Abdominal Wall Tumor Research Articles

Curious case of mesh associated foreign body granuloma- a case report

Background: Foreign body granuloma represents granulomatous response of the tissue to any foreign body. Many cases of foreign body granuloma with various foreign bodies have been reported. However, mesh acting as a foreign body is quite a rare occurrence.
 Summary: Here we report a case of a 52 yrs old lady who presented to us with complaints of swelling over abdomen in supraumbilical area since 6 months. Patient had a history of umbilical hernioplasty done 4 yrs back. On clinical evaluation, the provisional diagnosis of an ?abdominal wall tumor ?recurrent hernia was made. Ultrasound and computed tomography of the abdomen was done which was suggestive of a midline abdominal wall abscess. Excision of the swelling and consecutive histopathological analysis suggested it to be a foreign body granuloma associated with the mesh.
 Conclusion: Thus, it is very important to keep in mind foreign body granuloma as a differential diagnosis in patients with history of hernia surgery presenting with swelling in the same region.
 Keywords- abdominal wall lump, abdominal wall abscess, foreign body granuloma

Granular cell tumor of abdominal wall

Granular Cell Tumor (GrCT) is a rare benign tumor, likely arising from Schwann cells and accounts for 0.5% of soft tissue tumor. About 0.5% to 2% cases are malignant. The case was retrieved from the hospital record. A 46 year old male presented with a painful nodular mass in flank for six months. It was firm, immobile subcutaneous swelling, fixed to skin with irregular margin measuring 3 × 2 cm. Ultrasonography revealed it as localized lesion. FNAC was inconclusive. Excision biopsy showed large polygonal cells with granular eosinophilic cytoplasm and eccentric nucleus with entrapped adnexal structure invading deep into adipose tissue. Cells were PAS positive & Diastase resistance. On immunohistochemistry, cells were positive for S-100 and CD-68 and negative for SMA & Vimentin. Diagnosis of GrCT of benign nature was made. Postoperative course was uneventful after 1.5 years of follow-up. GrCT was originally named as myoblastoma, but currently, it is considered to be neural in origin. It is commonly found in females of 2nd to 4th decade, most common site being tongue, oral cavity. Fanburg Smith Criteria distinguishes benign from malignant lesions, that includes (i) necrosis (ii) spindling (iii) vesicular nuclei with large nucleoli (iv) increased mitotic activity (> 2 mitosis/HPF) (v) increased nucleo-cytoplasmic ratio (vi) pleomorphism. If out of these 6; > 3 features are indicates malignancy. Abdominal wall GrCT is rare. We found only 11 cases of abdominal wall GCT in medical literature. Prognosis is good in non-malignant cases. Excision is the treatment choice, rarely recurs.

The utility of tumour infiltrating lymphocytes as a risk factor for local recurrences of abdominal wall fibromatosis

Background: Desmoid-type fibromatosis (DF) is a locally aggressive tumour of fibroblastic/myofibroblastic origin that usually occurs in young adults. Extra-abdominal tumours (including abdominal wall tumours) is a biologically different type with special aetiology, behaviour, and the morbidity associated. Abdominal wall fibromatosis comprises a major sector of fibromatosis cases. Until now few risk factors have been documented as predictors of tumour recurrences in this type. Aim: In the current study we proposed that the nature of the lymphocytic infiltrate in fibromatosis may provide a novel risk factor for predicting recurrences and may provide a novel approach for immunotherapy. Methods: Forty retrospective cases of abdominal wall desmoid tumours were collected from two hospitals from cases from 2011 to 2014. Cases were divided into two groups according to occurrence of recurrences in the period of 5 years (until 2019). Sections from the tumour were stained for immunohistochemical markers for CD4 and CD8. The number of positive cells for each marker was examined in 5 high power fields, both in tumour invading margin and tumour core using image analysis system. Results: Higher density of CD4 and CD8 T lymphocytes were found in cases of non-recurrent cases group (p<0.05). The tumour margin CD4 and CD8 cells were more associated with non-recurrent cases that intra-tumoural (core) cells (p<0.05). Conclusion: The study concluded that high CD4 and CD8 positive T lymphocytes mainly in the tumour margins are associated with favourable recurrence-free survival in abdominal wall fibromatosis and may present a portal for future immunotherapy for these cases.

