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Saran S, Phulware RH. A 40-year-old female with swelling in left lower back. Skeletal Radiol 2025; 54:165-168. [PMID: 38775946 DOI: 10.1007/s00256-024-04711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 11/19/2024]
Affiliation(s)
- Sonal Saran
- Department of Diagnostic and Interventional Radiology, AIIMS Rishikesh, Rishikesh, India.
| | - Ravi Hari Phulware
- Department of Pathology and Laboratory Medicine, AIIMS Rishikesh, Rishikesh, India
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2
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Maskal S, Chang J, Ellis R, Messer N, Melland-Smith M, Tu C, Miller B, Petro C, Simon R, Prabhu A, Rosen M, Beffa L. Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia. Hernia 2024; 28:457-464. [PMID: 38062203 DOI: 10.1007/s10029-023-02928-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection. METHODS This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class. RESULTS 120 patients were identified. Mean follow-up was 3.9 ± 3.4 years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4 cm; mean defect width was 8.1 ± 4.1 cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2 cm. CONCLUSION Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.
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Affiliation(s)
- S Maskal
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA.
| | - J Chang
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Ellis
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - N Messer
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Melland-Smith
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Tu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - B Miller
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Petro
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Simon
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - A Prabhu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Rosen
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - L Beffa
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
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Yeo M. Anterolateral Thigh Flap Reconstruction of Full Thickness Lateral Abdominal Wall Defect from Desmoid Tumour. Case Rep Surg 2024; 2024:1908212. [PMID: 38264711 PMCID: PMC10805552 DOI: 10.1155/2024/1908212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/21/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Desmoid tumours are benign but locally aggressive mesenchymal neoplasms that occur most commonly in the abdomen, with the potential to invade surrounding structures causing significant morbidity. Lateral abdominal wall defects are known to be more challenging and less frequently encountered compared to ventral abdominal wall defects. Asymmetric forces caused by contraction of remnant rectus and contralateral oblique muscles increase the risk of herniation postoperatively. We report a case of a challenging abdominal wall reconstruction after desmoid tumour resection in a 62-year-old male patient who presented to our hospital with a progressively enlarging left upper back lump of 6 months duration. A venous supercharged pedicled anterolateral thigh flap was combined with PROLENE® mesh for reconstruction, and the patient recovered well with good functional and aesthetic outcomes at 2-year follow-up. The pedicled anterolateral thigh flap with venous supercharging can be effectively used for the reconstruction of extensive lateral abdominal wall defects.
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Affiliation(s)
- Melissa Yeo
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
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4
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Hasnaoui A, Kacem S, Sassi I, Ben Abdallah F, El Guesmi S. MPNST of the abdominal wall in a patient with lynch syndrome: A case report of a rare presentation and unique association. Int J Surg Case Rep 2023; 110:108677. [PMID: 37603917 PMCID: PMC10445449 DOI: 10.1016/j.ijscr.2023.108677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION The abdominal wall is an extremely rare location for malignant peripheral nerve sheath tumors (MPNSTs). Besides presenting a rare location of MPNST, the peculiarity of our case lies in its association with Lynch syndrome, which is to our knowledge the first reported case of its kind. PRESENTATION OF CASE We present a case report of a 39-year-old male with a personal history of colonic cancer. Genetic counseling revealed Lynch syndrome with a heterozygous germline mutation in MLH1. Nine years after the right hemicolectomy, the patient presented with an asymptomatic lump in the abdominal wall. CT imaging showed a 3 cm mass in the aponeurosis of the right external oblique muscle. The patient underwent successful resection of the parietal tumor. Pathological examination revealed an MPNST. No additional treatment was warranted, and the patient exhibited no signs of relapse during the six months following the surgery. DISCUSSION MPNSTs of the anterior abdominal wall are extremely rare and challenging. Some studies have investigated the presence of mismatch repair (MMR) deficiency in patients with sarcomas. Our case consolidates the hypothesis of an association between sarcomas and Lynch syndrome, which raises the question of the efficacy of immune checkpoint inhibitor therapy in these cases where treatment options remain limited. CONCLUSION It is essential to have a deep understanding of the growth patterns of MPNSTs in the context of syndromes that predispose individuals to tumors, like Lynch syndrome. This knowledge is crucial for accurately predicting patient outcomes and developing appropriate plans for monitoring and treatment.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia.
| | - Salma Kacem
- Department of Oncologic Surgery, Salah Azaiez institute, Tunis, Tunisia
| | - Imen Sassi
- Department of Oncologic Surgery, Salah Azaiez institute, Tunis, Tunisia
| | | | - Sondes El Guesmi
- Department of Oncology, Menzel Bourguiba Hospital, Menzel Bourguiba, 7050 Bizerte, Tunisia
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Racem T, Mehdi D, Ahmed G, Faten S, Amen D, Adnen C. Synovial sarcoma of the abdominal wall: A case report for a rare entity with a challenging treatment. Int J Surg Case Rep 2023; 109:108596. [PMID: 37527598 PMCID: PMC10407252 DOI: 10.1016/j.ijscr.2023.108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Synovial Sarcoma is an intriguing disease, it represents a distinctive subtype of soft tissue sarcoma that does not exceed 10 % of all STS. This tumor can arise from the abdominal wall in very rare cases. Due to its unique presentation (occurring at a young age, various anatomical locations, and slow evolutionary kinetics), diagnosis can be challenging. The mainstay of treatment remains wide surgical excision with negative margins. CASE PRESENTATION We herein report a challenging diagnosis of synovial sarcoma with exceptional location, presented as a slowly evolving abdominal mass of the right iliac fossa. Soft tissue MRI confirmed the presence of a sub cutaneous mass without signs of local invasion. Surgical management as indicated. Anatomopathological findings were in favor of a synovial sarcoma of the abdominal wall. The patient was discharged. No complication was observed after 3 months follow up. CLINICAL DISCUSSION Patients with synovial sarcoma of the abdominal wall is a very rare entity, therefor positive pre operative diagnosis is hard to achieve, because of the lack of specific clinical and radiological signs. No standard treatment is advised, beside surgical management wish is the main course of management. CONCLUSION Synovial sarcoma is an infrequent pathology, with no specific signs in both clinical and radiological findings. The main course of management is surgery with healthy resection margins. Long term follow up is advised because of the high risk of recurrence.
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Affiliation(s)
- Trigui Racem
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia.
| | - Debaibi Mehdi
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia; Faculty of Medicine of Tunis, University of Tunis el Manar, Tunisia
| | - Guermazi Ahmed
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia
| | - Souai Faten
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia; Faculty of Medicine of Tunis, University of Tunis el Manar, Tunisia
| | - Dhaoui Amen
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia; Departement of Anatomical Pathology, Internal Security Forces Hospital, Marsa, Tunisia
| | - Chouchen Adnen
- Departement of General Surgery, Internal Security Forces Hospital, Marsa, Tunisia; Faculty of Medicine of Tunis, University of Tunis el Manar, Tunisia
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Zongo N, Djiguemde AR, Yameogo PB, Ka S, Traoré B, Dem A. Surgery for primary malignant tumors of the abdominal wall: experiences of three African surgical oncology units and review of the literature. World J Surg Oncol 2023; 21:235. [PMID: 37525223 PMCID: PMC10388487 DOI: 10.1186/s12957-023-03125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tumors of the abdominal wall are uncommon but diverse. The surgical challenge is double. The tumor must be completely removed and the abdominal wall repaired. Our aim was to describe the indications, techniques, and results of surgery on these tumors in an African context. METHODS Retrospective, multicentric and descriptive study conducted in three West African surgical oncology units. We included all abdominal wall tumors followed up between January 2010 and October 2022. Histological type, size, surgical procedure, and method of abdominal wall repair were considered. Survival was calculated using the Kaplan-Meier method and comparisons of proportions were made using the Student t test. RESULTS We registered 62 tumors of the abdominal wall and we operated on 41 (66.1%). The mean size of the tumors was 14.3 ± 26 cm. Dermatofibrosarcoma and desmoid tumor were present in 33 and 3 cases respectively. In 31.7% of cases in addition to the tumour, the resections carried away the muscular aponeurotic plane. Parietal resections required the use of a two-sided prosthesis in 6 cases. In 13 cases, we used skin flaps. The resections margins were invaded in 5 cases and revision surgery was performed in all of them. Incisional hernia was noticed in 2 cases. The tumor recurrence rate was 12.2% with an average time of 13 months until occurrence. Overall survival at 3 years was 80%. CONCLUSIONS Surgery is the mainstay of treatment for abdominal wall tumors. It must combine tumor resections and parietal repair. Cancer surgeons need to be trained in abdominal wall repair.
