Surgical Resection and Abdominal Wall Reconstruction of a Rapidly Progressive Desmoid Tumor: A Case Report

Summary

Desmoid tumors (DTs) are rare, locally invasive soft tissue neoplasms characterized by fibroblastic proliferation and a lack of metastatic potential. Despite their histologically benign nature, their infiltrative behavior and unpredictable progression present significant therapeutic challenges, particularly when located in the abdominal wall, where resection and reconstruction may be necessary. We present the case of a 37-year-old woman with a rapidly enlarging, painful mass in the right rectus abdominis muscle. Imaging and biopsy confirmed desmoid-type fibromatosis. After a period of surveillance, the tumor doubled in size over six months, necessitating surgical excision. A full-thickness resection resulted in a 15×21 cm abdominal wall defect, which was reconstructed using Sepramesh mesh anchored to both peritoneum and fascia, followed by layered closure. Histopathology revealed a spindle-cell neoplasm infiltrating skeletal muscle with negative surgical margins. At eight months postoperatively, the patient remained asymptomatic and free of recurrence. This case underscores the importance of individualized treatment strategies in desmoid tumors, particularly in the abdominal wall, where reconstruction plays a critical role. Mesh-reinforced repair appears to be a safe and effective option, as supported by recent literature. Surgical resection with negative margins and appropriate reconstruction can achieve durable outcomes, emphasizing the need for long-term surveillance.