UN CAS DE TUMEUR DESMOÏDE (TD) DE LA PAROI ABDOMINALE PRIS EN CHARGE A LA CLINIQUE UNIVERSITAIRE DE CHIRURGIE VISCÉRALE DU CENTRE NATIONAL HOSPITALIER UNIVERSITAIRE (CNHU-HKM) DE COTONOU -BÉNIN.

Abstract Background Desmoid tumors are rare locally invasive tumors, but without metastatic potential. We report a case of recurrent locally advanced desmoid tumor of the anterior abdominal wall. We discuss the place of surgery and systemic treatments in the management of desmoid tumors. Report A 51-year-old woman presented at the Visceral Surgery Department of The National University Hospital (CNHUHKM) in January 2021 for a recurrent anterior abdominal wall tumor. The recurrence occurred 3 years after a first resection performed in 2008. The mass was centered on the umbilicus and was estimated 24 cm, ulcerated and hemorrhagic. She underwent a wide resection. Pathology report concluded to an ulcerated desmoid tumor. The postoperative course was uneventful. Eight months after resection, she showed no clinical signs of recurrence. Conclusion We presented a case of recurrent desmoid tumor of the abdominal wall. Although the indications for surgery have been restricted in recent years, it remains essential treatment for well selected patients. Key words: Desmoid tumor, abdominal wall, wide resection.

Application of 3D Visualization Technology in Complex Abdominal Wall Defects.

PurposeTo explore the value of medical three-dimensional visualization technology in precise preoperative assessment of complex abdominal wall defects.MethodsThe clinical data of 30 patients were analyzed retrospectively from November 2017 to December 2020 in our department. Ten patients had abdominal wall hernias and 20 patients suffered from abdominal wall tumors. CT examination was performed, and data were stored in the form of DICOM. Three-dimensional reconstruction and related data analysis were performed by Medraw software, which can accurately show the calculation of the abdominal wall defect area, abdominal wall defect classification and zoning.ResultsThe ratio of the volume of the hernia sac to the whole abdominal volume in 10 patients with abdominal wall hernia was 4.75%. The average ratio of defect area to the whole abdominal wall in 16 patients suffered from abdominal wall tumors was 17.68%. Preoperative three-dimensional reconstruction can accurately obtain an average abdominal wall defect area of 227.83 ± 157.33 cm2 and accurate abdominal wall classification and zoning. Combined with clinical information, we can develop personalized surgical plans for patients. The average operating time was 5.39 ± 2.71 h, respectively, and the average hospital stay was 22.77 ± 11.59 days. The mean follow-up time was 21.09 ± 9.72 months. The incidence of postoperative complications was 23.33% (7/30). The recurrence rates of incisional hernias and abdominal wall tumors were 20.00% (2/10) and 15.00% (3/20), respectively. The patient survival rate was 86.67% (26/30).ConclusionThree-dimensional visualization technology can be used for the accurate evaluation of patients with complex abdominal defects before surgery and can help surgeons design personalized surgical plans for patients.

A case of simultaneous abdominal wall metastasis of hepatocellular carcinoma with long-term relapse-free survival after laparoscopic resection

We report our experience of an extremely rare case of a simultaneous extrahepatic metastasis of hepatocellular carcinoma (HCC) with long-term relapse-free survival, treated by laparoscopic resection of an abdominal wall tumor and subsequent radiofrequency ablation (RFA) of an intrahepatic lesion. A 76-year-old man visited a local clinic for right lower abdominal pain. He was treated with antibiotics and the symptom resolved. However, a mass was detected in the same region and he was referred to our hospital for further evaluation. Computed tomography (CT) of the abdomen showed a mass 5 cm in diameter, raising suspicions of an intra-abdominal tumor. Laparoscopic surgery was performed, and the tumor was found in the abdominal wall and completely resected. Histopathological examination yielded a diagnosis of extrahepatic HCC. Post-operative positron emission tomography (PET)-CT showed increased uptake of fluorodeoxyglucose in segment 3 (S3) of the liver. On performing a liver biopsy, HCC was diagnosed. Subsequently, the S3 lesion was treated with radiofrequency ablation. The patient has remained relapse-free for 6 years without further treatments.

