J Korean Surg Soc.  2010 May;78(5):320-324. 10.4174/jkss.2010.78.5.320.

Jejunal Mesenteric Fibromatosis

• Moon HH
• Yang SI
• Yoon KY
• Jang HK
• Seo KW
• Lee SH
• Choi KH

• KMID: 2211959
• DOI: http://doi.org/10.4174/jkss.2010.78.5.320

Abstract

Mesenteric fibromatosis is a rare benign fibrous tumor that can occur from bowel mesentery of the retroperitoneum. It can infiltrate the surrounding structures and tends to recur locally even after resection but does not have metastatic capability. Mesenteric fibromatosis represents 8% of all intra-abdominal desmoid neoplasm. We experienced a case of mesenteric fibromatosis in a 50-year-old woman with a painless abdominal mass. An exploratory laparotomy was performed, and two large, small bowel mesenteric masses were found which were invading the transverse colon. The segment of the jejunum and transverse colon including the masses were resected widely and the pathologic report confirmed the diagnosis of fibromatosis. We reviewed the features of the mesenteric fibromatosis, that is, clinical, imaging, pathological, immunohistological features, and differential diagnosis and treatment of mesenteric fibromatosis.

Keyword

Mesenteric fibromatosis; Desmoid tumor

MeSH Terms

Colon, Transverse
Diagnosis, Differential
Female
Fibroma
Fibromatosis, Aggressive
Humans
Jejunum
Laparotomy
Mesentery
Middle Aged

Figure

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  Fig. 1 Abdominal CT finding. 7×8 cm sized low-attenuating mass is visible in the small bowel mesentery. The anterior small bowel is pressured by the mass.

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  Fig. 2 Gross pathologic finding. Two retroperitoneal masses (10×9×4 cm, 7×7×3 cm) are noted on the serosal surface of small bowel. The cut surfaces of the masses are grayish white and firm with hemorrhage and myxoid apprearance.

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  Fig. 3 Micro pathologic finding. These are composed of broad, sweeping fascicles of monotonous spindle cell with abundant collagenous stroma.

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  Fig. 4 Immunohistochemical finding. Spindle cells show strong positivity for vimentin (A) and some nuclear staining for β-catenin (B).

Reference

1. Yantiss RK, Spiro IJ, Compton CC, Rosenberg AE. Gastrointestinal stromal tumor versus intra-abdominal fibromatosis of the bowel wall: a clinically important differential diagnosis. Am J Surg Pathol. 2000. 24:947–957.

2. Yoo C, Jung CK, Song KY, Jung ES, Lee KY. Mesenteric fibromatosis presenting as a submucosal tumor of the jejunum. J Korean Surg Soc. 2008. 74:312–315.

3. Nam KH, Kweon BC, Lee HK, Lee DW, Woo CK, Park JS, et al. A case of mesenteric fibromatosis after appendectomy. Korean J Med. 1998. 54:577–581.

4. Bethune R, Amin A. Mesenteric fibromatosis: a rare cause of acute abdominal pain. Ann R Coll Surg Engl. 2006. 88:1–2.

5. Forte MD, Brant WE. Spontaneous isolated mesenteric fibromatosis. Report of a case. Dis Colon Rectum. 1988. 31:315–317.

6. Colombo P, Rahal D, Grizzi F, Quagliuolo V, Roncalli M. Localized intra-abdominal fibromatosis of the small bowel mimicking a gastrointestinal stromal tumor: a case report. World J Gastroenterol. 2005. 11:5226–5228.

7. Batori M, Chatelou E, Mariotta G, Sportelli G, Straniero A, Casella G, et al. Giant mesenteric fibromatosis. Eur Rev Med Pharmacol Sci. 2005. 9:223–225.

8. Koppikar MG, Vaze AM, Patel MS, Phadke PP, Chitale AR, Bapat RD. Mesenteric fibromatosis. J Postgrad Med. 1980. 26:196A–198A.

9. Stout AP, Raffaele L. Tumors of the Soft Tissues, by Arthur Purdy Stout and Raffaele Lattes. 1967. Washington: Armed Forces Institute of Pathology.

10. Pai SA, Zaveri SS. Intra-abdominal fibromatosis of the jejunum and mesentery. J Clin Pathol. 2004. 57:1119.

11. Montgomery E, Torbenson MS, Kaushal M, Fisher C, Abraham SC. Beta-catenin immunohistochemistry separates mesenteric fibromatosis from gastrointestinal stromal tumor and sclerosing mesenteritis. Am J Surg Pathol. 2002. 26:1296–1301.

12. Monihan JM, Carr NJ, Sobin LH. CD34 immunoexpression in stromal tumours of the gastrointestinal tract and in mesenteric fibromatoses. Histopathology. 1994. 25:469–473.

13. Yi KH, Wi HS, Park IS, Lee JW, Jeong S, Lee DH, et al. A case of Gardner's syndrome associated with adrenal adenoma. Korean J Med. 2006. 71:415–419.