eISSN: 1897-4317
ISSN: 1895-5770
Gastroenterology Review/Przegląd Gastroenterologiczny
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3/2017
 
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Local recurrence of sporadic mesenteric fibromatosis following radical surgery attacking the proximal jejunum

Selçuk Gülmez, Ebubekir Gündeş, Aziz Serkan Senger, Orhan Uzun, Ulaş Aday, Hüseyin Çiyiltepe, Durmuş Ali Çetin, Emre Bozdağ, Kamuran Cumhur Değer, Erdal Polat

The term “desmoid” was first coined by Müller in 1838, having derived it from the Greek word “desmos,” meaning ligament or tendon [1]. Desmoid-type fibromatosis, also known as aggressive fibromatosis, is a rare mesenchymal tumour characterised by the over-multiplication of fibroblasts and myofibroblasts originating from the deep muscular fascia, aponeurosis, tendon, and scar tissue [2]. It accounts for about 0.03% of all tumours, while its rate is about 3% in all soft tissue tumours. Its annual incidence is 2–4 per million. Desmoid-type fibromatosis is seen more often in female patients aged between 10 and 40 years [3].
It histologically has a benign morphology, but it has been classified as “intermediate malign” due to its high rate of local recurrence because of the infiltration of neighbouring structures following radical surgery [4]. Although desmoid tumours have been characterised as aggressive with these characteristics, most of them grow slowly and do not metastasise [5].
A 48-year-old female patient presented with complaints of intermittent epigastric pain, nausea, and rarely vomiting. The patient, who had no previous history of abdominal surgery, had menstrual irregularities. Her family history revealed no malignity cases. There were no pathologies in her laboratory parameters other than iron deficiency anaemia. Her tumour markers were within normal values. The patient’s preoperative gastroscopy and colonoscopy results were normal. The abdominal computed tomography (CT) showed a heterogeneous solid mass of 9.5 × 8 × 7 cm in the upper abdomen middle part with smooth borders localised in the mesenteric bowel, closely neighbouring the transverse colon and intestinal loops, displacing them, but whose origin could not be clearly differentiated (Figure 1 A). Intraoperative findings included a mass invading the neighbouring omentum majus by surrounding the jejunal serosa originating from the jejunal mesentery at 10 cm distal from the Treitz (Figure 1 B). No additional intraabdominal pathologies and metastases were found. The 25 cm jejunum and the invaded omentum were resected in a block alongside the mass (Figure 1 C). End-to-end jejunojejunostomy was performed for intestinal continuity. The macroscopic analysis of the surgical piece revealed a circular, partly lobulated mass of 9.5 × 8 × 7 cm with smooth borders localised in the jejunal mesentery attacking the jejunal serosa, which had elastic consistency and a...


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