Laparoscopic approach of excision of anterior abdominal wall actinomycosis

Actinomycosis of the abdominal wall is a rare disease. While most of the reported cases are women, we present a 42-year-old male with an abdominal mass for 4 months. Clinical examination of the abdomen revealed a well circumscribed mass in the left iliac fossa. CT abdomen showed an anterior abdominal wall mass with infiltration to the sigmoid colon however colonoscopy ruled out intraluminal origin. In contrast to traditional open approach, a laparoscopic approach was done. The abdominal wall tumour and sigmoid colon was resected en- bloc and continuity restored extra- corporeally through a small incision. Histopathology of the specimen reported an abdominal wall actinomycosis and patient was discharged with antibiotics. Laparoscopic approach was successful as the tumour was small. We therefore conclude that an initial laparoscopic assessment can be advocated and a laparoscopic excision is always possible if the features are favourable.

A Case of Multiple Metastases to the Soft Tisues after Surgery for Metastatic Abdominal Wall Tumors of Gastric Cancer

A Case of Multiple Metastases to the Soft Tisues after Surgery for Metastatic Abdominal Wall Tumors of Gastric Cancer

Caesarean Scar Endometriosis May Require Abdominoplasty

Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.

The spectrum of abdominal wall desmoid fibromatosis and the outcomes of its surgical treatment

ABSTRACT BACKGROUND: Desmoid fibromatosis (DF) arises in musculoaponeurotic structures, most commonly the rectus abdominis muscle. It is locally aggressive with no propensity for metastasis. The aim was to describe the spectrum of abdominal wall DF and its surgical treatment and outcome at a tertiary institution METHODS: All abdominal wall DF resected from 2007 to 2019 were retrospectively analysed. The tumours had a full-thickness abdominal wall excision. The defect was reconstructed with biological implants covered by either skin edge undermining or split skin graft. Histological diagnosis was based on characteristic morphological and immunohistochemistry parameters. Parameters analysed were demographics, lesion size, procedure performed and outcomes RESULTS: Eleven female patients with a median age of 29 years (range 21-61) presented with rapid growth over 6-24 months of anterior abdominal wall tumours with a median maximum resected diameter of 163 mm (range 63-200 mm). There was no specific complication related to the abdominal wall reconstruction. With a median follow-up of 5 years (range 1-11 years), all patients displayed an asymptomatic abdominal wall bulge (eventration). One patient has had a small recurrence currently being observed CONCLUSION: Striking features of DF tumours at Chris Hani Baragwanath Academic Hospital (CHBAH) were their location, rapid growth, female gender and large size. Biological implant without complex plastic surgery techniques result in good outcomes, though the rate of progression of eventration to hernia is unknown Keywords: desmoid fibromatosis, abdominal wall, biological implants

Nodular fasciitis growing at the port site of robotic surgery for rectal cancer

BackgroundNodular fasciitis (NF) is a type of rare and rapidly growing tumor that affects the muscular fascial layers. Due to its locally aggressive nature and rapid growth, NF can be mistaken as a malignant process on either clinical or histological grounds.Case presentationA 61-year-old man was affected by rectal cancer. We performed a robotic, high-anterior resection with lymph node dissection. According to the 8th edition of Union for International Cancer Control, the diagnosis was stage I pT2N0M0. During a routine follow-up 1.5 years after the robotic surgery, a computed tomography examination revealed a tumor in the upper right abdominal wall, at the site of the surgical port, that measured 45 mm. Magnetic resonance imaging indicated a hypo-intensive mass within the right straight muscle of the abdomen. Port site recurrence following the robotic surgery for rectal cancer was suspected, and an ultrasound-guided fine-needle aspiration was performed; it revealed a low-grade myofibroblastic tumor or benign neoplasm, but was inconclusive. We performed an excision of the lesion, and histopathology confirmed NF, seen as a solid, nodular, spindle-cell lesion. The patient was postoperatively followed for more than 1 year without any sign of recurrence of either cancer or NF.ConclusionsNF is histologically benign, but local recurrence frequently occurs. We encountered a patient with NF at the port site after robotic surgery for rectal cancer.

