Not all abdominal masses after colorectal cancer surgery are malignant: intra-abdominal fibromatosis masquerading as recurrence

Our aim was to determine the incidence of fibromatosis in a cohort of patients undergoing cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) for suspected colorectal cancer recurrence. 171 CRS and HIPEC cases were performed at our Peritoneal Malignancy Institute between February 2007 and October 2018 for colorectal peritoneal metastases and were included in a prospectively maintained database. A total of 49 out of 171 cases (29%) were performed for primary colorectal cancer with peritoneal metastases, whereas 122 of 171 cases (71%) were performed for suspected colorectal cancer recurrence detected on surveillance imaging after primary colorectal cancer resection. On histological analysis of the resected specimen, 5 out of 122 (4.1%) cases undergoing CRS and HIPEC for colorectal recurrence had fibromatosis. Fibromatosis can masquerade as colorectal cancer recurrence. In this series it occurred with an incidence of 4.1% among a cohort of patients undergoing CRS and HIPEC for probable recurrence. Surgical resection may be the only option to confirm the diagnosis and rule out malignancy.

In this article, we illustrate a rare case of desmoid tumor formation in intracranial posterior fossa after suboccipital craniotomy for hemangioblastoma. A 43-year-old woman presented with headaches, dizziness, equilibrium disorders, nausea, and vomiting due to a hemangioblastoma in posterior fossa. A gross total resection was achieved. Three years postoperatively, the patient developed a growing mass at the intracranial intradural regions in posterior fossa near the previous incision. Surgical resection of the lesion was performed and the mass was totally resected. Postoperative imaging demonstrated no residual evidence of tumor and the pathological review of the surgical tumor specimen demonstrated desmoid tumor in intracranial posterior fossa. As desmoid tumors seem to arise at the location of a previous surgical site, they should be considered in the differential diagnosis for superficial masses occurring in the surgical bed after posterior surgery. Additionally, identifying the relationship between the basic effects of tumor surgery and desmoid tumor formation is considerably needed.

Recently, there has been a paradigm shift in the treatment of Desmoid Tumor toward an initial approach of active surveillance, rather than surgery with or without radiation. This shift occurred because the behavior of DT is unpredictable, and spontaneous growth arrest and regression can occur. In addition, patients can be asymptomatic. Herein, we describe our approach to the management of DT and the evidence base for selecting therapies in specific clinical scenarios.

A Desmoid tumor in the neck is a rare tumor in an even more unusual site. Our patient was an 18-year-old primigravid Bedouin woman from northwest Egypt. She presented with a dormant neck nodule that grew explosively during her first pregnancy and stopped abruptly after delivery. The presentation was confusing at first, as the fixation of the tumor to the underlying tissues implied a malignancy, while a 1-year history of non-metastasis alluded to a benign process. Pre-operative tissue diagnosis revealed an Estrogen receptor-expressing desmoid tumor. This report aims to increase awareness of peripartum Desmoid tumors, as well as discuss the surgical-site, psychological and socioeconomic challenges in the peculiar case of this Bedouin woman, and our recommendations after this experience and literature review.

The objective of this study was to develop an alternative method of non-contrast monitoring of tissue ablation during focused ultrasound treatment. Desmoid tumors are benign but locally aggressive soft tissue tumors that arise from fibroblast cells. Magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as an alternative to conventional therapies, showing promising results in reduction of tumor volume without significant side effects. The gold-standard assessment of the reduction of viable tumor volume post-treatment is non-perfused volume (NPV) and evaluation of NPV is typically performed with post-treatment gadolinium enhanced MR imaging. However, as gadolinium cannot be repeatedly administered during treatments, there is a need for alternative non-contrast monitoring of the tissue to prevent over and under treatment. Double-echo and multi-echo images were acquired before, during and after the MRgFUS treatment. T2 maps were generated with an exponential fit and T2 maps were compared to post-treatment post-contrast images. In all five MRgFUS treatment sessions, T2 mapping showed excellent qualitative agreement with the post-contrast NPV. T2 mapping may be used to visualize the extent of ablation with focused ultrasound and can be used as a predictor of NPV prior to the administration of contrast during the post-treatment assessment.