Pregnancy-associated desmoid fibromatosis: A Dutch multi-centre retrospective study

Impact and safety of pregnancy on desmoid fibromatosis management in the era of active surveillance. An international multicenter retrospective observational study

AIM

To evaluate desmoid fibromatosis (DF) progression and obstetric outcomes during and after pregnancy, providing evidence to inform clinical decision-making and counseling.

METHODS

This international, multicenter, retrospective observational study included data from 157 women with DF, contributing 177 pregnancies. Women were classified into three groups: DF diagnosed during pregnancy (Group A), pregnancy occurring after the diagnosis of DF (Group B: DF in situ during pregnancy), or pregnancy in previously resected DF (Group C). Logistic regression and tumor size trend analyses were conducted.

RESULTS

Among 177 pregnancies, Group A exhibited the highest rates of DF progression (68.7 % during pregnancy, 40.6 % postpartum), while Groups B and C had lower progression rates (9.5 % during pregnancy, 8.3 % postpartum). Active treatment was required in 5.6 % of cases. Spontaneous regression occurred in 23.7 % of pregnancies, particularly following progression. Obstetric complications were comparable to those in the general population.

CONCLUSION

Pregnancy is generally safe for women with DF, particularly after prolonged disease stability. Individualized counseling is essential for managing risks of progression and recurrence, supporting informed fertility decisions. Referral to specialized centers is recommended to optimize DF management during family planning and pregnancy.

Marginal resection preferred over radical resection for a large abdominal wall desmoid tumor during pregnancy: A case report

Desmoid tumors are locally aggressive soft-tissue tumors known for their lack of metastatic potential but high recurrence rate after resection. Few cases of desmoid tumors during pregnancy have been reported, making treatment decisions more challenging. This report presents the case of a woman with an abdominal wall desmoid tumor resected at 17 weeks of gestation. The large mass (13.4 cm × 7.4 cm) was compressing the uterus, which necessitated surgical intervention. Marginal resection of the tumor was performed with microscopically positive margins. The patient's postoperative course was uneventful, and she had a normal vaginal delivery at 38 weeks. No recurrence of the tumor was observed at 24-month follow-up. This case represents the largest pregnancy-related abdominal desmoid tumor (22 cm × 12 cm) resected marginally during pregnancy. The procedure allowed for a vaginal delivery rather than a cesarean section. Surgical management of desmoid tumors in pregnancy should aim to remove the tumor while preserving function and anatomical integrity. While this approach is feasible for smaller tumors, larger tumors, as in this case, may result in loss of function and anatomical structure. This raises the question of whether marginal resection should be considered when preservation of function and structure is not feasible with radical resection. This case reinforces the fundamental surgical principle that when clear surgical margins cannot be achieved without compromising function and structure, marginal resection should be considered.

Desmoid Tumors in the Active Surveillance Era: Evaluation of Treatment Options and Pain Relief in a Single-Center Retrospective Analysis

In patients with desmoid tumors (DTs), active surveillance has been increasingly preferred over surgery, while treatment (including pharmacological therapy, radiotherapy, and/or surgery) is performed in cases with confirmed disease progression. This study aimed to evaluate event-free survival and pain management according to different treatment strategies. We evaluated event-free survival, including recurrence after initial surgical treatment or changes in the therapeutic management after initial non-surgical treatment and pain management according to different treatment strategies. All patients referred for DT in 2001-2021 at our institutions were stratified into four groups: those treated surgically prior to 2012 (SGPre12) or after 2012 (SGPost12), those treated pharmacologically (MG), and those under active surveillance (ASG). An event was defined as recurrence after initial surgical treatment or a change in therapeutic management. Overall, 123 patients were included in the study: 28 in SGPre12, 41 in SGPost12, 38 in MG, and 16 in ASG. Pharmacological treatment resolved painful symptoms in 16/27 (60%) patients (p = 0.0001). The median follow-up duration was 40 months (IQR 23-74). Event-free survival at 1, 3, and 5 years was: 85%, 70%, and 62% in SGPre12; 76%, 58%, and 49% in SGPost12; 49%, 31%, and 31% in MG; and 45%, 45%, and 45% in ASG. Our findings support the role of active surveillance as initial management, as demonstrated by the fact that about half the patients did not experience any progression, while surgery can be reserved as a first-line approach for selected patients. In terms of pain relief, medical therapy led to symptom resolution in more than half the cases.