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Surgical excision of an abdominal wall granular cell tumour with Permacol(R) mesh reconstruction: a case report.

Chaudhry A, Griffiths EA, Shah N, Ravi S - Int Semin Surg Oncol (2008)

Bottom Line: Although rare, granular cell tumours can present as an abdominal wall mass.It is important that clinicians are aware of their existence.We used a new biosynthetic procine mesh (Permacol(R)) which appeared to work well in this situation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Blackpool Victoria Hospital, Blackpool Fylde and Wyre NHS Trust, Blackpool, FY2 8NR, UK. eagriffiths@btinternet.com.

ABSTRACT

Introduction: Granular cell tumours of the abdominal wall are extremely rare: less than 10 have been reported in the worldwide medical literature. We report this interesting case, review the relevant literature on this tumour and discuss surgical abdominal wall reconstruction options.

Case presentation: A 70 year old lady presented with a left abdominal mass. This was thought to be a soft tissue sarcoma on CT imaging prior to surgical excision. En-bloc surgical resection was performed. Surgical reconstruction of the abdominal wall defect was performed using Permacol(R) mesh. Histopathological examination of the surgical specimen showed it to be a granular cell tumour.

Conclusion: Although rare, granular cell tumours can present as an abdominal wall mass. It is important that clinicians are aware of their existence. The closure of large defects, after surgical resection of abdominal wall tumours, is a surgical challenge. We used a new biosynthetic procine mesh (Permacol(R)) which appeared to work well in this situation.

No MeSH data available.


Related in: MedlinePlus

This figure documents the surgical resection. (A and B) shows the abdomen after the en-bloc resection of the abdominal wall tumour. Stay sutures are shown on the edges of the large surgical defect. (C) The Permacol® mesh has been sutured on to the inner layer of the abdominal wall in direct contact with the bowel. (D) The peritoneal surface of the excised surgical specimen is shown.
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Figure 2: This figure documents the surgical resection. (A and B) shows the abdomen after the en-bloc resection of the abdominal wall tumour. Stay sutures are shown on the edges of the large surgical defect. (C) The Permacol® mesh has been sutured on to the inner layer of the abdominal wall in direct contact with the bowel. (D) The peritoneal surface of the excised surgical specimen is shown.

Mentions: On examination in the outpatient clinic a 10 × 7 cm firm, fixed lump was found in the left iliac fossa area of the abdomen. Urgent colonoscopic examination revealed mild sigmoid diverticular disease with no evidence of colonic malignancy. Computer Tomography was preformed (Figure 1) and showed the mass to be arising from the anterior abdominal wall muscles, in particular the internal oblique and transversus abdominis. There was no evidence of distant metastatic disease to the liver or lungs. The clinical suspicion was of a malignant abdominal wall sarcoma. Fine needle aspiration or percutaneous biopsy was not performed. En-bloc surgical resection of the tumour was performed via a left flank incision (Figure 2). At surgical resection the tumour mass involved the internal oblique, transversus abdominis and there was a small area of peritoneal ulceration. No distant disease was found at surgery. The tumour was excised en-bloc with a surrounding margin of healthy tissue (Figure 2). Part of the external oblique aponeurosis was preserved to allow adequate closure. The large abdominal wall defect was closed using a sheet of Permacol® mesh (Tissue Science Laboratories plc, Hampshire, England). The Permacol® mesh was sutured to the posterior leaf of the rectus sheath medially and the internal oblique laterally using a slow absorbing polydioxanone suture. The remaining external oblique muscle was closed over the mesh and the subcutaneous tissue and skin were closed in a standard fashion.


Surgical excision of an abdominal wall granular cell tumour with Permacol(R) mesh reconstruction: a case report.

Chaudhry A, Griffiths EA, Shah N, Ravi S - Int Semin Surg Oncol (2008)

This figure documents the surgical resection. (A and B) shows the abdomen after the en-bloc resection of the abdominal wall tumour. Stay sutures are shown on the edges of the large surgical defect. (C) The Permacol® mesh has been sutured on to the inner layer of the abdominal wall in direct contact with the bowel. (D) The peritoneal surface of the excised surgical specimen is shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267469&req=5

Figure 2: This figure documents the surgical resection. (A and B) shows the abdomen after the en-bloc resection of the abdominal wall tumour. Stay sutures are shown on the edges of the large surgical defect. (C) The Permacol® mesh has been sutured on to the inner layer of the abdominal wall in direct contact with the bowel. (D) The peritoneal surface of the excised surgical specimen is shown.
Mentions: On examination in the outpatient clinic a 10 × 7 cm firm, fixed lump was found in the left iliac fossa area of the abdomen. Urgent colonoscopic examination revealed mild sigmoid diverticular disease with no evidence of colonic malignancy. Computer Tomography was preformed (Figure 1) and showed the mass to be arising from the anterior abdominal wall muscles, in particular the internal oblique and transversus abdominis. There was no evidence of distant metastatic disease to the liver or lungs. The clinical suspicion was of a malignant abdominal wall sarcoma. Fine needle aspiration or percutaneous biopsy was not performed. En-bloc surgical resection of the tumour was performed via a left flank incision (Figure 2). At surgical resection the tumour mass involved the internal oblique, transversus abdominis and there was a small area of peritoneal ulceration. No distant disease was found at surgery. The tumour was excised en-bloc with a surrounding margin of healthy tissue (Figure 2). Part of the external oblique aponeurosis was preserved to allow adequate closure. The large abdominal wall defect was closed using a sheet of Permacol® mesh (Tissue Science Laboratories plc, Hampshire, England). The Permacol® mesh was sutured to the posterior leaf of the rectus sheath medially and the internal oblique laterally using a slow absorbing polydioxanone suture. The remaining external oblique muscle was closed over the mesh and the subcutaneous tissue and skin were closed in a standard fashion.

Bottom Line: Although rare, granular cell tumours can present as an abdominal wall mass.It is important that clinicians are aware of their existence.We used a new biosynthetic procine mesh (Permacol(R)) which appeared to work well in this situation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Blackpool Victoria Hospital, Blackpool Fylde and Wyre NHS Trust, Blackpool, FY2 8NR, UK. eagriffiths@btinternet.com.

ABSTRACT

Introduction: Granular cell tumours of the abdominal wall are extremely rare: less than 10 have been reported in the worldwide medical literature. We report this interesting case, review the relevant literature on this tumour and discuss surgical abdominal wall reconstruction options.

Case presentation: A 70 year old lady presented with a left abdominal mass. This was thought to be a soft tissue sarcoma on CT imaging prior to surgical excision. En-bloc surgical resection was performed. Surgical reconstruction of the abdominal wall defect was performed using Permacol(R) mesh. Histopathological examination of the surgical specimen showed it to be a granular cell tumour.

Conclusion: Although rare, granular cell tumours can present as an abdominal wall mass. It is important that clinicians are aware of their existence. The closure of large defects, after surgical resection of abdominal wall tumours, is a surgical challenge. We used a new biosynthetic procine mesh (Permacol(R)) which appeared to work well in this situation.

No MeSH data available.


Related in: MedlinePlus