. Imaging findings were compared using the Chi square test, Fisher's exact test, and student t test.

RESULTS

Desmoid tumors frequently showed well-defined margins (9/16) and smooth contours (12/16), whereas peritoneal seeding had ill-defined margins (13/16) and lobulated contours (11/16) (P = 0.028 and 0.013, respectively). Intra-lesional fat was found more frequently in desmoid tumors (7/16) than peritoneal seeding (1/16) (P = 0.014). Desmoid tumors showed iso-attenuation (13/16) compared to psoas muscle in portal phase, while peritoneal seeding depicted high attenuation (12/16) (P = 0.002). Mean HU was significantly lower in desmoid tumors (64.3) than peritoneal seeding lesions (95.1) (P = 0.001). However, the mean SUV_max of desmoid tumors (4.1) did not significantly differ from peritoneal seeding lesions (5.2) (P = 0.519).

CONCLUSION

Several CT features including iso-attenuation in portal phase and presence of intra-lesional fat can be helpful in differentiating desmoid tumors from peritoneal seeding in patients with history of intra-abdominal cancer surgery.

Successful treatment of giant mesenteric fibromatosis with surgery and tamoxifen: case report

A 65-year-old man underwent excision of a giant mesenteric fibromatosis (MF) via combined splenectomy and partial transverse colectomy. Pathological examination confirmed the presence of MF, whereas genetic testing indicated that the tumor was sensitive to tamoxifen. Over a 1-year follow-up, no symptoms of abdominal discomfort or recurrence was noted.

Intra-abdominal desmoid tumors mimicking gastrointestinal stromal tumors - 8 cases: A case report

BACKGROUND

Intra-abdominal desmoid tumors (DTs) can mimic recurrence or progression of gastrointestinal stromal tumors (GISTs). Differential diagnosis is important to avoid unnecessary or inappropriate treatment.

CASE SUMMARY

All 8 patients experienced surgical resection of GIST, and median time to diagnosis of DT was 1.8 years after surgical resection. All sites of DT were in the peritoneum around the surgical sites of GIST. The following clinical suspicion coupled with radiological findings contributed to the suspicion of intra-abdominal DTs: (1) Occurrence of a new single lesion in the peritoneum around the surgical sites of GIST; (2) uncontrolled lesion with imatinib while other lesions being controlled with imatinib; (3) well-defined ovoid shaped lesion with delayed or mild enhancement and absence of necrosis, hemorrhage, and cystic change on computed tomography; and (4) a lesion showing mild or no hypermetabolic activity on 18fluorodeoxyglucose-positron emission tomography, contrary to initially hyperactive lesion of GIST. All DTs were surgically removed except for one unresectable DT and only one DT recurred at another site of peritoneum, which was also surgically removed.

CONCLUSION

Intra-abdominal DT should be a differential diagnosis for a new single lesion in patients with GIST.

New intra-abdominal mass after operation for colorectal cancer: desmoid tumor versus peritoneal seeding

PURPOSE

To identify differential clinical and imaging findings between intra-abdominal desmoid tumors and peritoneal seeding that developed after surgery for colorectal cancer.

METHODS

8 patients (9 desmoid tumors) and 11 patients (13 peritoneal seeding masses) were enrolled in our retrospective study. Patients with three or more tumors were excluded. Clinical findings including location of initial tumors, type of surgery, T- and N-stages of initial tumors, time interval between initial surgery and development of intra-abdominal tumors, and level of carcinoembryonic antigen (CEA) were evaluated. Imaging findings of intra-abdominal tumors including size, number, growth rate, location, shape, homogeneity, relative enhancement, and maximum standardized uptake value were evaluated. The Mann-Whitney U test and Fisher's exact test were used to compare clinical and imaging findings between desmoid tumors and peritoneal seeding.

RESULTS

In patients with a desmoid tumor, initial T-stage, initial N-stage, and level of CEA at the time of surgery for intra-abdominal tumor were lower than in patients with peritoneal seeding (p = 0.027, p = 0.033, and p = 0.017). The desmoid tumors were frequently located in the small bowel mesentery (p = 0.018) and were larger at detection (p = 0.041). Round or ovoid shapes on CT images were more frequently observed with the desmoid tumors (p = 0.035).

CONCLUSIONS

Stage of colorectal cancer, CEA level, and location, size, and shape of new intra-abdominal tumors can be helpful for differentiating between intra-abdominal desmoid tumors and peritoneal seeding in patients with a history of colorectal cancer surgery.

Multiple rapidly growing desmoid tumors that were difficult to distinguish from recurrence of rectal cancer

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.

Mesenteric fibromatosis

Mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. Because of rarity, these tumors pose a diagnostic and therapeutic challenge. These tumors may remain asymptomatic, but commonly present as a painless mass. There are no clear treatment guidelines. Surgical excision with wide margin is the preferred modality of treatment. Medical therapy is indicated for inoperable and recurrent tumors. There are several isolated case reports on mesenteric fibromatosis with different and unusual presentations and its complications. Though several studies have been published on extra-abdominal fibromatosis as well as on extramesenteric abdominal fibromatosis, but extensive research studies are still lacking on mesenteric fibromatosis. The aim of this article is to present current knowledge on mesenteric fibromatosis, our experience of four cases, and comprehensive review of available literature.

Intra-abdominal fibromatosis after gastrectomy for gastric cancer

Intra-abdominal fibromatosis (IAF) may arise either sporadically or in association with familial adenomatous polyposis. The characteristics of fibromatosis are slow-growth, benign histological features, and aggressive local invasion. Surgery remains a reasonable first treatment option. Here, we report 2 cases of a phenomenon rarely described in published literature, IAF after gastrectomy for gastric cancer. Intra-abdominal masses were found during the routine follow-up period in a 50-year-old man who had received a radical subtotal gastrectomy for early gastric cancer. Two mesenteric masses were detected in the upper abdomen by CT and were excised completely along with segments of the jejunum. Another intra-abdominal mass was found in 60-year-old man who had received a radical total gastrectomy for advanced gastric cancer. A 4.2-cm-sized mass was detected in the periumbilical region by follow-up CT and was excised completely along with a segment of the ileum.