Desmoid Tumor (DT), also called aggressive fibromatosis, is a non-malignant tumor of the mesenchymal stem cells. Although DTs are not malignant and do not metastasize, they are locally aggressive tumors and are hence referred to as a “benign malignancy.” Due to the variable natural history of DTs, there is no standard treatment modalities. However, surgical resection with microscopic negative margins (R0) is considered the mainstay therapy for a DT.
There is scarce literature discussing this rare
tumor. Here, we report a case of a 30-year-old male patient who presented with
an extremely large abdominal wall DT, with the size of 15x16x20 cm. The tumor
had developed beneath the incision site of previous surgery. The tumor was
removed with microscopic negative surgical margins. In a one-year follow-up,
patient had no complaints and there were no signs of tumor recurrence. His MRI
did not show regrowth of the tumor.
Figure 1: CT-scan of the patient’s abdominal DT. CT scan was performed prior to surgery with and without contrast. The CT scan shows the presence of a large abdominal tumor. There is a 154x118 mm tumor soft tissue mass lesion on the left side of the abdominal wall with subtle enhancement. The differential diagnosis based on the CT scan was a solitary fibroma tumor, abdominal fibromatosis or soft tissue sarcoma.
Figure 2: The patient’s abdominal mass immediately prior to surgical resection and two weeks after surgery. The DT, due to its large size, was causing cosmetic concerns and difficulty sleeping for the patient.
Figure 3: The raw DT that was recovered from the patient immediately following surgery. The DT was extremely large, with the size of 15x112x8 cm, one of the largest cases of abdominal fibromatosis reported in the literature.
Figure 4: The histologic sample biopsy. The microscopic
examination of the biopsy shows “neoplastic component with a proliferation of
benign-looking spindle fibers with a fascicular architecture”. The cells show a
vesicular nucleus with inconspicuous nucleoli and eosinophilic cytoplasm
separated by bundles of collagen. No mitotic figures or necrosis were present
in the microscopic exam of the biopsy slides. According to the presentation and
the microscopic features of the biopsy, the final diagnosis was made to be a
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