Takada Musashi, Okuyama Takashi, Yoshioka Ryuji, Noie Tamaki, Takeshita Emiko, Sameshima Shinichi, Oya Masatoshi
Department of Surgery, Saitama Medical Center, Dokkyo Medical University, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
Surg Case Rep. 2019 Feb 28;5(1):38. doi: 10.1186/s40792-019-0587-8.
Intra-abdominal desmoid tumors are rare and generally occur in some patients with familial adenomatous polyposis or secondary to an external stimulus such as surgical trauma. We report herein a case of intra-abdominal desmoid tumor in the jejunal mesentery after laparoscopic colectomy for sigmoid colon cancer.
A 74-year-old woman underwent laparoscopic sigmoid colectomy for colon cancer with pathological stage I. Follow-up computed tomography (CT) 18 months after primary surgery showed a nodular and enhanced soft tissue density mass, 20 mm in size, in the mesentery at the left side of the abdomen. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range. Fluorodeoxyglucose positron emission tomography did not suggest cancer recurrence. Another CT scan, done 1 month later, revealed that the tumor had enlarged to 25 mm in size. Although the pathological diagnosis was not obtained, we suspected recurrence of the sigmoid colon cancer and applied chemotherapy using capecitabine, oxaliplatin, and bevacizumab. After 3 cycles of chemotherapy, however, the tumor had enlarged further. Therefore, the surgical resection of the tumor was performed to determine the diagnosis and to achieve possible curative resection of the tumor. The tumor existed in the mesentery of the jejunum, 100 cm from the ligament of Treitz, and showed invasive growth. We resected 40 cm of the jejunal segment together with the tumor. Microscopically, the tumor was composed of fibroblast, myofibroblast, and infiltrating the inflammatory cell and diagnosed as desmoid tumor by immunostaining (desmin+/-, β-catenin+, CD117-, vimentin+). At 33 months after the resection of the desmoid tumor, neither the sigmoid colon cancer nor desmoid tumor has had a recurrence.
After surgery for gastrointestinal cancer, it is difficult to differentiate between intra-abdominal desmoid tumor and recurrence. The possibility of intra-abdominal desmoid should be considered along with tumor recurrence during postoperative surveillance after resection of gastrointestinal cancer, especially when the risk of recurrence is low.
腹腔内硬纤维瘤罕见，通常发生于某些家族性腺瘤性息肉病患者或继发于手术创伤等外部刺激。我们在此报告一例乙状结肠癌腹腔镜结肠切除术后空肠系膜内腹腔硬纤维瘤病例。
一名74岁女性因病理分期为I期的结肠癌接受了腹腔镜乙状结肠切除术。初次手术后18个月的随访计算机断层扫描（CT）显示，腹部左侧肠系膜内有一个大小为20毫米的结节状强化软组织密度肿块。血清癌胚抗原（CEA）和糖类抗原19-9（CA19-9）水平在正常范围内。氟脱氧葡萄糖正电子发射断层扫描未提示癌症复发。1个月后进行的另一次CT扫描显示肿瘤已增大至25毫米。尽管未获得病理诊断，但我们怀疑乙状结肠癌复发，遂应用卡培他滨、奥沙利铂和贝伐单抗进行化疗。然而，3个周期的化疗后，肿瘤进一步增大。因此，进行了肿瘤手术切除以明确诊断并实现肿瘤的根治性切除。肿瘤位于距屈氏韧带100厘米处的空肠系膜内，呈浸润性生长。我们连同肿瘤一起切除了40厘米的空肠段。显微镜下，肿瘤由成纤维细胞、肌成纤维细胞组成，并伴有炎性细胞浸润，免疫染色诊断为硬纤维瘤（结蛋白±、β-连环蛋白+、CD117-、波形蛋白+）。硬纤维瘤切除术后33个月，乙状结肠癌和硬纤维瘤均未复发。
胃肠道癌手术后，难以区分腹腔内硬纤维瘤和复发。在胃肠道癌切除术后的监测中，应考虑腹腔内硬纤维瘤的可能性以及肿瘤复发，尤其是在复发风险较低时。
