Updated: 7/19/2020

Desmoid Tumors

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Snapshot
  • A 45-year-old man presents to his primary care physician after noticing a mass in his mid-abdomen. He denies any pain, nausea, vomiting, or changes in his bowel habits. He was recently found to have multiple polyps in his recent colonoscopy. His father also had a similar condition and required complete removal of his colon. On physical examination, there is a firm and oblong mass in the epigastric region that is not painful to palpation. An MRI of the abdomen demonstrates an intraabdominal mass without clear compression or invasion to adjacent structures. He underwent complete resection of the mass and was doing well. However, approximately 6 months later he developed the mass again in the same region of his abdomen.
Introduction
  • Overview
    • slow growing, locally aggressive fibroblastic tumors associated with a high rate of recurrence despite complete resection
    • have no metastatic potential
  • Epidemiology
    • incidence
      • rare (0.03% of all neoplasms)
    • location
      • trunk/extremity
      • abdominal wall
      • intraabdominal (e.g., bowel and mesetary)
        • predominate in familial adenomatous polyposis
    • risk factors
      • familial adenomatous polyposis
      • Gardner syndrome
      • high estrogen states (e.g., pregnancy)
      • antecedent trauma
  • Pathophysiology
    • pathobiology
      • APC gene and beta-catenin appear to be involved
  • Genetics
    • mutations
      • Wnt signaling is thought to play a role
  • Associated conditions
    • familial adenomatous polyposis
    • Gardner syndorme
    • pregnancy
  • Prognosis
    • natural history of disease
      • variable, most progressively grow overtime and may have growth arrest or spontaneously regress
    • prognostic variable
      • familial adenomatous polyposis
        • desmoid tumors tend to recur at surgical sites
      • infiltration to vital organs can result in death even though it is histologically benign
Presentation
  • Symptoms
    • common symptoms
      • painless or minimally painful mass
    • intestinal obstruction
      • nausea and vomiting
    • bowel ischemia
      • abdominal pain
  • Physical exam
    • desmoid tumors can occur at any body site
    • mass on abdominal palpation
      • nontender to palpation
    • breast mass in breast demoids (rare)
Imaging
  • Cross-sectional imaging with CT or MRI 
    • indications
      • to visualze the mass affecting a designated part of the body
    • findings
      • desmoids do not have a charateristic imaging fings and are hard to distinguish from malignant soft tissue tumors
Studies
  • Invasive studies
    • histology
      • performed with incisional viopsy
        • obtains much more tissue than a core needle biopsy
      • findings
        • monoclonal fibroblastic prolierations 
          • spindle cells with abundant fibrous stroma
Differential
  • Keloids
    • differentiating factors
      • painful and pruritic
      • does not spontaneously regress
Treatment
  • Nonoperative
    • observation
      • indication
        • asymptomatic patients who can be reliably followed
    • radiation therapy
      • indications
        • patients who are not surgical candidates
        • patients who refuse surgery
        • in patients with significant surgical morbidity after resection
  • Operative
    • complete surgical excision
      • indication
        • resectable extraabdominal or abdominal wall desmoids
Complications
  • Death
    • if desmoid tumor grows in vital structures and organs (e.g., bowel), it can directly compress or disrupt its function

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