Radiological appearance of cortical desmoid in a 14-year-old male patient: A case report

Cortical desmoid is an uncommon benign bony lesion that can typically be diagnosed through conventional radiographic methods. However, here we present an atypical case of a 14-year-old male who presented with a history of trauma, and the initial X-ray showed a right femur suspicious bony lesion. Still, the subsequent use of CT and MRI confirmed the diagnosis of cortical desmoid, so conservative management and follow-up imaging was recommended. This case highlights the importance of proper identification of this entity can prevent unnecessary biopsy and surgical intervention.

Desmoid tumors, also known as deep fibromatosis or desmoid-type fibromatosis, represent a rare subset of deep fibromatoses. It is a locally aggressive tumor, with no specific symptoms, and no metastatic potential. We report a case of a 38-year-old male patient with an abdominal mass. Radiological findings showed 2 tumors, the first was a solid inguinal mass of the left lateral iliac pedicle, and the second was a giant cystic mass in the abdominal cavity. An elective explorative laparotomy was performed to remove the 2 masses. Histopathological examination confirmed the desmoid tumor diagnosis of both lesions.

INTRODUCTION AND IMPORTANCE: Desmoid tumours typically arise in the abdomen and extremities. They are rare, originating from mesenchymal cells, with intra-abdominal desmoid tumours (DT) being even less common. While non-malignant and non-metastatic, they can be locally invasive, often necessitating surgical intervention for complete resection. CASE PRESENTATION: We present the case of a 26-year-old woman referred to our emergency department with pelvic pain three months after cesarean delivery. Abdominal computed tomography revealed a 7 cm retro-uterine mass extending to the right colon, appendix, and cecum. Although MRI suggested an intra-mesenteric benign tumour, a definitive diagnosis was not established. Surgical excision was performed for both diagnostic and therapeutic purposes, revealing a 5.5 cm desmoid tumour infiltrating adipose and muscular tissue of the last ileal loop, with negative resection margins. Postoperative recovery was uneventful, and the patient is under CT surveillance. CLINICAL DISCUSSION: Intra-abdominal DTs are exceedingly rare and can present with a spectrum of symptoms. Imaging findings may mimic other conditions, making diagnosis challenging. Surgical expertise is crucial for optimal management, with complete resection being the primary therapeutic approach. CONCLUSION: In conclusion, intra-abdominal desmoid tumours are rare entities that pose diagnostic and therapeutic challenges. Surgeons experienced in handling such cases are essential for achieving favourable outcomes. Continued surveillance is necessary due to the potential for recurrence.

OBJECTIVE: To elucidate the magnetic resonance imaging (MRI) characteristics for distinguishing solitary fibrous tumors (SFTs) from desmoid tumors (DTs). MATERIALS AND METHODS: A retrospective study of 66 consecutive patients with histopathologically proven SFT (n = 34; 13 males and 21 females; mean age, 52.0 ± 17.1 years) or DT (n = 32; 11 males and 21 females; mean age, 39.0 ± 21.3 years) was conducted. The two groups were quantitatively compared in terms of the size, signal intensity ratio (SIR), and apparent diffusion coefficient value. For qualitative analysis, the tumor location, boundary, shape, internal uniformity, predominant signal intensity, T1-weighted images (T1WI) characteristics (hyperintense area), T2-weighted images (T2WI) characteristics (hypointense area, marked hyperintense area, flow void, band sign, and yin-yang sign), and contrast-enhanced T1WI characteristics (unenhanced area and degree of enhancement) were compared between the two groups. Multiple stepwise logistic regression analyses were conducted to distinguish between the SFT and DT. RESULTS: T1 (P = 0.010) and T2 (P = 0.026) SIRs were higher in SFTs than in DTs. Hyperintense areas on T1WI (P < 0.001), marked hyperintense areas on T2WI (P = 0.025), and flow void (P = 0.025) were more frequently noted in SFTs. On T1WI, the solid component predominantly revealed hyperintensity in SFTs and isointensity in DTs (P < 0.001). Indistinct tumor boundary (P < 0.001), hypointense area on T2WI (P < 0.001), and band sign (P < 0.001) were more frequently observed in DTs. Multiple stepwise logistic regression analysis revealed that the hyperintense area on T1WI (odds ratio favoring SFT, 12.80, P = 0.002) and band sign (odds ratio favoring DT, 0.03; P < 0.001) were independent predictors. CONCLUSION: MRI characteristics can help distinguish SFT from DT. The presence of a hyperintense area relative to the skeletal muscle on T1WI in SFTs and the band sign on T2WI in DTs are important MRI features.

BACKGROUND: The treatment of aggressive fibromatosis (AF) poses a challenge for physicians due to propensity for local recurrence and aggressive nature, with traditional surgical excision often resulting in recurrence. Ultrasound-guided ablation, offering minimal trauma and reusability, has emerged as a novel therapeutic option for invasive fibromas. We report our experience of microwave ablation (MWA) as a local and analgesic treatment for inoperable or recurring AF. METHODS: This study includes 8 patients who underwent percutaneous MWA of 10 AF between November 2021 and November 2023. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 1 November 2024. RESULTS: In this study, the 10 tumors in 8 patients have a preoperative size ranging from 1.84 to 477.96 ml, with a mean of 71.90 ± 147.55 ml. Postoperatively, at 6 months, the lesion sizes ranged from 0 to 174.99 ml, with a mean of 24.97 ± 53.78 ml (P < 0.05). The mean volume reduction ratio (VRR) was 55.86% (range 15.48-100%), with an overall treatment effectiveness rate of 80% (8 out of 10). Long-term follow-up revealed 2 cases meeting complete response (CR) criteria, 4 cases achieving partial response (PR), and 2 cases meeting stable disease (SD) criteria. The average pre-treatment VAS score among the 8 patients was 6.38 (range 5-9), which decreased to 3.0 (range 0-6) after 1 month of treatment, demonstrating a significant average pain reduction of 3.38 (p < 0.05). The study reported an adverse reaction incidence of 12.5% (1/8) due to neural heat damage from ablation, with symptom improvement following supportive care. CONCLUSION: MWA is an effective therapeutic option for the local treatment and for the analgesic management of AF.

Desmoid fibromatosis is a rare subtype of soft tissue neoplasms known for its locally aggressive behaviour and fibrotic consistency. While these tumours can arise in various anatomical sites, their occurrence within the colon is exceptionally rare and poses diagnostic and therapeutic challenges. We present a case of a female patient in her 30s with no significant medical history who presented with vague gastrointestinal and urinary symptoms. Imaging studies revealed a sizeable abdominal mass, initially raising uncertainty regarding its origin. Subsequent exploratory laparotomy revealed a desmoid fibromatosis involving the muscularis propria of the caecum, prompting a right hemicolectomy. Histopathological analysis confirmed the diagnosis, and the patient underwent a successful resection with negative margins. This case underscores the importance of individualised treatment plans and long-term surveillance in managing colonic desmoid tumours for optimal outcomes and disease-free survival.