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A Rapidly Growing Abdominal Mass: Desmoid Tumor in Pregnancy.

Leon MG, Moussa HN, Movahedian M, Viteri OA, Longo M, Sibai BM - AJP Rep (2014)

Bottom Line: Case A giant desmoid tumor arising from the left abdominal wall of a young female patient with rapid growth during pregnancy is described.Decision made by a multidisciplinary team was not to intervene before birth, and abdominal delivery at term was accomplished.Future studies are needed for better understanding of the pathogenesis, diagnosis, and treatment of desmoid tumors in pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health and Science Center at Houston, Houston, Texas.

ABSTRACT
Background Desmoid tumors are benign soft tissue tumors that locally invade adjacent tissue. There is a paucity of reports describing the rapid growth of these tumors during pregnancy. Case A giant desmoid tumor arising from the left abdominal wall of a young female patient with rapid growth during pregnancy is described. Preoperative evaluation included ultrasonography and magnetic resonance imaging. Decision made by a multidisciplinary team was not to intervene before birth, and abdominal delivery at term was accomplished. Conclusion Desmoid tumors should be part of the differential diagnosis in an abdominal wall tumor of rapid growth during pregnancy. Future studies are needed for better understanding of the pathogenesis, diagnosis, and treatment of desmoid tumors in pregnant women.

No MeSH data available.


Related in: MedlinePlus

(A) Linea alba. (B) Spine. (C) Left psoas muscle. Arrow: Left abdominal wall mass. Tip of arrow: Gravid uterus at 28 weeks of gestational age.
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FI140037-3: (A) Linea alba. (B) Spine. (C) Left psoas muscle. Arrow: Left abdominal wall mass. Tip of arrow: Gravid uterus at 28 weeks of gestational age.

Mentions: A 24-year-old woman presented to our department for prenatal care at 14 weeks of gestational age (GA). Her obstetrical history included a first trimester spontaneous abortion and two full term pregnancies resulting in spontaneous vaginal deliveries. She had a 2-year history of a hyperdense lesion documented by computed tomography scan that had undergone minimal interval growth within the anterior left abdominal wall (Fig. 1). No other relevant surgical or medical history was noted. Physical examination at 23 weeks of GA revealed a mass protruding from the left abdominal wall. Ultrasonography revealed a single intrauterine pregnancy, as well as a large 11.7 × 12.3 × 17 cm left lower quadrant mass located above the bladder and below the gravid uterus. Considering the characteristics of the mass, the first diagnostic presumption was that of a uterine fibroid. A follow-up ultrasound at 28 weeks demonstrated interval growth of the mass to 16.5 × 11.8 × 18.5 cm (Fig. 2). Magnetic resonance imaging (MRI) for better characterization showed a 19.5 × 10.8 cm transverse × 13.3 cm craniocaudal mass with heterogeneously T2 hyperintense and T1 iso- to slightly hyperintense mass centered within the left abdominal wall musculature (Fig. 3). The mass displaced the gravid uterus and compressed the left gonadal vessels, left ureter, and left psoas muscle without a clear fat plane between the mass and these structures. It also abutted several loops of small bowel in the left abdomen and extended into the peritoneal cavity. Mild left hydronephrosis and hydroureter were also found proximal to the ureteral compression. No enlarged lymph nodes were found. Given patient's age, gender, and tumor location, a large abdominal wall desmoid tumor was suspected. A multidisciplinary evaluation including general surgery resolved not to intervene until after delivery. This decision was driven by the vast vascularization of the tumor and the need for further testing. At 38 weeks and 6 days of GA a slightly tender mass was palpated on physical examination (Fig. 4). Follow-up ultrasonography reported a mass of 18 × 13 × 18.9 cm and a fetus in complete breech presentation.


A Rapidly Growing Abdominal Mass: Desmoid Tumor in Pregnancy.

Leon MG, Moussa HN, Movahedian M, Viteri OA, Longo M, Sibai BM - AJP Rep (2014)

(A) Linea alba. (B) Spine. (C) Left psoas muscle. Arrow: Left abdominal wall mass. Tip of arrow: Gravid uterus at 28 weeks of gestational age.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502627&req=5

FI140037-3: (A) Linea alba. (B) Spine. (C) Left psoas muscle. Arrow: Left abdominal wall mass. Tip of arrow: Gravid uterus at 28 weeks of gestational age.
Mentions: A 24-year-old woman presented to our department for prenatal care at 14 weeks of gestational age (GA). Her obstetrical history included a first trimester spontaneous abortion and two full term pregnancies resulting in spontaneous vaginal deliveries. She had a 2-year history of a hyperdense lesion documented by computed tomography scan that had undergone minimal interval growth within the anterior left abdominal wall (Fig. 1). No other relevant surgical or medical history was noted. Physical examination at 23 weeks of GA revealed a mass protruding from the left abdominal wall. Ultrasonography revealed a single intrauterine pregnancy, as well as a large 11.7 × 12.3 × 17 cm left lower quadrant mass located above the bladder and below the gravid uterus. Considering the characteristics of the mass, the first diagnostic presumption was that of a uterine fibroid. A follow-up ultrasound at 28 weeks demonstrated interval growth of the mass to 16.5 × 11.8 × 18.5 cm (Fig. 2). Magnetic resonance imaging (MRI) for better characterization showed a 19.5 × 10.8 cm transverse × 13.3 cm craniocaudal mass with heterogeneously T2 hyperintense and T1 iso- to slightly hyperintense mass centered within the left abdominal wall musculature (Fig. 3). The mass displaced the gravid uterus and compressed the left gonadal vessels, left ureter, and left psoas muscle without a clear fat plane between the mass and these structures. It also abutted several loops of small bowel in the left abdomen and extended into the peritoneal cavity. Mild left hydronephrosis and hydroureter were also found proximal to the ureteral compression. No enlarged lymph nodes were found. Given patient's age, gender, and tumor location, a large abdominal wall desmoid tumor was suspected. A multidisciplinary evaluation including general surgery resolved not to intervene until after delivery. This decision was driven by the vast vascularization of the tumor and the need for further testing. At 38 weeks and 6 days of GA a slightly tender mass was palpated on physical examination (Fig. 4). Follow-up ultrasonography reported a mass of 18 × 13 × 18.9 cm and a fetus in complete breech presentation.

Bottom Line: Case A giant desmoid tumor arising from the left abdominal wall of a young female patient with rapid growth during pregnancy is described.Decision made by a multidisciplinary team was not to intervene before birth, and abdominal delivery at term was accomplished.Future studies are needed for better understanding of the pathogenesis, diagnosis, and treatment of desmoid tumors in pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health and Science Center at Houston, Houston, Texas.

ABSTRACT
Background Desmoid tumors are benign soft tissue tumors that locally invade adjacent tissue. There is a paucity of reports describing the rapid growth of these tumors during pregnancy. Case A giant desmoid tumor arising from the left abdominal wall of a young female patient with rapid growth during pregnancy is described. Preoperative evaluation included ultrasonography and magnetic resonance imaging. Decision made by a multidisciplinary team was not to intervene before birth, and abdominal delivery at term was accomplished. Conclusion Desmoid tumors should be part of the differential diagnosis in an abdominal wall tumor of rapid growth during pregnancy. Future studies are needed for better understanding of the pathogenesis, diagnosis, and treatment of desmoid tumors in pregnant women.

No MeSH data available.


Related in: MedlinePlus