Desmoid Tumors: A Clear Perspective or a Persisting Enigma? A Case Report and Review of Literature

Abstract

Desmoid tumors are benign but locally aggressive tumors of mesenchymal origin which are poorly circumscribed, infiltrate the surrounding tissue, lack a true capsule and are composed of abundant collagen. History of trauma or surgery to the site of tumor origin is elicited in up to one in four cases and they most commonly develop in the anterior abdominal wall and shoulder girdle but they can arise in any skeletal muscle. The clinical behavior and natural history of desmoid tumors are unpredictable and management is difficult with many issues remaining controversial, mainly regarding early detection, the role, type and timing of surgery and the value of non-operative therapies. We report a case of anterior abdominal wall desmoid tumor in a 40-year-old male with a previous history of surgery.

Keywords: Adenomatous polyposis coli mutation; Desmoid; Familial adenomatous polyposis; Gardner’s syndrome; Mesenchymal tumors.

Figure 1

Fine-needle aspirates of desmoid tumors showing coherent clusters of uniform spindle cells with abundant cytoplasm and oval to elongated nuclei with evenly distributed chromatin. Large, basophilic multinucleate cells representing atrophic muscle fibers are also seen.

Figure 2

Core needle biopsies of desmoid tumors showing the characteristic histological features, including evenly distributed fibroblastic tumor cells enclosed in a collagenous matrix, medium sized angulated vessels and enclosure of atrophic muscle fibers.

Figure 3

Fibrocytic cells of a desmoid tumor growing in a haphazard manner and producing collagen.

Figure 4

Desmoid tumor spindle cells invading skeletal muscle.