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Affiliation(s)
- Nayi Zongo
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso.
| | - Adeline R Djiguemde
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso
| | - Paratyandé Bonaventure Yameogo
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso
| | - Sidy Ka
- Joliot Curie Institute of Dakar (Senegal)Cheikh Anta Diop University of DakarCheikh Anta Diop University, 10700, Dakar, Senegal
| | - Bangaly Traoré
- Surgical Oncology Unit, Donka Hospital of Conakry, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Ahmadou Dem
- Joliot Curie Institute of Dakar (Senegal)Cheikh Anta Diop University of DakarCheikh Anta Diop University, 10700, Dakar, Senegal
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Meade A, Wisecarver I, Cho MJ, Davis JJ, Duque S, Farewell JT, Zhang AY. The Role of Reconstruction on Desmoid Tumor Recurrence: A Systematic Review and Technical Considerations. Ann Plast Surg 2023; 90:S195-S202. [PMID: 36729103 DOI: 10.1097/sap.0000000000003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Desmoid tumors occur throughout the body, presenting as aggressive, locally invasive lesions that can impede quality of life. Many controversies remain regarding the optimal surgical treatment of desmoid. This article presents a systematic review and meta-analysis on surgical management, focusing on risk of recurrence and the utility of reconstruction within this unique patient population. METHODS A systematic review was conducted to search for articles. The clinical course of patients diagnosed with desmoid tumors and treated by our institution's multidisciplinary team was retrospectively reviewed over a 13-year period. Meta-analysis study findings were compared with our cohort. RESULTS From the systematic review, 10 studies with level of evidence III were found, which resulted in 981 patients. Twenty patients from our institution met the inclusion criteria for our study. In both our study cohort and the pooled results, recurrence was significantly higher in patients with positive microscopic margin after resection. In our study cohort, patients with recurrence had higher rates of positive margins compared with those without recurrence (83.3% vs 7.1%, P = 0.004), whereas the pooled study showed a difference of margin positivity of 50% vs 40% ( P = 0.01). No patients who underwent reconstruction in our study cohort had a recurrence during the study period. CONCLUSION In both our cohort and pooled results, recurrence was significantly higher in patients with positive margins after initial resection. Reconstruction was not found to be a risk factor for recurrence. Reconstruction following desmoid tumor resection should be considered a viable option if a large and aggressive resection is required to obtain negative margins.
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Affiliation(s)
- Anna Meade
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian Wisecarver
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Justin J Davis
- Institute for Plastic Surgery, Southern Illinois University, Springfield, IL
| | - Sofia Duque
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jordyn T Farewell
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew Y Zhang
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Espinoza AF, Onwuka E, Hicks MJ, Masand P, Monson L, Okcu MF, Pinglay N, Vidimos A, Vasudevan SA. Dermatofibrosarcoma protuberans case report: Aggressive tumor in a preadolescent child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Yadav SK, Das S, Joshi D, Lal S, Kapoor N. Giant cell tumor of soft tissue: A case report. Int J Surg Case Rep 2023; 104:107952. [PMID: 36868106 PMCID: PMC9996205 DOI: 10.1016/j.ijscr.2023.107952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Giant cell tumor of soft tissue (GCT-ST) is a rare primary neoplasm of soft tissues. It usually involves superficial and deeper soft tissues of upper and lower extremities, followed by trunk. CASE PRESENTATION A 28-year-old female, presented with a painful mass in left abdominal wall for three months. On examination, it measured 4 × 4 cm with ill-defined margins. CECT showed ill-defined enhancing lesion deep to muscle planes with possible invasion of peritoneal layer. Histopathology showed multinodular architecture with intervening fibrous septa and metaplastic bony tissue encasing the tumor. Tumor composed of round to oval mononuclear cells and osteoclast like multinucleated giant cells. Mitotic figures were eight per hpf. A diagnosis GCT-ST of anterior abdominal wall was made. Patient was treated with surgery followed by adjuvant radiotherapy. Patient is disease free at one year follow up. CLINICAL DISCUSSION These tumors mostly involve extremities and trunk and usually presents as a painless mass. Clinical features depend upon the exact location of the tumor. Common differential diagnosis includes tenosynovial giant cell tumors and malignant giant cell tumors of soft tissue and GCT of Bone. CONCLUSION Diagnosis of GCT-ST is difficult on cytopathology and radiology alone. Histopathological diagnosis should be done to rule out the malignant lesions. Complete surgical resection with clear resection margins is the mainstay of treatment. Adjuvant radiotherapy should be considered in case of incomplete resection. Long follow-up is necessary for these tumors as local recurrence and risk of metastasis cannot be predicted.
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Affiliation(s)
- Shakti Kumar Yadav
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India.
| | - Saikat Das
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhopal, India.
| | - Deepti Joshi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Shyam Lal
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - Neelkamal Kapoor
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, India
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Wang D, Zheng S, Qiu X, Fu Y. Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection. Surg Innov 2023; 30:50-55. [PMID: 35357985 DOI: 10.1177/15533506221087074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection.Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5 cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain.Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0 cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20 months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain.Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.
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Affiliation(s)
- Dianchen Wang
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shouhua Zheng
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Xinguang Qiu
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Yang Fu
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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11
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Bergeron E, Dami M, Do XV, Vallee C, Noujaim J. Case report of an angiosarcoma of the abdominal wall during liraglutide injections: A coincidence? Int J Surg Case Rep 2022; 97:107444. [PMID: 35878547 PMCID: PMC9403282 DOI: 10.1016/j.ijscr.2022.107444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
Angiosarcoma is a very rare but highly aggressive malignant vascular tumor. Abdominal wall is a very rare site for angiosarcoma and occurs almost exclusively in obese patients. Liraglutide injection is explored for a possible association with the occurrence of angiosarcoma of the abdominal wall.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, Greenfield Park, Canada,Corresponding author at: Charles LeMoyne Hospital, 3120, Boul. Taschereau, Greenfield Park, Quebec J4V 2H1, Canada.
| | - Meriame Dami
- Department of Anatomopathology, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Xuan Vien Do
- Department of Medical Imaging, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Chantal Vallee
- Department of Medicine, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Jonathan Noujaim
- Department of Medical Oncology, Maisonneuve-Rosemont Hospital, Montreal, Canada
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12
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Deb PQ, Chokshi RJ, Li S, Suster DI. Pleomorphic Rhabdomyosarcoma: A Systematic Review with Outcome Analysis and Report of a Rare Abdominal Wall Lesion. Int J Surg Pathol 2022:10668969221105622. [PMID: 35707991 DOI: 10.1177/10668969221105622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Pleomorphic rhabdomyosarcoma (RMS) is an aggressive and rare malignant neoplasm with a poor prognosis. As its name suggests, this tumor exhibits extensive pleomorphism with features of skeletal muscle differentiation. Due to its rarity, its diagnosis is often a clinical and pathological challenge. Since only small case series and a few scattered case reports exist in the literature, the impact of different demographic features, tumor site, and/or treatment modality on patient outcomes has yet to be extensively studied. Methods. We report a case of a pleomorphic RMS presenting atypically as an abdominal wall mass. We have also analyzed the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database to determine the factors affecting the outcome of this neoplasm. Moreover, we present a review and summary of pleomorphic RMS cases arising from the abdominal wall reported in the English language literature. Results. We found two hundred and forty-two cases of pleomorphic RMS in the SEER database. The majority of the patients were diagnosed after the age of 40, with the age of diagnosis showing a unimodal distribution. The majority of the patients were Caucasian (82%) and male (59%). Age of diagnosis, tumor stage, and surgical management significantly affected the patients' outcome, while patients' ethnicity, sex, or tumor site did not affect the outcome. We only found five previously reported cases of pleomorphic RMS arising from the abdominal wall. Conclusions. Pleomorphic RMS arising from the abdominal wall is extremely rare. Our data sheds light on the factors affecting the outcome of pleomorphic RMS. We have also discussed the challenges involving the histopathological diagnosis of this rare neoplasm and how to best approach this task.
