Rapid progression of a pregnancy-associated intra-abdominal desmoid tumor in the post-partum period: A case report.
BACKGROUND
The clinical behavior of desmoid tumors can be unpredictable, particularly when they arise in the ante-partum or post-partum period. We present a case of an intra-abdominal desmoid tumor that was identified in the ante-partum period, progressed rapidly in the post-partum period, and was subsequently resected.


METHODS
The patient is a 19 year-old female who was found to have a 12cm intra-abdominal mass on a fetal assessment ultrasound. The decision was made to observe the patient and monitor the mass for growth. However, the mass rapidly grew in the post-partum period. The patient was transferred to our institution after an exploratory laparotomy revealed a large intra-abdominal mass emanating from the small bowel mesentery. The 30cm×24cm×16cm mass was successfully resected with negative margins, and the pathologic diagnosis of desmoid tumor was confirmed. The patient had an uncomplicated post-operative course and was discharged on post-operative day 6.


CONCLUSIONS
The majority of pregnancy-associated desmoid tumors are in the abdominal wall, arising from the rectus abdominus muscle or from previous Cesarean section scars. These tumors may spontaneously regress in the post-partum period and therefore, patients with these tumors are often observed. Close follow-up is important so that rapid tumor progression, which may lead to unresectability, can be identified and managed appropriately.


CONCLUSIONS
A patient with a rare case of a giant pregnancy-associated, intra-abdominal desmoid tumor that rapidly progressed in the post-partum period and was successfully treated with surgical resection with negative margins.
University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States. Electronic address: David.Hanna@som.umaryland.edu.
David
D
Hanna
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, United States. Electronic address: mmagarakis@smail.umaryland.edu.
Michail
M
Magarakis
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, United States. Electronic address: wtwaddell@umm.edu.
William S
WS
Twaddell
Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, United States. Electronic address: HRAlexander@smail.umaryland.edu.
H Richard
HR
Alexander
Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, United States. Electronic address: skesmodel@smail.umaryland.edu.
Susan B
SB
Kesmodel
Desmoid rapid progression; Intra-abdominal desmoid tumor; Post-partum desmoid; Pregnancy-associated desmoid; Soft tissue tumor