PMC9037953_01
A clinical presentation of a giant right abdominal mass before surgical treatment. (A) The giant mass of right abdomen was visibly prominent. (B) The preoperative contrast-enhanced CT showed a large, inhomogeneous mass in the right abdominal wall that invaded right testis, spermatic cord, and right abdominal wall muscles, and demonstrated mild enhancement.
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F1
Physical examination revealed a large, muscle infiltrating prominent lump in the right abdomen, with an irregular shape, without varicosities, hydrocele, or varicocele (Figure 1A). The preoperative contrast-enhanced computed tomography (CT) was performed; it showed a large, inhomogeneous mass in the right abdominal wall that appeared to be continuous with the right testis, spermatic cord, and right abdominal wall muscles and demonstrated mild enhancement (Figure 1B).
Images of the surgery. (A) Right abdominal wall defect created by the lumpectomy of the underlying musculature (right obliquus externus abdominis, obliquus internus abdominis, transverses abdominis, and rectus abdominis). (B) The defect was then repaired with a flat sheet of polypropylene mesh.
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F2
The abdominal wall defect (Figure 2A) was then repaired with a polypropylene mesh (Progrip ; Medtronic, Minneapolis, MN, USA) (Figure 2B).
Surgical specimen of the right abdominal mass. (A) The surgical specimen of en bloc resection of the abdominal mass. (B) Cross-sectional view of the surgical specimen. The mass was large (30 cm x 24 cm x 15 cm in size), and the section was presented as fibrous tissue interleaving.
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F3
This excised lesion was 30 cm x 24 cm x 15 cm in size, containing a grossly circumscribed firm texture (Figure 3A). On the cut surface, it was pale and had the appearance of fish meat (Figure 3B).
Representative photomicrographs in pathologic diagnosis. (A) The typical desmoid fibromatosis (DF) illustrating fascicles of spindle cells evenly arranged within a uniform collagenous stroma (H&E, X200). (B) Immunohistochemistry staining of vimentin showed a diffuse cytoplasmic staining pattern (X200). (C) Smooth muscle actin (SMA) positive expression is detected by immunohistochemistry staining (X200). (D) Immunoreactivity for beta-catenin is seen in tumor cells (X200). (E) Staining patterns for CD34 (X200). (F) The tumor cells showed very low Ki-67 labeling index (X200).
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F4
The histological findings revealed a proliferation of spindle cells surrounded by abundant fibrillar collagen and occasional mitotic (Figure 4A). Immunohistochemical analyses were positive for vimentin (Figure 4B), smooth muscle actin (SMA) (Figure 4C), and beta-catenin (Figure 4D), whereas CD34 was negative (Figure 4E). <8% of cells were Ki-67 positive (Figure 4F).
Clinical images at postoperative 20th month. (A) The postoperative contrast-enhanced CT showed no findings of recurrence. (B) Physical examination showed the swelling of right lower extremity.
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F5
The patient remains in good health and shows no symptoms or imaging modality of recurrence at 20 months postoperative (Figure 5A). Physical examination revealed the swelling of the right lower extremity (Figure 5B).