Incidental Finding and Management of Mesenteric Fibromatosis

Exophytic Gastric Mass Posing a Diagnostic Dilemma: A Case of Mesenteric Fibromatosis

Mesenteric fibromatosis (MF) and gastrointestinal stromal tumor (GIST) are distinct types of lesions that are often mistaken for one another. Fibromatosis of the stomach is a rare condition that can be misdiagnosed as GIST, with MF accounting for only 0.3% of all tumors. Due to its rarity, accurately identifying and appropriately treating this condition poses a significant challenge. Here, we report a case of a 45-year-old female who presented with multiple episodes of vomiting after food intake. Initial radiological investigations suggested a diagnosis of GIST. However, histopathological examination of the surgical excision specimen confirmed fibromatosis with a keloid pattern. Beta-catenin is a key marker for MF; although immunohistochemistry markers were negative for beta-catenin in this case, it is important to note that beta-catenin positivity is observed in only 70-80% of cases. Differentiating these two distinct tumors can be challenging due to potential overlaps in clinical presentation, macroscopic appearance, and even histological features.

Giant mesenteric fibromatosis associated with non-Hodgkin lymphoma. A case report and literature review

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.

Desmoid tumour in an inguinal hernia in a patient with a previous diagnosis of melanoma

A 68-year-old man, without a family history of cancer, was treated for primary cutaneous melanoma of the scalp. Two years later, a right lateral cervical lymph recurrence was observed and he was treated with lymphadenectomy and adjuvant nivolumab for 1 year. Four years from the initial melanoma diagnosis, a computer tomography scan showed a solid nodular lesion of 26 × 40 × 75 mm inside the previously known inguinoscrotal hernia. A new recurrence of melanoma was the most probable diagnosis and a right inguinal hernioplasty was performed. Notably, the histopathological examination revealed a mesenteric fibromatosis with the typical immunohistochemical pattern (strong nuclear staining of β-catenin). Interestingly, this represents the first case of a patient with a mesenteric desmoid tumour presenting as an inguinal hernia masking a cutaneous melanoma recurrence.

A giant mesenteric fibromatosis adherent to the appendix and colonic wall, case report

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MF is a rare tumor, derived from the mesenchymal tissue.

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The gold standard in diagnosis is the final pathology result confirmed by immunohistochemistry examining.

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The definitive treatment is surgical resection when possible.

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New approach “wait-and-see”, is getting more popular.

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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.

Rare acute abdominal condition caused by mesenteric fibromatosis perforation: A case report

RATIONALE

Mesenteric fibromatosis is a rare benign neoplasm with a tendency to spread and recur locally, without metastasis. It may present with a wide spectrum of clinical features; however, onset as a perforation is extremely rare.

PATIENT CONCERNS

The present patient was an 18-year-old female with a 10-hour history of increasing abdominal pain that arose suddenly with nausea and vomiting. She had experienced an appendectomy 2 years before this admission.

DIAGNOSES

A gastrointestinal perforation was initially suspected on the basis of complaints and physical examination. The patient was thoroughly investigated for further diagnosis. Computed tomography showed a large well-defined intra-abdominal mass measuring 7.1 × 6.7 × 5.9 cm in the right lower quadrant, with adjacent small intestine compression and free intraperitoneal air. Then, the patient underwent a laparotomy. Finally, postoperative pathology and immunohistochemistry confirmed mesenteric fibromatosis, with a consecutive perforation from ileum to the bottom of tumor.

INTERVENTIONS

The patient has been treated by a resection of the mass with the adhesive small intestine, without chemotherapy or radiotherapy postoperatively.

OUTCOMES

The patient had an uneventful postoperative recovery. Three months after surgery, the patient reviewed the colonoscopy, no intestinal polyps were noted. The present case has been followed up for 17 months without tumor recurrence.

LESSONS

Our case illustrates another possible cause of acute abdominal pain. Although rare, treating physicians should maintain a high suspicion index while managing a patient with an abdominal mass and pain. Close follow-up is essential because of the high incidence of local tumor recurrence.

Mesenteric fibromatosis in a patient with a history of neuroblastoma: a case report

Mesenteric fibromatosis (MF) is a locally aggressive proliferative spindle cell lesion of the mesentery. A 34-year-old male presented with increasing abdominal pain and constipation. On workup, patient was found to have a large pelvic mass on CT A/P concerning for cancer. The patient underwent surgical excision of >15 cm intra-abdominal tumor along with adherent small bowel section. Histology of the tumor showed a spindle cell lesion consistent with MF. Previous reports have shown association of MF with Gardner syndrome and familial adenomatous polyposis. We present the first reported case of MF in a patient with previous neuroblastoma.

Mesenteric fibromatosis misdiagnosed with lymph node metastasis after successful laparoscopic right hemicolectomy: a report of two cases with review of literature

Fibromatosis is a rare type of tumor derived from the mesenchymal tissue. This is a benign tumor with infiltrating growth but may invade locally and recur following excision. As one type of fibromatosis, mesenteric fibromatosis (MF) accounts for a mere 8% of cases. Although studies have revealed that the etiology of MF is related to trauma, surgery, hormones, and heredity, the specific etiology of fibromatosis remains unclear. With such low incidence, MF has been rarely reported and tends to be misdiagnosed due to insufficient recognition. In this paper, we describe the cases of two patients with MF who were misdiagnosed with lymph node metastasis and who had previously undergone successful laparoscopic right hemicolectomy. We provide this information in order to broaden the clinical understanding of MF.

Giant mesenteric fibromatosis – A case report

Mesenteric fibromatosis or intra-abdominal desmoids tumor is a rare clinical entity. It is a locally aggressive tumor but not metastasizing proliferation. We report a case of a 27-year-old woman with no significant medical and a previous cesarean section, admitted for abdominal pain. The CT abdominal evaluation revealed subserosal uterine fibroid. The patient underwent an elective laparotomy and a mass measuring 20/15/15 cm in diameter to the medial wall of the cecum was discovered. Complete removal was accomplished with right hemicolectomy. Histopathological examination reported mesenteric fibromatosis. Postoperatively, patient was well and 6 month follow-up showed good recovery. Moreover the next month she became pregnant and the pregnancy and birth were uneventful.

Desmoid Fibromatosis Presenting as Deep Venous Thrombosis: A Case Report and Discussion

Patient: Male, 40

Final Diagnosis: Desmoid fibromatosis

Symptoms: Discomfort

Medication: —

Clinical Procedure: Surgery and radiotherapy

Specialty: Surgery