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Bini F, Fiore M, Provenzano S, Bertulli R, Ottini A, Colombo C, Vitellaro M, Greco G, Morosi C, Gronchi A, Casali PG, Palassini E. Management of serious complications in intra-abdominal desmoid-type fibromatosis. Cancer Rep (Hoboken) 2021; 4:e1411. [PMID: 34165246 PMCID: PMC8714535 DOI: 10.1002/cnr2.1411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022] Open
Abstract
Background Desmoid fibromatosis (DF) is a rare and locally infiltrative monoclonal fibroblastic proliferation arising from connective tissues, with lack of metastatic potential. About 10% of all DF cases are intra‐abdominally sited. Complications in this site, due to the locally infiltrative nature of the disease, may be severe and potentially life threatening. However, data on incidence, management, and outcome of these complications are limited. Aim Data of patients with sporadic or FAP‐related intra‐abdominal DF treated at Istituto Nazionale dei Tumori (INT) in Milano from 2005 to 2020 who developed a serious complication during the course of their disease were retrospectively collected and analyzed with a descriptive statistics. Methods and Results Out of 72 intra‐abdominal DF, 8 cases were identified (M/F: 5/3, median age: 35 years, FAP‐related/sporadic: 2/6): 3 with bowel obstruction, 5 with bowel perforation. In 4 cases the serious complication was the first evidence of disease; in the other 4 cases it occurred at a time interval from diagnosis in the range of 4–44 months (during an active surveillance program in one case and during chemotherapy in the other 3 cases). A surgical treatment was feasible and successful in 5 cases. In 3 surgically unmanageable patients, all progressing and experiencing acute complications while on chemotherapy, a non‐surgical approach with intensive supportive treatment and with a prompt change of chemotherapy regimen was implemented, being successful in two, the other patient dying due to a concomitant progressive lymphoma thereafter. Conclusion In this series of intra‐abdominal DF, the incidence of serious complications was 11%. Most patients were successfully treated with surgery. When surgery was deemed to be unfeasible, a conservative management with intensive supportive care and a careful choice of chemotherapy was adopted, ensuring a favorable outcome in most.
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Affiliation(s)
- Federica Bini
- Postgraduation School in Medical Oncology, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Fiore
- Oncological Surgery Unit 4, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Provenzano
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rossella Bertulli
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arianna Ottini
- Postgraduation School in Medical Oncology, Università degli Studi di Milano, Milan, Italy
| | - Chiara Colombo
- Oncological Surgery Unit 4, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Vitellaro
- Hereditary Digestive Tract Tumors Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Greco
- Diagnostic and Interventional Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Diagnostic and Interventional Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Oncological Surgery Unit 4, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| | - Elena Palassini
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Sioda NA, Wakim AA, Wong T, Patel S, Coan K, Row D. A Large Sporadic Intra-abdominal Desmoid-Type Fibromatosis in a Young Male: A Case Report. Front Surg 2020; 7:60. [PMID: 33117845 PMCID: PMC7493805 DOI: 10.3389/fsurg.2020.00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Desmoid type fibromatosis (DTF) is a rare benign tumor of connective tissue origin. While these tumors are typically not malignant, they can exhibit aggressive growth patterns causing mass effect on surrounding organs. These tumors typically present in the extremities and abdominal wall, rarely occurring in the mesentery, and abdominal organs. Due to the rarity of this tumor and the variable size and origin, it is difficult to provide exact prognosis, recurrence, and treatment efficacy regarding desmoid tumors arising from the ileocolic mesentery. We present a case of a young male with a sporadic 31 × 25 × 12 cm DTF arising from the ileocolic mesentery that was complicated by mass effect on bowel and intra-abdominal organs requiring surgical intervention. On presentation, the patient exhibited weight gain and abdominal pressure. Abdominal distension without tenderness on palpation was noted on physical examination. The tumor biopsy confirmed the diagnosis of DTF. No evidence of familial adenomatous polyposis or Gardner syndrome was identified. The tumor was surgically excised and intimately associated with the bowel requiring ileocolonic resection with primary anastomosis. At 3-months follow up, surveillance MRI showed no residual or recurrent lesion. A multi-disciplinary approach to this patient's diagnosis and treatment allowed for an accurate diagnosis, efficient treatment, and follow up plan.
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Affiliation(s)
- Natasha A Sioda
- Creighton University School of Medicine, Phoenix, AZ, United States
| | - Andre A Wakim
- Creighton University School of Medicine, Phoenix, AZ, United States
| | - Tina Wong
- Department of Surgery, Creighton University Arizona Health Education Alliance, Phoenix, AZ, United States
| | - Shyamal Patel
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Kathryn Coan
- Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - David Row
- Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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Burke E, Saeed M, Anant P, Sami B, Salama M, Ahmed I. Large intra-abdominal desmoid tumour posing diagnostic and therapeutic challenges, a case report. J Surg Case Rep 2018; 2018:rjy304. [PMID: 30443319 PMCID: PMC6232280 DOI: 10.1093/jscr/rjy304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/08/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022] Open
Abstract
We present the case of a 46-year-old gentleman originally from China who presented to the acute surgical assessment unit complaining of upper abdominal discomfort, dyspepsia and early satiety ongoing for the previous 6 months. On exam he had a palpable mass in the left upper quadrant. He underwent an esophagogastroduodenoscopy which was normal and later received a CT abdomen which identified a well-circumscribed soft tissue mass in the mesenteric fat and lying adjacent to the transverse colon with no obvious cleavage plane between them. Colonoscopy was then performed which was normal. After discussion at MDT he was taken for laparotomy. At laparotomy the mass was found to be adherent to major vessels, small bowel and large bowel necessitating an extended right hemicolectomy and small bowel resection. The mass itself could not be completely excised. Histology from the resected specimen confirmed desmoid tumour.
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Affiliation(s)
- Eoghan Burke
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Munir Saeed
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Paul Anant
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Babur Sami
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Mohamed Salama
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
| | - Ibrahim Ahmed
- Department of Surgery, Our Lady Of Lourdes Hospital, Drogheda, Ireland
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