Michaelides A (1), Ang A (1), ChinAleong J (2), Kocher HM (3, 4).
(1) HPB Surgery, Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK. (2) Dept of Pathology, Centre for Tumour Biology, Barts Health NHS Trust, London, London, UK. (3) HPB Surgery, Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK h.kocher@nhs.net. (4) Barts Cancer Institute, Queen Mary University of London, London, London, UK.
Publication
BMJ Case Rep
Summary
A 74-year-old man was being investigated for a pancreatic insulinoma when an incidental mesenteric mass measuring 2.6 cm x 2.5 cm was noticed on CT imaging. A wait-and-see approach was decided on. Thirty-nine months later, the patient presented with symptoms of abdominal obstruction. CT images revealed the mesenteric mass filled majority of the abdominal cavity and measured 29 cm x 26 cm x 16 cm. The patient underwent an open bypass gastrojejunostomy which stopped working a few weeks later due to further compression by the tumour. A debulking surgery was performed: a right hemicolectomy and small bowel resection with excision of the desmoid tumour and bypass gastrojejunostomy. The tumour measured 12.6 kg and was macroscopically visualised to have a white cut surface with a focal translucent area. Microscopic analysis revealed bland spindle cells with pale eosinophilic cytoplasm showing no cytological atypia, in keeping with a mesenteric desmoid tumour. Currently, two and a half years from the debulking surgery, the patient remains well and in remission with planned surveillance.
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