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

World Journal of Surgical Oncology, Oct 2017

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. 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. 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.

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

Nakanishi et al. World Journal of Surgical Oncology Multiple rapidly growing desmoid tumors that were difficult to distinguish from recurrence of rectal cancer Koki Nakanishi 0 Dai Shida 0 Shunsuke Tsukamoto 0 Hiroki Ochiai 0 Junichi Mazaki 0 Hirokazu Taniguchi 1 Yukihide Kanemitsu 0 0 Department of Colorectal Surgery, National Cancer Center Hospital , 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045 , Japan 1 Pathology and Clinical Laboratory Division, National Cancer Center Hospital , 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045 , Japan 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. Desmoid tumors; Mesenteric fibromatosis; Rectal cancer; Intra-abdominal; Cancer recurrence Background A desmoid tumor is a monoclonal fibroblastic proliferation that arises from deep soft tissue and is characterized by infiltrative growth and a tendency toward local recurrence but an inability to metastasize [ 1 ]. Desmoid tumors are usually solitary, but multifocal desmoid tumors develop on rare occasions, comprise less than 5% of all desmoid tumor cases, and typically occur at the extremities in premenopausal women [ 2 ]. Intra-abdominal desmoid tumors can be sporadic or occur in association with familial adenomatous polyposis (FAP) [ 3 ]. 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 [ 4–6 ]. Here we report a case of multiple rapidly growing intra-abdominal desmoid tumors which appeared 6 months postoperatively, which could not be differentiated from recurrence of rectal cancer. Case presentation A 51-year-old male, who had received neoadjuvant chemotherapy (nine courses of oxaliplatin/5-fluorouracil/ leucovorin (mFOLFOX6)) for locally advanced lower rectal cancer, underwent abdominal perineal resection with lateral lymph node dissection. He had no remarkable medical or medication history, except for diabetes. He had no family history of FAP. His postoperative recovery was uneventful, with the exception of intrapelvic fluid collection which was drained percutaneously. Histological examination of the tumor revealed a well- to moderately differentiated adenocarcinoma (stage II (pT3N0M0) according to the 7th TNM classification of the International Union Against Cancer) [ 7 ]. He was scheduled for regular cancer surveillance after surgery with three monthly serum carcinoembryonic antigen (CEA) and serum carbohydrate antigen 19-9 (CA19-9) measurements and six monthly contrast-enhanced computed tomography (CT) evaluations of the thorax, abdomen, and pelvis. Six months postoperatively, CT revealed a solitary mass (lesion 1) in the pelvic mesentery, 20 mm in size (Fig. 1). Serum CEA and CA19-9 levels were normal. Recurrence of rectal cancer was suspected, but could not be confirmed, and thus, close follow-up was chosen. Another CT, performed 3 months later, showed that the mass had grown to be 35 × 30 mm in size (lesion 1), with two new masses measuring 20 × 15 mm (lesion 2) and 15 × 10 mm (lesion 3) forming at the mesentery of the small bowel (Fig. 2). Pelvic magnetic resonance imaging (MRI) on T2weighted images revealed that the central part of the tumor was hypointense and the peripheral part was hyperintense, which was gradually enhanced with gadolinium contrast MRI (Fig. 3). Positron emission tomography (PET)-CT showed increased fluorodeoxyglucose (FDG) uptake in all tumors (max standardized uptake value: SUV = 3.31 (lesion 1), 2.55 (lesion 2), and 2.22 (lesion 3)) (Fig. 4) (...truncated)


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Koki Nakanishi, Dai Shida, Shunsuke Tsukamoto, Hiroki Ochiai, Junichi Mazaki, Hirokazu Taniguchi, Yukihide Kanemitsu. Multiple rapidly growing desmoid tumors that were difficult to distinguish from recurrence of rectal cancer, World Journal of Surgical Oncology, 2017, pp. 180, DOI: 10.1186/s12957-017-1248-7