Desmoid tumor of the abdominal wall: a case report

Abstract

Introduction: Desmoid tumors are rare lesions without any metastatic potential but a strong tendency to invade locally and to recur. These tumors are associated with women of fertile age, especially during and after pregnancy.

Case presentation: The case of a desmoid tumor of the anterior abdominal wall in a 40-year-old Caucasian man with no relevant family history is presented, describing its appearance on computed tomography and ultrasonography. The patient, who presented with a painless mass in the left anterolateral abdomen, had a history of previous urgent abdominal surgery after a shotgun injury two years earlier. Radical resection of the affected abdominal wall musculature was performed, and the defect was reconstructed with polypropylene mesh.

Conclusion: The diagnosis of desmoid tumor should be strongly considered even in male patients with an abdominal mass and a history of previous abdominal surgery. The goal of its treatment is complete tumor excision and avoidance of the development of complications such as hernia.

Figure 1

Ultrasound image showing a large mass of heterogeneous echogenicity with smooth, sharply defined margins.

Figure 2

Axial CT scan images of the abdomen. Computed tomography examination before (A) the intravenous administration of contrast medium revealing a well-circumscribed mass originating from the left rectus abdominis muscle and of attenuation equal to that of the muscle. The mass demonstrates a mild enhancement even in the delayed images after the intravenous administration of contrast medium (B). The presence of multiple foreign bodies caused by the shotgun injury.

Figure 3

Intraoperative pictures of surgery for abdominal wall desmoid tumor. A) Abdominal wall with tumor. B) Macroscopic view of the tumor. C) Abdominal wall after polypropylene mesh repair.

Figure 4

Microscopic view of the excised rectus desmoid tumor showing fascicles of fibroblastic spindle cells with abundant intercellular collagen. (Hematoxylin and eosin stain; original magnification × 200.)