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Affiliation(s)
- Pratik Q Deb
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Sharon Li
- Division of Medical Oncology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - David I Suster
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
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13
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Stiles ZE, Lohman RF, Mann GN. Plastic Surgery Reconstruction of Sarcoma Resection Defects. Surg Clin North Am 2022; 102:583-599. [DOI: 10.1016/j.suc.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Souiki T, Belhaj A, Ait Abderrhim A, Alami B, Tahiri L, Chbani L, Ibn Majdoub K, Toughrai I, Mazaz K. Dermatofibrosarcoma protuberans of the anterior abdominal wall: case report and literature review. J Surg Case Rep 2022; 2022:rjac272. [PMID: 35783239 PMCID: PMC9246286 DOI: 10.1093/jscr/rjac272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare and slowly growing cutaneous tumor with high risk of local invasion and recurrence. Here, we report a case of a DFSP of the anterior abdominal wall diagnosed in a 45-year-old woman. The clinical examination showed an indurated well-limited oval mass localized in the supra-umbilical level and measuring 5 cm by 3 cm. The histological finding of skin biopsy was consistent with the diagnosis of DFSP. A wide local excision was performed while respecting minimum safety margins of 3 cm. The primary closure was possible after advancing the subcutaneous adjacent tissue. The histological examination of the surgical specimen confirmed the DFSP diagnosis and determined safe microscopic margins. After 4 years of regular follow-up, no locoregional or distant recurrence was observed. We discuss through this case the diagnosis difficulties and the particularities of the abdominal wall localization.
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Affiliation(s)
- Tarik Souiki
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
| | - Anas Belhaj
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
| | - Abderrahim Ait Abderrhim
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
| | - Badreeddine Alami
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Radiology, University Hospital Hassan II , Fez , Morocco
| | - Layla Tahiri
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Pathology, University Hospital Hassan II , Fez , Morocco
| | - Laila Chbani
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Pathology, University Hospital Hassan II , Fez , Morocco
| | - Karim Ibn Majdoub
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
| | - Imane Toughrai
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
| | - Khalid Mazaz
- Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University , Fez , Morocco
- Department of Visceral Surgery (E3), University Hospital Hassan II , Fez , Morocco
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15
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Abouzid A, Shetiwy M, Hossam A, Abd Elghaffar M. Abdominal wall reconstruction using Omental Flap with Mesh repair following resection of Aggressive Abdominal Wall Neoplasms. Oncol Res Treat 2022; 45:415-422. [PMID: 35537417 DOI: 10.1159/000524871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resection of large anterior abdominal wall tumors causes a large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point. METHODS Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU) Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic Polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics, operative data including defect size, mesh size, intrabdominal tumor extension and postoperative outcomes and complications. RESULTS Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 mins. The mean size of the abdominal wall defect was 50.78 cm2 (range: 25 - 90 cm2). The meshes used in reconstruction had a mean size of 89.53 cm2 (range: 55 - 130 cm2). The median follow-up period of the patients was 13.5 months (range: 5-54 months). Post-operative complications included infection (n = 4 cases), seroma (n = 2 cases), hematoma (n =1 case) and abnormal sensation (n = 5 cases). Tumor recurrence was reported in two cases and no cases developed incisional hernia during the follow up period. CONCLUSION Immediate use of omental flap with synthetic (PP) mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone.
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Affiliation(s)
- Amr Abouzid
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Amr Hossam
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Abd Elghaffar
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
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16
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Moore D, Burns L, Creavin B, Ryan E, Conlon K, Kelly ME, Kavanagh D. Surgical management of abdominal desmoids: a systematic review and meta-analysis. Ir J Med Sci 2022; 192:549-560. [PMID: 35445926 PMCID: PMC10066066 DOI: 10.1007/s11845-022-03008-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Desmoid tumours are benign fibromatous tumours arising from dysregulated myofibroblast proliferation within musculoaponeurotic structures. They can occur sporadically but more commonly are associated with genetic syndromes such as familial adenomatous polyposis [1] (FAP). Mutations in either the Wnt, β-catenin or APC genes are 'key' triggers for the development of these tumours [5]. Classically, these tumours do not metastasise; however, they are associated with significant morbidity and mortality due to their infiltrative pattern and/or local invasion. Historically, surgical resection was the cornerstone of treatment. There remains paucity of data regarding outcomes following the surgical management of abdominal desmoid tumours in terms of success, recurrence and morbidity. OBJECTIVES The aim of this review was to assess the current evidence for surgical management of abdominal desmoid tumours in terms of success, recurrence and morbidity. METHODS A systematic search of articles in PubMed, EMBASE and The Cochrane Library databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the period from January 2000 to November 2020. RESULTS Twenty-three studies were included, of which, 749 patients had surgical resection (696 for primary and 53 for recurrent desmoids), 243 patients (18.8%) were medically managed and 353 patients (27.3%) underwent surveillance. Median follow-up was 51.4 months (range 1-372). Six-hundred and ninety-six of the 749 resections (92.9%) underwent primary desmoid resection, with the remaining 53 (7.1%) undergoing resection for recurrence. One-hundred and two surgically managed patients (19%) developed a (re)recurrence, with mesenteric involvement the commonest site for recurrence (55%). When comparing recurrence post-surgery to progression following medical therapy, there was a trend towards better outcomes with surgery, with 25% of surgical patients having a recurrence versus 50.5% having progression with medical therapy [OR 0.40 (95% CI 0.06-2.70), p = 0.35]. Major morbidity following surgery was 4.4% (n = 33) with 2% (n = 14) mortality within 30 days of resection. CONCLUSION The management of desmoids has considerable heterogeneity. Surgical resection for abdominal desmoids remains a valid treatment option in highly selective cases where negative margins can be obtained, with low major morbidity and/or mortality.
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Affiliation(s)
- Dave Moore
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland.
| | - Lucy Burns
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland
| | - Ben Creavin
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland
| | - Eanna Ryan
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Kevin Conlon
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland
| | - Michael Eamon Kelly
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland
| | - Dara Kavanagh
- Department Surgery, Tallaght University Hospital, Tallaght, Dublin, D24 NR04, Ireland
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17
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Zhang M, Crago A, Yoon SS, Singer S, Alektiar K. Radiation Therapy in Primary Soft Tissue Sarcoma of the Superficial Trunk. Ann Surg Oncol 2022; 29:2316-2323. [PMID: 34652567 PMCID: PMC9487906 DOI: 10.1245/s10434-021-10927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Despite anatomical differences, truncal soft tissue sarcomas (STS) often are grouped with extremity sarcomas. We evaluated the clinical outcome of patients with truncal STS who underwent gross total resection (GTR) and radiation therapy (RT), with special emphasis on those treated with intensity modulated radiation therapy (IMRT). METHODS From January 1, 2001 to December 31, 2018, 64 patients received GTR and RT, where 48 patients were male, 35 patients were aged ≤ 60 years, and 48 patients had tumors ≤ 10 cm. Sixty-two tumors were high grade, 36 were in the chest wall, 7 in the abdominal wall, and 21 were paraspinal. During surgery, 7 received mesh reconstruction, and 6 received flap closure. R0 resection was achieved in 53 patients. Thirteen patients received chemotherapy. RESULTS With a median follow-up of 57 months, the 5-year actuarial local control (LC) was 71%. In the IMRT subset (50/64, 78%), the 5-year LC for the chest/abdominal wall was 84%, and 69% for the paraspinal subsite. Grade 2+ radiation dermatitis was seen in 21 of 64 (33%) patients, 5 of 64 (8%) developed noninfectious wound complications, 5 of 64 (8%) developed infectious wound complications, and 1 of 64 (2%) developed grade 2 chest wall pain. No additional grade 2+ late toxicity was observed. CONCLUSIONS Based on this study, achieving LC in truncal STS treated with GTR and RT remains challenging even with IMRT (5-year LC: 78%). While the use of IMRT was more promising for tumors of the chest/abdominal wall with 5-year LC of 84%, it was 69% for those located in the paraspinal subsite, indicating a need for further improvement.
