Goscinski Mariusz Adam, Hole Knut Håkon, Tønne Elin, Ryder Truls, Grøholt Krystyna Kotanska, Flatmark Kjersti
Departments of Gastroenterological Surgery, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Departments of Radiology and Nuclear Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
World J Surg Oncol. 2016 Mar 3;14:63. doi: 10.1186/s12957-016-0818-4.
Abdominoperineal excision is performed in patients with locally advanced, low rectal carcinoma. Reconstruction of the dorsal vagina and perineum using the vertical rectus abdominis myocutaneous flap following extensive surgery results in favorable surgical outcome and quality of life. However, the rectus abdominis muscle, as part of the anterior abdominal wall, may develop fibrous lesions also as a transplant.
A 39-year-old female patient with low rectal cancer and extensive colorectal polyposis was treated with neoadjuvant chemoradiotherapy followed by colectomy and abdominoperineal excision with resection of the dorsal vaginal wall and subsequent reconstruction of the perineum using the vertical rectus abdominis myocutaneous flap. At the 6-month follow-up, a suspected 2 × 2 cm tumor recurrence was detected in the transposed tissue and was subsequently surgically removed. Histologic examination concluded with fibromatosis. Genetic testing revealed a known disease-causing mutation in the adenomatous polyposis coli gene, confirming the diagnosis of familial adenomatous polyposis.
Fibromatosis may affect the anterior abdominal wall, that is the rectus abdominis muscle, at the primary site or may develop in the muscle after its transposition into the perineum at pelvic reconstruction. Fibromatosis in the muscle flap after pelvic reconstruction may present a difficult diagnostic challenge for the multidisciplinary team.
腹会阴联合切除术用于局部晚期低位直肠癌患者。广泛手术后使用腹直肌肌皮瓣重建阴道后壁和会阴可取得良好的手术效果和生活质量。然而，腹直肌作为前腹壁的一部分，作为移植组织时也可能发生纤维性病变。
一名39岁患有低位直肠癌和广泛结肠息肉病的女性患者接受了新辅助放化疗，随后行结肠切除术和腹会阴联合切除术，切除阴道后壁，随后使用腹直肌肌皮瓣重建会阴。在6个月的随访中，在移植组织中检测到疑似2×2 cm的肿瘤复发，随后手术切除。组织学检查结果为纤维瘤病。基因检测发现腺瘤性息肉病基因存在已知致病突变，确诊为家族性腺瘤性息肉病。
纤维瘤病可能影响前腹壁即腹直肌的原发部位，或在骨盆重建时腹直肌转移至会阴后在肌肉中发生。骨盆重建后肌皮瓣中的纤维瘤病可能给多学科团队带来诊断难题。