Solitary extrapleural fibrous tumor with hepatic bilobar metastases: multimodal approach treatment

BackgroundSolitary fibrous tumor is an unusual fibroblastic mesenchymal neoplasm typically described in the pleura. It may appear anywhere with a varied anatomic distribution and essentially it can develop from any soft tissue or visceral location. Its course is usually indolent and it rarely causes distant metastases, so it has a prolonged survival rate. It sometimes presents itself as a disseminate disease being the liver the most frequently involved location. In these occasions, the management should be discussed in a multidisciplinary tumor committee formed by surgeons, oncologists and radiologists. Surgery remains the gold standard for treatment.Case representationWe present the case of a woman with a tumor in the left abdominal wall and bilobar massive liver metastases, both locations histologically diagnosed as solitary fibrous tumor. She receives biological treatment for a severe case of Crohn´s disease. Evaluated in a multidisciplinary committee, surgery was recommended for both the primary lesion and the liver metastases. The hepatobiliary surgeons considered a two-stage hepatectomy with portal vein embolization (PVE) as the best strategy. After the first procedure consisting in cleaning the left hepatic lobe followed by PVE the future liver remnant volume (FLRV) was considered inadequate, so the patient was also treated with right transarterial radioembolizacion with yttrium 90 (TARE-Y90) intending a double goal: to treat the tumor and to increased the FLRV. Furthermore, a severe flare of Crohn´s disease forced us to intensify the patient’s treatment with the addition of biological agents (infliximab and adalimumab) until complete remission of the symptoms. The second stage of the liver surgery had to be postponed for more than 6 months and could finally be carried out without complications, achieving an R0 resection. The postoperative course was uneventful and the follow up has showed no recurrence to date.ConclusionSolitary fibrous tumours with extensive liver metastases are infrequent but when they appear modern surgical strategies like two stage hepatectomy are the treatment of choice and must be carried out by specialised units. The therapeutic decisions should be guided by a multidisciplinary committee.

The Management of Desmoid Tumors: A Retrospective Study of 30 Cases.

Objectives Desmoid tumor also called aggressive fibromatosis is a rare type of benign tumor. It is a mesenchymal malignancy without metastatic potential. The standard management is resection, but other options including observation may be discussed. Desmoid-type fibromatosis may occur throughout the body, but the abdominal wall is the most common site. The aim of our study was to assess the clinicoepidemiological profile, prognostic factors, and treatment outcome of desmoid tumors. Methods A monocentric retrospective study was conducted over a period of 19 years between February 2000 and November 2019 at the oncology department of Salah Azaïz Institute. Our study concerns 30 patients with desmoid tumor. All data regarding patients were obtained from the medical record. Results Thirty patients were included. The median age was 35 years with a female predominance (sex ratio = 0.07). A palpable mass was the most common complaint (n = 27). Median tumor size was 5 cm. The principal site of involvement was the abdominal wall (n = 14). Surgery was performed in 27 patients. The histopathology reports listed 14 (52%) cases with negative margins and 13 (48%) cases with positive margins. Radiation therapy was performed in 2 patients. One patient received tamoxifen. Local recurrence occurred in 11 patients. Two patients died of their desmoid tumor. Abdominal wall tumors have less risk of recurrence compared with other sites (p=0.047). Macroscopic margin involvement (R2) was the only prognostic factor influencing disease-free-survival (p=0.034). Conclusion Desmoid tumors are aggressive tumors with a tendency for local recurrence. Abdominal wall tumors have less risk of recurrence. Macroscopic margin involvement was the only prognostic factor that affects disease-free-survival.