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Affiliation(s)
- Minsi Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Aimee Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sam S Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
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18
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Tattersall HL, Baia M, Messina V, Borghi A, Tirotta F, Almond M, Desai A, Ford SJ, Gronchi A. Overall survival in abdominal wall sarcoma treated with curative intent surgery: A retrospective study from two European referral centres. J Surg Oncol 2022; 126:365-371. [PMID: 35333402 DOI: 10.1002/jso.26867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Primary abdominal wall sarcomas are rare, heterogeneous tumours. The mainstay of management is surgery, although local recurrences (LR) and distant metastases (DM) are common. OBJECTIVES Overall survival (OS) and disease-free survival (DFS) were primary outcomes; factors associated with prognosis secondary outcomes. MATERIALS AND METHODS Patients undergoing surgery of primary abdominal wall sarcomas between April 2008 and May 2018 were identified at two referrals centres for sarcoma surgery. Patient demographics, tumour and treatment-related characteristics were recorded and analysed. RESULTS A cohort of 65 patients underwent surgical resection with a median follow-up of 56 months, 5-year OS and DFS were 69% and 71%, respectively. Eleven patients (16.9%) experienced a recurrence event: 6 LR (9.2%), 10 DM (15.4%) and 5 both (7.7%). At univariate analysis, size (p = 0.03), grade (p = 0.001) and depth (p = 0.04) were associated with OS while size (p = 0.02) was associated with DFS. No significant relationship with tumour depth, type of surgery, surgical margin status or neo-/adjuvant treatment was demonstrated. CONCLUSION Recurrence events are less common following treatment of abdominal wall sarcomas if compared to extremities STSs, but size (≥5 cm), high malignancy grade (FNCLCC 3) and depth are associated with worse OS.
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Affiliation(s)
- Hannah L Tattersall
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Marco Baia
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Valentina Messina
- Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Sarcoma Service, Milan, Italy
| | - Alessandra Borghi
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Alessandro Gronchi
- Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Sarcoma Service, Milan, Italy
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19
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Mancera J, Vergara A, Cadena ME, Lozada-Martinez ID, Guardo-Carmona D, Cabrera-Vargas LF, Ataullah A. Metastasis of the abdominal wall in a patient with diagnosis of pulmonary adenocarcinoma: An interesting finding. Respir Med Case Rep 2022; 38:101703. [PMID: 35879972 PMCID: PMC9307449 DOI: 10.1016/j.rmcr.2022.101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Tumors of the abdominal wall are rare, divided into benign and malignant lesions that are composed of primary tumors and by the parietal invasion of intra-abdominal tumors and metastatic parietal implants. In the case of metastases in the abdominal wall, the most frequent are metastases from neoplasms of colonic origin. The case described below is that of a 68-year-old patient with a history of stage IIA left lung adenocarcinoma who received partial response radiotherapy with an indication for chemotherapy, which she refused and lost follow-up.
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20
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Neuberg M, Mir O, Levy A, Sourrouille I, Dumont S, Haddag-Miliani L, Ngo C, Mihoubi F, Rimareix F, Le Péchoux C, Adam J, Honart JF, Ceribelli C, Le Cesne A, Leymarie N, Faron M, Honoré C. Surgical management of soft tissue tumors of the abdominal wall: A retrospective study in a high-volume sarcoma center. J Surg Oncol 2021; 124:679-686. [PMID: 34120344 DOI: 10.1002/jso.26566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/04/2021] [Accepted: 05/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the study is to evaluate functional and oncological outcomes of patients undergoing abdominal wall soft tissue tumors (AWSTT) surgery. METHODS All consecutive patients that underwent surgery for malignant and intermediate AWSTT from 1999 to 2019 were retrospectively analyzed. RESULTS Ninety-two patients were identified, 20 (22%) operated on for a desmoid tumor and 72 (78%) for a soft tissue sarcoma (STS). Fifty-two patients (57%) had in toto resection of the abdominal wall (from the skin to the peritoneum) and 9 (10%) required simultaneous visceral resection. The closure was direct in 28 patients (30%) and requiring a mesh, a flap or a combination of the two in respectively 42, 16, and 6 patients (47%, 17%, 6%). The postoperative complications rate was 26%. Thirteen patients (14%) developed an incisional hernia after a median delay of 27 months. After a median follow-up of 40 months, out of the 72 patients operated on for STS, 7 (10%) developed local recurrence and 11 (15%) distant recurrence. The median recurrence-free and overall survivals were 61 and 116, months respectively. CONCLUSIONS Management of AWSTT requires extensive surgery but allows good local control with an acceptable rate of incisional hernia.
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Affiliation(s)
- Maud Neuberg
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | | | - Sarah Dumont
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Carine Ngo
- Department of Pathology, Gustave Roussy, Villejuif, France
| | - Fadila Mihoubi
- Department of Radiology, Gustave Roussy, Villejuif, France
| | | | | | - Julien Adam
- Department of Pathology, Gustave Roussy, Villejuif, France
| | | | | | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
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21
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Schwannoma of the abdominal wall: updated literature review. Eur Surg 2021. [DOI: 10.1007/s10353-021-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Summary
Background
Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerves. It is often asymptomatic and can develop in the retroperitoneum, mediastinum, head and neck region, and upper and lower extremities. Schwannoma of the abdominal wall is extremely rare, but differential diagnosis with malignant neoplasms is important to reduce the risk of undertreatment.
Methods
A narrative review of abdominal wall schwannoma was performed using PubMed, EMBASE, and Web of Science database and the search terms “schwannoma”, “neurinoma”, “neurilemmoma”, “soft tissue tumors”, “neurogenic tumor”, “rectus abdominis mass”, “abdominal wall”. In addition, the hospital charts were reviewed to report the personal experience.
Results
Only 9 single case-reports of benign schwannoma of the abdominal wall were found in the English medical literature over the past decade. None of the patients received preoperative biopsy and all were resected with clear margins. In addition to the literature review, we report the case of a 58-year-old man referred for a palpable mass in the left upper abdominal quadrant. Ultrasonography and magnetic resonance imaging revealed a solid and well-encapsulated mass inside the left rectus abdominis muscle. A core biopsy of the lesion provided the diagnosis of cellular schwannoma and this was confirmed by histopathologic examination of the surgical specimen.
Conclusions
Benign schwannoma of the abdominal wall is extremely rare. Percutaneous core needle biopsy is important for the differential diagnosis with more common and biologically more aggressive malignancies, such as desmoid tumors and sarcomas, and may be relevant for planning the most appropriate management.
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22
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Vijayakumar A, Grignol V. Adenocarcinomas presenting as abdominal wall masses. BMJ Case Rep 2020; 13:13/10/e236125. [PMID: 33012713 DOI: 10.1136/bcr-2020-236125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients with abdominal wall masses as primary malignant tumours or metastatic disease are rare. Thorough evaluation with biopsy and imaging is required prior to surgical resection for treatment planning. We present a case series of three patients who presented with abdominal adenocarcinoma of unknown primary origin. All patients ultimately underwent surgical resection and final pathology showed a gynaecological origin for these tumours. Multidisciplinary management is required for these rare and complex tumours.
