Girardi Martina, Marano Alessandra, Fortunato Mirella, Gelarda Enrico, Giuffrida Maria Carmela
Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy.
Department of Pathology, Santa Croce e Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy.
Int J Surg Case Rep. 2022 Apr;93:106979. doi: 10.1016/j.ijscr.2022.106979. Epub 2022 Mar 29.
Abdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT.
A healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient's post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected.
The current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis.
Since AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.
腹壁肿块有不同的病因。诊断包括硬纤维瘤（DTs）以及其他良性和恶性病变，其中包括腹壁子宫内膜异位症（AWE）。如果症状不具特异性，诊断具有挑战性，且影像学检查的作用可能有限。我们报告一例AWE病例，根据临床病史和影像学检查被误诊为DT。
一名35岁健康女性，剖宫产术后4年，在右腹直肌内出现一个迅速生长的无痛性脐下肿块。超声和磁共振成像怀疑为DT。患者接受了肿块的完整切除，病理检查显示肌肉中有子宫内膜异位灶。患者术后恢复顺利，18个月随访未发现复发。
本例突出了AWE和DT在临床表现和影像学上的差异，强调了诊断中可能存在的陷阱。在有既往妇科腹部手术史的年轻女性中，当瘢痕部位出现肿块时，AWE是最可能的疾病。鉴别诊断复杂，不过仍应考虑像DT这样的罕见实体。完整的手术切除且切缘阴性被认为是AWE和某些DT的主要治疗方法。肿瘤的最终病理检查可明确诊断。
由于AWE和DT有相似的临床体征和非特异性影像学检查，在有子宫相关手术史的育龄女性出现腹壁肿块时，应考虑这两种疾病。
