Rapidly growing abdominal wall desmoid tumor during pregnancy

Case contributed by Dr Michael P Hartung

Presentation

Further evaluation of left ureteral dilation.

Patient Data

Age: 30 years
Gender: Female

Split-bolus urogram with dilation of the left ureter and collecting system, with gradual fading of contrast-enhanced urine in the distal ureter. 

Two small enhancing masses in the left rectus abdominis muscle below the umbilicus.

MRI

1.5 years later after pregnancy

Very large bilobed mass arising from the left rectus abdominis muscle with mass effect on the lower abdomen/pelvis, with the posterior margin of the mass contacting the anterior L5 vertebral body. 

Case Discussion

Small abdominal wall desmoid can be seen in retrospect on the CT urogram. It grew very rapidly and was detected during pregnancy, with pathology confirmed by ultrasound-guided biopsy (low-grade spindle cell neoplasm, consistent with desmoid-type fibromatosis). The mass continued to grow post-partum and the patient underwent tamoxifen therapy. 

There are important associations with desmoid tumors growing during or after pregnancy, particularly in the rectus musculature. Although poorly understood, it is felt that a combination of abdominal wall trauma/stretching and hormonal and immunological factors play roles. 

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Case information

rID: 75363
Published: 26th Mar 2020
Last edited: 8th Apr 2020
Inclusion in quiz mode: Included

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