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Affiliation(s)
- Ammu Vijayakumar
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Valerie Grignol
- Department of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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23
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Zhao XF, Shen YM, Chen J. Multiple recurrent neurofibromas in the abdominal wall: A case report. World J Clin Cases 2020; 8:4223-4227. [PMID: 33024782 PMCID: PMC7520774 DOI: 10.12998/wjcc.v8.i18.4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neurofibroma can be a clinical manifestation of neurofibromatosis, which is a benign neurogenic tumor that occurs sporadically. Neurofibromas in the abdomen usually appear in the retroperitoneal space. Reports on neurofibromas in the abdominal wall are rare, and multiple recurrent neurofibromas in this area have not yet been reported.
CASE SUMMARY This is a case of a 73-year-old man who suffered from multiple recurrent neurofibromas in the abdominal wall for 16 years and received 13 surgical treatments.
CONCLUSION We need to pay due attention to its treatment, and primary surgery should be designed thoroughly.
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Affiliation(s)
- Xue-Fei Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ying-Mo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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24
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Harhar M, Ramdani A, Bouhout T, Serji B, El Harroudi T. Myxoid Liposarcoma: A Case Report of a Rare Location in the Abdominal Wall. Cureus 2020; 12:e8715. [PMID: 32699710 PMCID: PMC7372226 DOI: 10.7759/cureus.8715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Liposarcomas are considered to be the most common soft tissue sarcomas and have five histological subtypes. The myxoid subtype often occurs in the lower limbs and the retroperitoneum; however, the abdominal wall location is extremely rare. The clinical presentation and radiological findings are non-specific. Wide local excision with a minimum margin of 3 cm remains the mainstay of treatment to prevent local recurrences. We herein report a rare location of myxoid liposarcoma in the abdominal wall.
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Affiliation(s)
- Marouane Harhar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Abdelbassir Ramdani
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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25
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Zhao X, Cao Z, Nie Y, Liu J, Yuan X, Chen J, Shen Y. Retrospective analysis of defect reconstruction after abdominal wall tumor resection in 30 patients. Hernia 2020; 25:375-381. [PMID: 32451791 DOI: 10.1007/s10029-020-02219-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE It is difficult to manage the full-thickness defect that is created by radical resection of an abdominal wall tumor. This report aimed to review our institutional experience with immediate reconstruction using mesh reinforcement after abdominal wall tumor resection. METHODS We retrospectively examined patients who underwent abdominal wall tumor resection with immediate mesh-reinforced reconstruction between April 2014 and November 2018. The patients' records were reviewed to collect data regarding their demographic characteristics, surgical procedures, and complications. RESULTS We identified 30 eligible patients, including 5 who underwent simultaneous resection of affected intra-abdominal organs or tissues. The median size of the resulting abdominal wall defect was 60 cm2 (interquartile range: 32-127.5 cm2) and the median mesh size was 150 cm2 (interquartile range: 150-225 cm2). The median operative time was 85 min (interquartile range: 60-133.8 min), the mean hospital stay was 19.4 ± 9.0 days, and the mean follow-up period was 28.6 ± 16.0 months. The complications included seroma (n = 4), infection (n = 2), massive hematoma (n = 1), and abnormal sensation (n = 3). Tumor recurrence was observed in two patients, and three patients died because of cancer progression. No patient developed a ventral hernia or abdominal bulging. CONCLUSION Immediate mesh-reinforced reconstruction is feasible and effective for patients who require abdominal wall tumor resection.
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Affiliation(s)
- X Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Z Cao
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Y Nie
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - J Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - X Yuan
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
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26
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Song YH, Huang WJ, Yan YT, Zhang S, Xie YY, Hada G, Lu AQ, Wang Y, Lei WZ. Application of double circular suturing technique (DCST) in the repair of large abdominal wall defects after resection of abdominal wall tumor. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:367. [PMID: 32355811 PMCID: PMC7186725 DOI: 10.21037/atm.2020.02.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The aim of this study was to investigate the clinical effects of repairing large defects using the double circular suturing technique (DCST) after resection of abdominal wall tumor. Methods The clinical data of 62 patients (25 men, 37 women; average age 41.7±22.4 years) who underwent DCST between October 2010 and November 2018 for the repair of large abdominal wall defects with anti-adhesion underlay mesh after resection of abdominal wall tumor were retrospectively analyzed. The maximum diameter of abdominal wall defect after resection of abdominal wall tumor was 10.4±5.6 cm. The course of disease was 1–341 months, and the average was 32.4 months. Operative time, postoperative hospitalization time, perioperative complications, tumor recurrence in situ, incidence of postoperative chronic pain, and hernia were recorded. Results All 62 operations were completed successfully. The operative time was 73.2±31.4 minutes, and the mean postoperative hospitalization time was 9.6 days (range, 2–20 days). In total, 54 patients were followed up postoperatively for a median 6.7 years (range, 0.9–9.0 years). Partial splitting of incisions occurred in 2 patients, fat liquefaction of incisions occurred in 3 patients, and chronic pain occurred in 4 patients. No tumor in situ recurrence, hernia, or other complications were found in any cases in the follow-up. Tumor metastasis occurred in 9 patients with 6 of these patients dying of tumour progression. Conclusions With simple operations, short procedure time, few complications, low tumor recurrence rate, and low incidence of postoperative chronic pain, application of DCST in the repair of large abdominal wall defects is effective after resection of abdominal wall tumor.
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Affiliation(s)
- Ying-Han Song
- Department of Day Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wei-Jia Huang
- West China School of Clinical Medicine, Sichuan University, Chengdu 610041, China
| | - You-Tong Yan
- West China School of Clinical Medicine, Sichuan University, Chengdu 610041, China
| | - Sen Zhang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yan-Yan Xie
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Gonish Hada
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - An-Qing Lu
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yong Wang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wen-Zhang Lei
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, Middleton WD, Mellnick VM. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics 2020; 40:684-706. [PMID: 32330085 DOI: 10.1148/rg.2020190170] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Parisa Mazaheri
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Daniel C Oppenheimer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
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Nandwani M, Barmon D, Begum D, Kataki AC. Rare Sites Metastasis in Ovarian Carcinoma: a Compilation of 3 Case Reports. Indian J Surg Oncol 2020; 11:150-153. [DOI: 10.1007/s13193-019-00988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2019] [Indexed: 11/28/2022] Open
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Postoperative radiotherapy in primary resectable desmoid tumors of the neck: a case-control study. Strahlenther Onkol 2019; 195:1001-1006. [PMID: 31172208 DOI: 10.1007/s00066-019-01479-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Desmoid tumors (DTs) are rare soft tissue tumors, which frequently recur after surgery. The optimal treatment approach is still controversial due to lack of randomized data. The purpose of the study was to review a relative large series of DTs of the neck with emphasis on the value of postoperative radiotherapy (RT). METHODS A total of 68 patients with DTs of the neck region with or without postoperative RT between 1/2008 and 12/2017 were included. They were individually matched for factors including age, gender, tumor size and margin status with a cohort of patients who underwent operative without postoperative RT. The event-free survival (EFS) was compared in the two groups. RESULTS For the study, 34 patients and 34 matched control subjects were identified. The two groups did not differ in terms of age (p = 0.810), gender (p = 0.328), tumor size (p = 0.803) and margin status (p = 0.799). Patients who received surgery plus RT had a significantly higher 3‑year EFS than those who received surgery alone (74.6% vs. 13.3%, P < 0.001). Factors including postoperative RT and margin status were independent factors of EFS. The values of P were <0.001 and 0.003 and the hazard ratios (95% confidence interval) were 11.929 (4.732-30.072) and 0.299 (0.133-0.671), respectively. None of the patients treated with RT developed serious complications. CONCLUSIONS According to our results, postoperative radiotherapy is an effective treatment in desmoid tumors of the neck. Multi-institutional and prospective studies are warranted to further validate our findings.
