PMC4198783_01
Abdominal computed tomography (sagittal reconstruction): A: desmoid-type fibromatosis; B: sigmoid colon involved; C: ileal loop involved.
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Intraoperative view: A: desmoid-type fibromatosis (15 x 10 x 6.5 cm); B: ileal loop and mesentery involved.
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The patient, after having signed his informed consent, was submitted to laparotomy which revealed, at the base of the mesentery of the fourth to last intestinal loop, a well-circumscribed mass, firm in consistency, measuring 15 cm at its greatest diameter (Figure 2). It was not possible to isolate the tumor mass from both the sigmoid colon (Figure 3) and the ileal loop (Figure 2) and this is why a resection of the mass en bloc with the adjacent infiltrated colon and a tract of small intestine (20 cm) was performed.
Intraoperative view: A: desmoid-type fibromatosis (15 x 10 x 6.5 cm); B: sigmoid colon involved.
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It was not possible to isolate the tumor mass from both the sigmoid colon (Figure 3) and the ileal loop (Figure 2) and this is why a resection of the mass en bloc with the adjacent infiltrated colon and a tract of small intestine (20 cm) was performed.
(a) Low magnification showing a fibrous proliferation involving smooth muscle layer of colonic bowel (hematoxylin and eosin; magnification x60). (b) Higher magnification showing intersecting fascicles composed of bland-looking spindle-shaped cells (hematoxylin and eosin; magnification x100). These morphological features are consistent with desmoid-type fibromatosis.
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Histologically, the typical morphological features of desmoid-type fibromatosis were identified: proliferation of bland-looking spindle-shaped cells arranged in long sweeping fascicles and set in a finely collagenous stroma (Figures 4(a) and 4(b)).
(a) Area of desmoid-type fibromatosis showing extensive myxoid stroma with interspersed keloid-like collagen fibers (hematoxylin and eosin; magnification x100). (b) Immunostaining for beta-catenin shows nuclear expression in neoplastic cells (immunoperoxidase staining; magnification x100).
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Interestingly, majority of tumor areas (about 70% of the entire neoplasm) were composed of haphazardly arranged spindled, to stellate, to polygonal cells set in a prominent myxoid stroma containing interspersed keloid-like collagen fibers and normal or ectatic, thin-walled blood vessels with perivascular edema or hyalinization (Figure 5(a)). Nuclear immunoreactivity for beta-catenin was observed in 70-80% of neoplastic cells (Figure 5(b)).