The Desmoid Tumor Research Foundation

November 2025

Misleading Lesions in Gynecological Malignancies: A Case Report of Desmoid Tumor During Pregnancy and a Narrative Review of the Literature

Author Information

Emma Bonetti Palermo 1, Federico Ferrari 1 2 3, Cecilia Dell'Avalle 2, Ilaria Nodari 2, Emma Paola Ongarini 2, Iacopo Ghini 4, Andrea Giannini 5, Hooman Soleymani Majd 3, Giuseppe Ciravolo 1, Franco Odicino 1

1S.C. Ostetricia e Ginecologia, ASST Spedali Civili Brescia, Dipartimento Area Della Donna e Materno Infantile, 25136 Brescia, Italy. 2Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy. 3Gynaecology Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK. 4Department of Pathology, ASST Spedali Civili Brescia, 25136 Brescia, Italy. 5Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy-Policlinico Umberto I, Viale Regina Elena, 328, 00161 Rome, Italy.

Publication

J Clin Med

Summary

Background: Desmoid tumors (DTs) are rare, locally aggressive soft-tissue neoplasms that often affect women of reproductive age. Pregnancy and prior abdominal surgery or trauma have been associated with tumor development and growth, while imaging frequently overlaps with abdominal-wall endometriosis. We present the case of a 39-year-old woman with an abdominal-wall DT and provide a narrative review of the literature focused on pregnancy/postpartum patterns, differential diagnosis, and management. Methods: A narrative review of PubMed/MEDLINE and Web of Science (January 1982-December 2024) was conducted. We included English-language case reports/series, narrative/descriptive reviews, and consensus statements relevant to DTs in pregnancy or reproductive-age women, emphasizing abdominal-wall disease. Results: The patient's right abdominal-wall mass enlarged during pregnancy and further post-partum imaging repeatedly suggested endometriosis. En bloc resection revealed desmoid-type fibromatosis composed of bland spindle cells in a collagenous stroma, with nuclear β-catenin and lymphoid enhancer-binding factor 1 (LEF1) positivity on immunohistochemistry. Magnetic resonance imaging (MRI) at 12 months showed no recurrence. Across included studies, pregnancy and post-partum enlargement is common, abdominal-wall DTs frequently mimic scar endometriosis, and pre-operative ultrasound has limited specificity. Current practice supports watch-and-wait for stable, asymptomatic lesions and function-preserving surgery for symptomatic progression, while systemic options (anti-estrogens, low-dose chemotherapy, and tyrosine kinase inhibitors) are reserved for progressive or unresectable disease. Recurrence risk relates to age, size, site, and β-catenin status; future pregnancy is not contraindicated. Conclusions: Abdominal-wall DTs, although rare, should be considered in the differential diagnosis of reproductive-age women presenting with abdominal-wall masses, particularly during or after pregnancy.

View Abstract