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Li H, Li J, Zhan Y, Han Z, Liu F, Liang P, Yu X. Ultrasound-Guided 125I Seed Implantation in Treatment of Abdominal Wall Metastases. Cancer Biother Radiopharm 2019; 34:218-223. [PMID: 30810349 DOI: 10.1089/cbr.2018.2690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The treatment of abdominal wall metastasis presents a challenge, because resection can be followed by poor healing and external radiotherapy is associated with serious adverse events. This study aimed to evaluate the efficacy and safety of interstitial 125I seed implantation under ultrasound (US) guidance for treating abdominal wall metastasis. Materials and Methods: The cases of 21 patients with 28 abdominal wall metastases who received brachytherapy with 125I seeds at the department from August 2010 to March 2015 were retrospectively reviewed. 125I seeds were implanted in the abdominal wall lesions under US guidance and with the help of a treatment planning system. Follow-up was performed using computed tomography at 1 d and at 3, 6, and 12 months after implantation. The lymphocyte count before the surgery was compared with the 3-month postoperative count. The main indicators observed were changes in tumor size, side effects, and complications. Results: All 21 patients were successfully treated with 125I seed implantation under US guidance. The median follow-up since 125I seed implantation was 15 months (range 6-23 months). The response rates and local tumor control after 3, 6, and 12 months were 78.6% and 89.3%, 64.3% and 85.7%, and 52.4% and 71.4%, respectively. The mean preoperative lymphocyte count was 0.262 ± 0.117 × 109/L, which did not differ significantly from the postoperative count, which was 0.259 ± 0.094 × 109/L (p = 0.122). Procedure-related complications included fever, bleeding, and pain, but all these were Grade 1-2. No severe side effects or complications were noted. Conclusions: Percutaneous interstitial implantation of 125I seeds under US guidance is safe and feasible for abdominal wall metastases. However, its long-term efficacy requires further investigation.
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Affiliation(s)
- Huarong Li
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,2 Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jianming Li
- 3 Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yong Zhan
- 4 Department of Ultrasound, The 82nd Group Army Hospital, Baoding, Hebei, China
| | - Zhiyu Han
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- 1 Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Lin CH, Chang TJ, Hou MM, AbdelRahman M, Wang CW, Wang LJ, Kao D, Hsu SC, Kwon SH, Huang SY, Chang JC. How to differentiate abdominal wall leiomyomas from desmoid tumors? FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_115_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Spera LJ, Danforth RM, Hadad I. Incisions and reconstruction approaches for large sarcomas. Transl Gastroenterol Hepatol 2018; 3:86. [PMID: 30505973 DOI: 10.21037/tgh.2018.10.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/19/2018] [Indexed: 01/02/2023] Open
Abstract
Large intraabdominal, retroperitoneal, and abdominal wall sarcomas provide unique challenges in treatment due to their variable histology, potential considerable size at the time of diagnosis, and the ability to invade into critical structures. Historically, some of these tumors were considered inoperable if surgical access was limited or the consequential defect was unable to be closed primarily as reconstructive options were limited. Over time, there has been a greater understanding of the abdominal wall anatomy and mechanics, which has resulted in the development of new techniques to allow for sound oncologic resections and viable, durable options for abdominal wall reconstruction. Currently, intra-operative positioning and employment of a variety of abdominal and posterior trunk incisions have made more intraabdominal and retroperitoneal tumors accessible. Primary involvement or direct invasion of tumor into the abdominal wall is no longer prohibitive as utilization of advanced hernia repair techniques along with the application of vascularized tissue transfer have been shown to have the ability to repair large area defects involving multiple quadrants of the abdominal wall. Both local and distant free tissue transfer may be incorporated, depending on the size and location of the area needing reconstruction and what residual structures are remaining surrounding the resection bed. There is an emphasis on selecting the techniques that will be associated with the least amount of morbidity yet will restore and provide the appropriate structure and function necessary for the trunk. This review article summarizes both initial surgical incisional planning for the oncologic resection and a variety of repair options for the abdominal wall spanning the reconstructive ladder.
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Affiliation(s)
- Leigh J Spera
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel M Danforth
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ivan Hadad
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Macciò A, Kotsonis P, Lavra F, Chiappe G, Mura E, Melis L, Madeddu C. A PET-positive rapidly growing mass of the abdominal wall after cesarean section with an unexpected diagnosis of vernix caseosa granuloma: a case report. GYNECOLOGICAL SURGERY 2018; 15:17. [DOI: 10.1186/s10397-018-1050-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/26/2018] [Indexed: 09/27/2023]
Abstract
Abstract
Background
Abdominal wall tumors are rare and include heterogeneous diseases. Among them, desmoid tumors are the most frequent and are often diagnosed in young women during or early after pregnancy; inflammatory response after trauma or microtrauma, such as after cesarean section, may favor their growth.
Results
A 37-year-old woman presented with a progressive mass in the abdominal wall after a cesarean section. Positron emission tomography imaging confirmed a positive mass with a high maximum standardized uptake value; a biopsy suggested a myofibroblastic tumor. With continued tumor growth and worsening symptoms, the mass resembled a desmoid tumor; therefore, we proceed with its resection. The final diagnosis was foreign body granuloma as a reaction to the spillage of meconium and keratinous material in the amniotic fluid during cesarean section.
Conclusions
The present case provides information on an abdominal wall foreign body granuloma arisen from meconium and vernix caseosa after cesarean section, which presented an atypical clinical picture, mimicking a desmoid, thus requiring a careful diagnostic and treatment approach.
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Kostrzeba E, Barczyk M, Wichtowski M, Garstecki R, Murawa D. Clear Cell Carcinoma of the abdominal wall. POLISH JOURNAL OF SURGERY 2017; 89:40-43. [DOI: 10.5604/01.3001.0010.6753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Clear cell carcinoma in scars after cesarean section is extremely rare, with only 22 cases reported in the literature. Management of this condition needs to be further explored. Here, we report of a patient with clear cell carcinoma of the abdominal wall that developed 35 years after cesarean section. Case Report: The material of the study was a group of 61 patients divided into two groups. Group I – 35 deaf or with profound sensorineural hearing loss children (the pupils of the deaf and hard of hearing school), aged 5–17 years (average 9,2 years), 14 males, 21 females, II – control group comprised 26 normal hearing patients, aged 5–16 years (average 10,4 years), 14 males, 12 females (patients of Department of Pediatric Otolaryngology, Audiology and Phoniatrics, Medical University of Lodz). In both groups, exon 2 sequencing of GJB2 gene was performed. Results. A 58-year-old woman was admitted to our department due to abdominal pain and a progressively growing mass in the abdominal wall. Based on biopsy, a preliminary diagnosis of clear cell carcinoma was made. A wide surgical excision of the tumor with clear margins, hysterectomy with bilateral salpingo-oophorectomy, and abdominal wall reconstruction using synthetic mesh were performed. The patient was discharged in good condition after fifteen days of hospitalization. The patient remained recurrence-free 6 months after the treatment. Conclusions: T Lack of standardized management of rare malignant transformations hinders patient care. Due to a growing number of cesarean deliveries, we can expect clear cell carcinoma prevalence of the abdominal wall to increase. Therefore, patients and clinicians should attend to any pain, itching, or change in the size of abdominal wall scars.
