PMC7351623_01
There was a mass near the cecum. The elevation of tissue fascia and free air were detected (A). There were several small polyps at ileocecal section (B).
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The CT revealed a mass with elevation of tissue fascia and free air near the cecum (Figure 1A). We did not detect the mass from the resected specimen (Figure 1B), and pathological examination revealed no malignancy.
The enhanced CT in December 2017 showed the mass of 38mm with dyeing ring form in the left rectus abdominis muscle. The mass was located near the ileostomy closure scar. The triangle points to the tumor.
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The mass was located near the scar of ileostomy closure (Figure 2).
The MRI in April 2018 showed the mass of 40mm in the left rectus abdominis muscle. The mass showed low intensity area like muscle in T2 weighted images (A). It was uniformly enhanced (B). The triangle points to the tumor.
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T2 weighted image showed a low intensity area similar to muscle (Figure 3A), and the tumor was uniformly enhanced (Figure 3B).
We performed a midline incision similar to the previous scar and we cut a spindle shape around the mass at 2cm margin from the mass (A). There was no exposure of the tumor to abdominal side. We used ultrasonically activated scalpel when we cut the muscle (B). Next, we removed the rectus abdominis muscle from the left lateral end. The abdominal wall defect was 10cmx10cm (C). The hernia was repaired with a simple closure using anterior layer of rectus sheath and the defect was closed by suturing the right anterior layer of rectus sheath to the left aponeurosis of external oblique muscle (D). We used a fascia lata patch measuring 15 cm x 5 cm (E) to repair the defect in the left abdomen (F).
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We performed a midline incision similar to the previous scar and cut a spindle shape around the mass at 2-cm margin from the mass (Figure 4A). We used the Harmonic ScalpelTM (Ethicon Endo-Surgery, Cincinnati) to cut the muscle to prevent bleeding (Figure 4B). The abdominal wall defect measured 10 cm x 10 cm (Figure 4C). The hernia was repaired with a simple closure using anterior layer of rectus sheath and the defect was closed by suturing the right anterior layer of rectus sheath to the left aponeurosis of external oblique muscle (Figure 4D). We used a fascia lata patch measuring 15 cm x 5 cm (Figure 4E) to repair the defect in the left abdomen (Figures 4F and 5A-C).
The final form after resection of tumor (A). The gray zone is the part that was removed. The defect was repaired with a simple closure and the defect was closed by suturing the right anterior layer of rectus sheath to the left aponeurosis of external oblique muscle (B). We used fascia lata patch as on lay mesh on defect (C).
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We used a fascia lata patch measuring 15 cm x 5 cm (Figure 4E) to repair the defect in the left abdomen (Figures 4F and 5A-C).
The tissue image is a magnified view of the red square part in the lower right image. The black line at the bottom left shows 50microm. The size of the mass was 45mmx45mm, the cut surface was white (A). The growth of fibroblasts was seen, the nuclear heteromorphic was poor. There was abundant collagen fibers between fibroblasts (B). A nuclear positive image of beta-Catenin was observed by immunostaining (C).
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The macroscopic view of the resected tumor revealed its whitish color (Figure 6A). Pathological analysis revealed the growth of fibroblasts, defect of the nuclear heteromorphism, and presence of abundant collagen fibers between fibroblasts (Figure 6B). Additionally, a nuclear-positive image of beta-catenin was observed on immunostaining (Figure 6C).