Mesenteric desmoid tumors in Singapore familial adenomatous polyposis patients: clinical course and genetic profile in a predominantly Chinese population.
OBJECTIVE
This study examined the mutational profile of the adenomatous polyposis coli gene in relation to the development of desmoid tumors in familial adenomatous polyposis patients from a predominantly Chinese population.


METHODS
This is a retrospective review of all patients with familial adenomatous polyposis coli from the Singapore Polyposis Registry. Identification of specific adenomatous polyposis coli gene mutation was performed and clinical course of associated desmoid disease obtained from case records and a computerized database.


RESULTS
Two hundred five patients from 75 families afflicted with familial adenomatous polyposis coli were reviewed, with gene mutations identified in 107 patients. Of these, 23 (11.2 percent) developed desmoids. The male-to-female ratio was 1:1.3 and the ethnic distribution was Chinese (n=17) and Malay (n=6). Of the 92 patients with mutations 5' to codon 1444, 11 patients (12 percent) developed desmoids compared with 6 of 15 (40 percent) patients with adenomatous polyposis coli gene mutations 3' to codon 1444 (P<0.01). The clinical course of desmoid tumors can be divided into stable (n=11), variable (n=3), progressive (n=6), and aggressive growth (n=3). Only 3 (13 percent) patients with aggressive tumor growth required chemotherapy. There was no correlation between the site of mutation and the clinical progression of the desmoids. Seventy-four percent of these desmoids (17/23) developed at a mean interval of 2.98 years after restorative proctocolectomy, while only 30 percent (7/23) were diagnosed preoperatively or discovered during the initial surgery. The most common complications related to the mesenteric desmoids were intestinal obstruction (21.7 percent), ureteric obstruction (17.4 percent), and encasement of superior mesenteric vessels (13 percent).


CONCLUSIONS
The clinical course of desmoids in an individual familial adenomatous polyposis patient remains unpredictable and no reliable genetic marker is available for prognostication in desmoid disease.
Koh
Poh-Koon
PK
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Loi
Carol
C
Cao
Xia
X
Cheah
Peh-Yean
PY
Ho
Kok-Sun
KS
Ooi
Boon-Swee
BS
Tang
Choong-Leong
CL
Eu
Kong-Weng
KW
D011125:Adenomatous Polyposis Coli / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics* / Q000601:surgery; D000328:Adult; D002681:China / Q000208:ethnology; D003062:Codon; D005260:Female; D018221:Fibromatosis, Abdominal / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics* / Q000601:surgery; D005838:Genotype; D006801:Humans; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008643:Mesentery; D009154:Mutation; D016133:Polymerase Chain Reaction; D016737:Proctocolectomy, Restorative; D012042:Registries; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
D003062:Codon