Mesenteric fibromatosis successfully resected with duodeno-jejunectomy and nephrectomy.
We report a rare case of intra-abdominal fibromatosis of the jejunal mesentery. A 71-year-old man, who was incidentally diagnosed with left hydronephrosis, was found to have a tumor near the duodeno-jejunal junction. The tumor appeared to invade the intestinal wall and was obstructing the left ureter. The tumor was indefinite in diagnosis preoperatively. The patient underwent an en-bloc excision of the tumor by a partial duodeno-jejunectomy combined with a left nephrectomy. Microscopic examination of the tumor showed that non-dysplastic fibroblasts proliferating in the jejunal mesentery had infiltrated into the adjacent small intestines and ureter, resulting in a diagnosis of intra-abdominal fibromatosis. This diagnosis was supported by findings of immunohistochemical analyses showing positive staining for vimentin and smooth muscle actin and negativity for keratin, CD34, C-kit and S-100. To our knowledge, this is the first documented case of intra-abdominal fibromatosis of the jejunal mesentery completely resected with the operative procedure described herein. In cases of a preoperatively undiagnosed retroperitoneal or mesenteric tumor that invades adjacent structures, it is important to consider intra-abdominal fibromatosis as a possible differential diagnosis. This may be helpful in planning the appropriate therapeutic strategies including extended multi-organ resection in selected patients.
Kato
Yutaro
Y
Department of Surgery, Tokyo Denryoku Hospital, Japan. yutarokato@aol.com
Tsuyuki
Akira
A
Kikuchi
Kiyoshi
K
Kurihara
Naoto
N
Fujishiro
Yasuo
Y
D000368:Aged; D000714:Anastomosis, Surgical; D001707:Biopsy, Needle; D004386:Duodenum / Q000601:surgery; D018221:Fibromatosis, Abdominal / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000601:surgery; D007150:Immunohistochemistry; D007583:Jejunum / Q000601:surgery; D007680:Kidney Neoplasms / Q000556:secondary* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008643:Mesentery / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome