Search

A 71-year-old man with a right renal tumor underwent nephrectomy. The procedure was converted from laparoscopy to open surgery due to profound bleeding from the renal vein. Pathological diagnosis was clear cell carcinoma G2pT3b v1 ly1 INFα. Three years after surgery, a 5 cm tumor in the abdominal wall was found on computed tomography (CT). A mild uptake was shown on positron emission tomography/CT and as the tumor was located near the surgical wound, recurrence of the renal cell carcinoma was suspected. However, desmoid tumor was suggested by the pathological examination of the tumor biopsy. En-bloc resection of the mass was carried out and the pathological examination showed an array of proliferating and tangling atypical spindle-shaped tumor cells. Immunohistochemical staining of the tumor cells was positive for vimentin, but negative for CD34, c-kit, and s100. Pathological diagnosis was desmoid tumor. There has been no recurrence so far. Desmoid tumor, despite its extremely low incidence, should be considered in a postoperative neoplasm.

A 46-year-old man presented to our hospital for further examination following a positive fecal occult blood test. He also had a painless, palpable scrotal mass that had been present for several years, but he had not previously sought treatment. Colonoscopy demonstrated multiple adenomatous polyps and colon cancer ; when taken together with his family history, these findings led to the diagnosis of familial adenomatous polyposis. A computed tomography scan revealed a right intrascrotal tumor, and the patient was referred to our department. Together with digestive surgeons, we carried out scrotal mass resection and colectomy under general anesthesia. On scrotal exploration, a large, solid mass was identified ; it was separate from the testis and epididymis. Although the mass was adhered to the surface of the corpus cavernosum penis, we were able to completely resect the mass along with part ofthe corpus cavernosum penis. The tumor was composed ofabundant collagen fibers and mature fibroblasts. Histopathology revealed the right scrotal mass to be a desmoid tumor. The patient is alive with no evidence ofdisease 24 months after surgery.

A 51-year-old man was referred to our hospital in 2005, because of an abdominal mass in thehypogastrium. There was no tenderness, and the tumor moved to epigastric resion easily. Therewere no important findings in a physical examination, except the mass. Enhanced CT showed themass with clear boundaries of 8cm size that the inside was contrasted heterogeneously in pelviccavity, and the internal was able to confirm tessellated mass by a supersonic wave. We doubtedintestinal GIST and performed an operation. We showed mass of mesoileum origin, in 15cm oralside from terminal ileum, there was no adhesion and invasion to circumference, so we underwent apartial resection of the terminal ileum. It was diagnosed as desmoid of a mesoileum origin by apostoperative histopathology diagnosis. There has been no recurrence for postoperative threeyears. Intraabdominal desmoid is relatively rare, and often noted a history of the laparotomy orestrogenic intervention, and combined with Gardner’s syndrome. In addition, it is assumed that itusually grows infiltrative, and easy to develop local recurrence. We experienced a rare case fallingunder neither, so we report it.

76歳男性.患者は頻尿により受診し, 尿沈渣はWBC 10～19/hpf, 抗生剤を投与していた.だが, 下腹部から尿道の不快感持続で, CTにて左腹壁から膀胱までの充実成分・嚢胞性成分の混在する腫瘤を認め, 尿管膜腫瘍を疑い, 今回入院となった.腹部造影CTでは左腹直筋から膀胱の前壁から頂部に連続した充実成分と嚢胞性成分の混在する腫瘤を認め, MRIでは更に恥骨, 前立腺にも連続し, T1で低吸収, T2で高吸収像であった.一方, 注腸検査ではS状結腸への浸潤像を認め, これらより感染性尿膜管腫瘍の膀胱・S状結腸浸潤と診断し, 腫瘍摘出術を施行した.術後経過は良好で経口摂取, 歩行も可能であったが, 術後2週間後に下肢の浮腫を認め, 精査で深部静脈血栓を認めて抗凝固療法, IVCフィルター留置と予防策をとったが, 3週後に肺梗塞で死亡した.なお, 病理所見では腹膜デスモイドと診断された., A 76-year-old male patient complained of frequent urination. Computed tomographic and magnetic resonance imaging scans revealed a heterogeneous mass involving his bladder, prostate and Sigmoid colon. He was diagnosed with an invasive urachal tumor and surgery was performed due to severe tumor adhesion to adjacent organs. Partial resection of the tumor was performed with partial cystectomy and sigmoidectomy. A post-operative pathological diagnosis revealed the tumor was a desmoid abdominal wall tumor. The desmoid abdominal wall tumor was not easily differentiated preoperatively from an urachal tumor.

A case of desmoid tumor of the abdominal wall which was preoperatively suspected as urachal tumor is presented. The patient was a 56-year-old man, who was referred to our clinic for further examination of the mass detected incidentally in the ventral region of the urinary bladder by computed tomography. Ultrasonography showed that the mass had a heterogenous and hypoechogenic content. An urachal tumor was suspected and surgery was performed to remove the tumor. During the operation we found that the tumor was completely separated from the urinary bladder and that it had originated from the left rectus abdominal muscle. The pathological diagnosis was desmoid tumor of the abdominal wall. Since urachal tumor has no characteristic findings on the imaging examinations, it is difficult to differentiate desmoid tumor of the lower abdominal wall from urachal tumor, preoperatively.