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Affiliation(s)
- Ewa Kostrzeba
- Oncological and General Surgery Ward I, the Greater Poland Cancer Center, Poznan, Poland
| | - M. Barczyk
- Oncological and General Surgery Ward I, the Greater Poland Cancer Center, Poznan, Poland
| | - M. Wichtowski
- Oncological and General Surgery Ward I, the Greater Poland Cancer Center, Poznan, Poland
| | - R. Garstecki
- Oncological and General Surgery Ward I, the Greater Poland Cancer Center, Poznan, Poland
| | - D. Murawa
- Department of General and Minimally Invasive Surgery, Hospital Baptismal Monument in Poland in Gniezno, Poland
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Smith H, Tzanis D, Messiou C, Benson C, van der Hage J, Fiore M, Bonvalot S, Hayes A. The management of soft tissue tumours of the abdominal wall. Eur J Surg Oncol 2017; 43:1647-1655. [DOI: 10.1016/j.ejso.2017.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 01/27/2023] Open
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Couto Netto SD, Teixeira F, Menegozzo CAM, Albertini A, Akaishi EH, Utiyama EM. Abdominal wall reconstruction after desmoid type fibromatosis radical resection: Case series from a single institution and review of the literature. Int J Surg Case Rep 2017; 33:167-172. [PMID: 28327422 PMCID: PMC5358906 DOI: 10.1016/j.ijscr.2017.02.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Abdominal wall desmoid type fibromatosis management has been changing over recent years, from an aggressive approach towards a more conservative one. When radical resection is indicated, the surgical team faces the challenge of abdominal wall reconstruction, for which optimal technique is still debated. The present study reports the experience from a single center with abdominal closures after desmoid type fibromatosis resection. MATERIAL AND METHODS Retrospective analysis of patients who underwent abdominal wall closure after sporadic abdominal desmoid type fibromatosis radical resection from 1982 to 2013. RESULTS Twenty-seven patients were included, mean tumor diameter was 10 + 5.3 cm, and the main choice of abdominal wall reconstruction was midline closure with anterior rectus sheath relaxing incisions and polypropylene onlay mesh (74% of the cases). Only 7% of the cases required more complex procedures for skin closure. Mean follow-up was 5 years and 89% remained disease-free. No grade 4 or 5 complications were observed. CONCLUSION High midline fascial closure rate can be achieved after resection of abdominal wall desmoid tumor using relaxing incisions and mesh, with low complication rate.
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Affiliation(s)
- S D Couto Netto
- Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - F Teixeira
- Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - C A M Menegozzo
- Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - A Albertini
- Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - E H Akaishi
- São Paulo State Cancer Institute - ICESP, University of Sao Paulo, Sao Paulo, Brazil
| | - E M Utiyama
- Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Davis BS, Dunn DP, Hostetler VC. Beyond hernias: a multimodality review of abdominal wall pathology. Br J Radiol 2016; 90:20160719. [PMID: 27792404 DOI: 10.1259/bjr.20160719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of abdominal wall pathology is often obvious on clinical physical examination; however, multimodality imaging often yields incidental, and occasionally important, findings aiding in assessing the overall clinical picture. While various hernias are common, there are numerous other causes of abdominal wall pathology. Knowledge of these entities is crucial to avoid misinterpretation and assure proper radiological judgment.
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Affiliation(s)
- Brady S Davis
- 1 David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA
| | - Dell P Dunn
- 1 David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA.,2 University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Valerie C Hostetler
- 1 David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA
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Abstract
The management of truncal sarcoma presents unique challenges to the treating physician for reasons specific to this tumor location. First, the reconstruction options after resection of the abdominal or chest wall require a balance between cosmesis and structural integrity due to the multiplanar forces exerted on this region. Second, the histologies that commonly arise in this region are often associated with high local recurrence rates, which often require complex decision making due to prior therapy. Finally, sarcomas of the trunk in the inguinal region involve those organs in the genitourinary system, of which resection can have significant psychosocial implications.
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Affiliation(s)
- John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33606, USA
| | - Ricardo J Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33606, USA.
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Rajaram V, Hill DA, Doherty GM, Liapis H, Dehner LP. Pleomorphic Rhabdomyosarcoma of the Anterior Abdominal Wall Following Multimodality Treatment for Carcinoma of the Rectum. Int J Surg Pathol 2016; 12:161-5. [PMID: 15173925 DOI: 10.1177/106689690401200213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postradiation sarcomas are rare, and the most commonly reported ones are malignant fibrous histiocytoma, osteosarcoma, angiosarcoma, fibrosarcoma, malignant peripheral nerve sheath tumor, and high-grade pleomorphic sarcoma, not otherwise specified. There are a few case reports of postradiation rhabdomyosarcomas following treatment of retinoblastoma, breast cancer, endometrial adenocarcinoma, and Hodgkin’s disease. Secondary neoplasms following radiation and surgical treatment of rectal adenocarcinomas have not been reported in the English literature. We report a case of pleomorphic rhabdomyosarcoma of the anterior abdominal wall following treatment of rectal carcinoma, and we review the literature.
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Affiliation(s)
- Veena Rajaram
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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Nussbaum DP, Rushing CN, Lane WO, Cardona DM, Kirsch DG, Peterson BL, Blazer DG. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 2016; 17:966-975. [DOI: 10.1016/s1470-2045(16)30050-x] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/20/2022]
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Iqbal N, Shukla NK, Deo SVS, Agarwala S, Sharma DN, Sharma MC, Bakhshi S. Nonrhabdomyosarcomatous abdominopelvic sarcomas: Analysis of prognostic factors. Indian J Med Paediatr Oncol 2016; 37:100-5. [PMID: 27168708 PMCID: PMC4854040 DOI: 10.4103/0971-5851.180134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Data concerning treatment outcome and prognostic factors in sarcomas of abdomen and pelvis are sparse in literature. METHODS AND RESULTS Of 696 patients with nonrhabdomyosarcomatous soft tissue sarcoma registered at our center between June 2003 and December 2012, 112 (16%) patients of sarcomas arising from abdomen and pelvis were identified, of which 88 patients were analyzed for treatment outcome and prognostic factors. The median age was 40 years (range: 1-78 years) with a male: female ratio of 0.7:1. Twenty-one (24%) patients were metastatic at baseline. The most common tumor sites were retroperitoneum in 70% patients and abdominal wall in 18% patients. Leiomyosarcoma was the most common histological subtype in 36% patients followed by liposarcoma in 17% patients. Thirty-five (40%) patients had Grade III tumors. Forty-six (52%) patients underwent surgical resection. At a median follow-up of 43 months (range: 2-94 months), the 5-year event-free survival (EFS) and overall survival (OS) were 35% and 42%, with a median of 22 months and 43 months, respectively. Multivariate analysis identified male gender (P - 0.03, hazard ratio [HR] - 0.46, 95% confidence interval [CI] - 0.23-0.92), baseline metastatic disease (P - 0.01, HR - 2.98, 95% CI - 1.27-6.98) and Grade III tumors (P - 0.02, HR - 1.84, 95% CI - 1.08-3.13) as factors associated with poor EFS, whereas baseline metastatic disease (P < 0.001, HR - 5.45, 95% CI - 2.31-12.87) and unresectability (P - 0.01, HR - 2.72, 95% CI - 1.27-5.83) were associated with poor OS. CONCLUSION This is a single-institutional study of patients with abdominopelvic sarcomas where gender was identified as a new factor affecting survival apart from baseline presentation, histologic grade, and surgical resection.
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Affiliation(s)
- Nida Iqbal
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nootan K Shukla
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Meher C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Wide Local Excision for Dermatofibrosarcoma Protuberans: A Single-Center Series of 90 Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:642549. [PMID: 26688814 PMCID: PMC4673335 DOI: 10.1155/2015/642549] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023]
Abstract
Background. Dermatofibrosarcoma protuberans (DFSP), a rare low-grade sarcoma of fibroblast origin, tends to extend in a finger-like fashion beyond macroscopic tumor margins. Therefore, incomplete removal and subsequent recurrence are common. This study aimed to determine the efficacy of wide local excision (WLE) for controlling local recurrence of DFSP. Methods. The medical records of 90 DFSP patients who received WLE at our hospital between June 1992 and January 2015 were retrospectively reviewed. WLE was conducted including a 3 cm (range, 1 to 5 cm) safety margin according to tumor size, location, and recurrence status. Clinical and tumor characteristics and surgical methods were evaluated for risk factor analysis and local recurrence-free survival. Results. DFSP occurred most often in patients in their 30s (30%) and on the trunk (51.1%). Five patients (5.5%) experienced local recurrence during the 43.4-month follow-up period. Recurrence was found at a mean of 10.8 months after WLE. Although no factors were significantly associated with recurrence, recurrences were more frequent in head and neck. Recurrence-free survival was 87% in 6 years and 77% in 7 years. Conclusions. WLE with adequate lateral and deep margins can effectively control local recurrence rate and is a simple and effective method to treat DFSP.
