Desmoid Tumor of Rectus Abdominis: Recommendations for the Treatment and Reconstruction of the Parietal Defect

Abstract

The desmoid tumor is a connective tissues neoplasm, derived from fibroblasts, characterized by the absence of histologic changes or biomarkers of aggressiveness. It has a tendency to local invasion as well as to recurrence, and has been described in association with familial adenomatous polyposis (Gardners syndrome). This disease prevails in pregnant women, during menacme, or during the postpartum. The biologic behavior of the desmoid tumor is unpredictable, which enables heterogeneity in its clinical course. Sometimes, it is possible to observe tumors with a high tendency to relapse even after an adequate surgery with safety margin resection. In other cases, initial growth is followed by a stable clinical course despite any therapeutic modality. When large and located at the rectus abdominis muscle, the surgical treatment represents a challenge, once a monoblock resection leads to severe defects on the abdominal wall. The difficulties found during the reconstruction require experienced teams and, in the majority of cases, the use of fasciocutaneous flaps or news special meshes. We report a case of a large desmoid tumor located at the upper and medium third of the left rectus abdominis, in a 41 years old, Afro-descendent, female patient, submitted to curative resection of the entire muscle segment and simultaneous reconstruction of the abdominal wall by the insertion of a polypropylene light mesh (15 12 cm). The patient had an uneventful recovery and was discharged within fourth postoperative days. Clinical control after one year of follow-up showed neither recurrence nor functional or aesthetic complications.




J Med Cases. 2014;5(1):4-8
doi: https://doi.org/10.4021/jmc1614e