PMC4818309_01
Sections from computed tomography scan with oral and intravenous contrast enhancement demonstrating the locations of the two intra-abdominal desmoid tumours indicated by the arrows. Arrows "A" demonstrate the distal jejunal lesion and arrows "B" show the lesion in the ileocaecal region.
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However, a CT of the abdomen and pelvis revealed two soft tissue masses in the abdomen; the largest measuring 6.8 cm in the mid abdomen appeared to be causing proximal small bowel obstruction, and separate mass of similar tissue density measuring 5 cm adjacent to the ileocaecal region surrounded by a small amount of free fluid (Fig. 1).
7 x 8 x 4 cm tumour arising from distal jejunal mesentery, involving the bowel wall. The bowel wall is covered in fibrinous exudates and there is associated congestion and haemorrhage in the mesentery.
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At laparotomy the next day he was found to have a necrotic 7 cm mass arising from the mesentery of the distal jejunum/proximal ileum invading the contiguous small bowel, causing obstruction and perforation (Fig. 2).
6 cm desmoid tumour arising from the meso-appendix.
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A second mass measuring 6 cm was found arising from the mesoappendix and infiltrating into the ileocaecal region (Fig. 3).
(A) Ileal mass. Acute inflammatory exudate at serosal surface (left). (H&E medium power). (B) Ileal mass replacing the bowel wall (H&E scanning view). (C) Ileal mass. Fibromatosis, characterised by uniform spindle cells, red cell extravasation and occasional mitoses. (H&E high power). (D) Ileo-caecal mass with prominent keloidal collagen. (H&E medium power). (E) Ileal mass. Expression of smooth muscle actin (internal control = muscularis propria). (F) Ileal mass. Nuclear expression of Beta-catenin, a characteristic finding in fibromatosis.
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The ileocaecal mass displayed prominent keloid collagen (Fig. 4).