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Abstract
BACKGROUND Desmoid tumors (DT) represent a group of rare, distinct lesions. There are few published studies examining outcomes and safety of complex reconstruction after DT resection. METHODS A retrospective review identified 39 patients who underwent surgical treatment of DT at St. Jude Children's Research Hospital over a 12-year period. A systematic review of the literature identified 17 further studies for inclusion. Treatment characteristics were analyzed. RESULT Thirty-nine patients were treated during the study period, with a total number of 67 resections. Median age was 12.2 years; 49% of patients were male, and 51% were female. Median tumor size was 9.8 cm. DT most commonly arose in the extremities (40%), thorax (23%), head and neck (21%), and trunk (16%). One- and 5-year recurrence-free survival were 97.1% and 73.1%, respectively. The majority of defects were closed primarily, with the exception of head and neck defects. Long-term outcomes were good for chest, abdomen, and upper extremity defects, but were problematic for head and neck, breast, and lower extremity defects. There were no recurrences at the site of flap harvest in either the study population or in reviewed studies. CONCLUSION For patients with DT, surgical extirpation should not come at the expense of functional preservation, as overall survival is excellent. However, specific defects, including those of the lower extremity, breast, and head and neck, will benefit from improved techniques for resection and reconstruction.
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Lv Y, Cao D, Guo F, Qian Y, Wang C, Wang D. Abdominal wall reconstruction using a combination of free tensor fasciae lata and anterolateral thigh myocutaneous flap: a prospective study in 16 patients. Am J Surg 2015; 210:365-73. [DOI: 10.1016/j.amjsurg.2014.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/05/2014] [Accepted: 11/23/2014] [Indexed: 01/23/2023]
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Khansa I, Janis JE. Modern reconstructive techniques for abdominal wall defects after oncologic resection. J Surg Oncol 2014; 111:587-98. [DOI: 10.1002/jso.23824] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/09/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ibrahim Khansa
- Department of Plastic Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Jeffrey E. Janis
- Department of Plastic Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
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Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk. Ann Surg 2014; 259:973-8. [PMID: 24477160 DOI: 10.1097/sla.0000000000000224] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. RESULTS Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery. CONCLUSIONS Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.
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Gonenc M, Bozkurt MA, Kapan S, Aras A, Surek A, Alis H. Acutely incarcerated abdominal wall hernia: what if it is a consequence? Hernia 2013; 18:837-43. [PMID: 24121841 DOI: 10.1007/s10029-013-1166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to emphasize the importance of differential diagnosis in patients with acutely incarcerated abdominal wall hernia (AWH). METHODS The medical records of patients who underwent emergency surgery with preoperative diagnosis of acutely incarcerated AWH and in whom acutely incarcerated AWH was the consequence of increased intraabdominal pressure due to other abdominal emergencies were reviewed. The following data were collected: demographics, the duration between the onset of symptoms and admission, clinical findings, biochemical test results that were abnormal, radiological findings, preoperative and intraoperative diagnosis, operative findings, surgical procedure, different diagnosis made in the postoperative period, reoperation, morbidity, mortality, and the length of hospital stay. RESULTS Ten patients were included to the study. The primary pathology was found to be perforated peptic ulcer disease in three, bowel obstruction due to neoplastic mass in three, complicated appendicitis in two, acute mesenteric ischemia in one, and acute diverticulitis in one. The correct diagnosis was made during emergency surgery for hernia repair, whereas the primary pathology was identified postoperatively in two patients. CONCLUSIONS Patients who are diagnosed to have acutely incarcerated AWH preoperatively should undergo further diagnostic workup, if any level of clinical suspicion for differential diagnosis is present. Moreover, the surgeon should consider general abdominal exploration if contradictory findings are encountered during the exploration of the hernia sac, even if preoperative diagnostic studies reveal no gross pathology or non-specific findings.
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Affiliation(s)
- M Gonenc
- Genel Cerrahi Klinigi, Dr. Sadi Konuk Egitim ve Arastirma Hastanesi, Bakirkoy, 34147, Istanbul, Turkey,
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Williams KJ, Hayes AJ. A guide to oncological management of soft tissue tumours of the abdominal wall. Hernia 2013; 18:91-7. [PMID: 24043554 DOI: 10.1007/s10029-013-1156-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/06/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION An abdominal mass is a common clinical presentation, and a small percentage of such patients will have an abdominal wall tumour with the two most common pathologies being fibromatosis and soft tissue sarcoma. METHODS Here we present the available literature on the diagnosis and management of both fibromatosis and soft tissue sarcoma, in the context of our experience in a tertiary referral centre for sarcoma. RESULTS AND DISCUSSION Appropriate cross-sectional imaging and a pre-operative tissue diagnosis by percutaneous core biopsy are necessary to define management. Desmoid fibromatosis can be managed initially by observation with serial imaging, with surgery being reserved for those patients who demonstrate progression. Soft tissue sarcoma can display a range of pathologies from relatively indolent tumours to locally aggressive sarcomas that can readily metastasise. An accurate pre-operative histological diagnosis and staging enables a multidisciplinary approach to management. This may include chemotherapy and radiotherapy, but the mainstay of treatment remains wide surgical resection and abdominal wall reconstruction. Patient outcomes are worse if referral is delayed or if the sarcoma is incompletely resected without an initial tissue diagnosis.
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Affiliation(s)
- K J Williams
- Academic Section of Vascular Surgery, Imperial College London, London, UK,
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Garvey PB, Booth JH, Baumann DP, Calhoun KA, Liu J, Pollock RE, Butler CE. Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence. J Am Coll Surg 2013; 217:472-80. [PMID: 23816381 DOI: 10.1016/j.jamcollsurg.2013.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The propensity of desmoid tumors to develop in scars has led some surgeons to limit the complexity of desmoid defect reconstruction as a strategy for avoiding desmoid recurrence. We hypothesized that desmoid recurrence rates are similar despite the magnitude of reconstruction. STUDY DESIGN We retrospectively compared recurrence rates between patients who underwent reconstruction and patients who underwent primary closure without reconstruction after desmoid tumor resection in consecutive patients for 15 years. Univariate and multivariate regression analyzed associations between patient, tumor, and treatment characteristics and outcomes. RESULTS We included 164 consecutive patients (80 [49%] reconstructions vs 84 [51%] primary closures). Mean follow-up duration was 7.1 ± 4.5 years. Patients who underwent reconstruction had more desmoids in an area of earlier trauma or surgery (p < 0.001), greater defect volume (p < 0.01), longer operative time (p < 0.001) and hospital stay (p < 0.001), and more postoperative complications (p = 0.015) compared with the primary closure group. Despite these differences, desmoid recurrence rates were similar for the reconstruction and primary closure groups (30% and 29%, respectively; p = 0.7), as was mean time to tumor recurrence, and no tumors recurred within flap donor sites. Multivariate regression analysis demonstrated the 45F mutation to be the only independent predictor of recurrence (hazard ratio = 1.87; p = 0.04). CONCLUSIONS Rates of desmoid recurrence in resection defects are similar for primary closures and complex reconstructions. Therefore, surgeons should not limit the magnitude of reconstructions in an attempt to avoid tumor recurrence. However, given the propensity of desmoids to recur, reconstructions should allow for the possibility of future resections and reconstructions, particularly in tumors with 45F gene mutations.
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Affiliation(s)
- Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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The use of Permacol for the reconstruction of a complex thoraco-abdominal wall defect from a recurrent leiomyosarcoma. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0814-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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