Retrospective analysis of defect reconstruction after abdominal wall tumor resection in 30 patients

It is difficult to manage the full-thickness defect that is created by radical resection of an abdominal wall tumor. This report aimed to review our institutional experience with immediate reconstruction using mesh reinforcement after abdominal wall tumor resection. We retrospectively examined patients who underwent abdominal wall tumor resection with immediate mesh-reinforced reconstruction between April 2014 and November 2018. The patients' records were reviewed to collect data regarding their demographic characteristics, surgical procedures, and complications. We identified 30 eligible patients, including 5 who underwent simultaneous resection of affected intra-abdominal organs or tissues. The median size of the resulting abdominal wall defect was 60 cm2 (interquartile range: 32-127.5 cm2) and the median mesh size was 150 cm2 (interquartile range: 150-225 cm2). The median operative time was 85min (interquartile range: 60-133.8min), the mean hospital stay was 19.4 ± 9.0days, and the mean follow-up period was 28.6 ± 16.0months. The complications included seroma (n = 4), infection (n = 2), massive hematoma (n = 1), and abnormal sensation (n = 3). Tumor recurrence was observed in two patients, and three patients died because of cancer progression. No patient developed a ventral hernia or abdominal bulging. Immediate mesh-reinforced reconstruction is feasible and effective for patients who require abdominal wall tumor resection.

Application of double circular suturing technique (DCST) in the repair of large abdominal wall defects after resection of abdominal wall tumor.

BackgroundThe aim of this study was to investigate the clinical effects of repairing large defects using the double circular suturing technique (DCST) after resection of abdominal wall tumor.MethodsThe clinical data of 62 patients (25 men, 37 women; average age 41.7±22.4 years) who underwent DCST between October 2010 and November 2018 for the repair of large abdominal wall defects with anti-adhesion underlay mesh after resection of abdominal wall tumor were retrospectively analyzed. The maximum diameter of abdominal wall defect after resection of abdominal wall tumor was 10.4±5.6 cm. The course of disease was 1–341 months, and the average was 32.4 months. Operative time, postoperative hospitalization time, perioperative complications, tumor recurrence in situ, incidence of postoperative chronic pain, and hernia were recorded.ResultsAll 62 operations were completed successfully. The operative time was 73.2±31.4 minutes, and the mean postoperative hospitalization time was 9.6 days (range, 2–20 days). In total, 54 patients were followed up postoperatively for a median 6.7 years (range, 0.9–9.0 years). Partial splitting of incisions occurred in 2 patients, fat liquefaction of incisions occurred in 3 patients, and chronic pain occurred in 4 patients. No tumor in situ recurrence, hernia, or other complications were found in any cases in the follow-up. Tumor metastasis occurred in 9 patients with 6 of these patients dying of tumour progression.ConclusionsWith simple operations, short procedure time, few complications, low tumor recurrence rate, and low incidence of postoperative chronic pain, application of DCST in the repair of large abdominal wall defects is effective after resection of abdominal wall tumor.

A case of gastric gastrointestinal stromal tumor complicated with granular cell tumor of abdominal wall

胃的胃肠间质瘤（GIST）合并腹壁颗粒细胞瘤非常罕见。2018年3月30日宁波市第一医院胃肠外科收治1例病例，经病理学检查证实胃GIST合并腹壁颗粒细胞瘤。患者于同年4月10日行手术切除治疗，胃肿瘤病理检查示核分裂像约5个/50 HPF，免疫组化：CD34（+++），CD117（+++），Dog-1（+++），S-100（-），Ki67（+）<5%，为高危GIST；基因检测提示，CKIT11外显子点突变，PDGFRA12外显子同义突变。腹壁肿块病理检查示CIK、PDGFRA均无突变。术后随访15个月无复发。.

Abdominal wall endometriosis: experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense.

to study the characteristics of women undergoing abdominal surgery with suspected abdominal wall endometriosis or abdominal wall tumor, and to assess the association with age, race and previous cesarean delivery. retrospective and analytical study carried out from January 2000 to December 2019, at the General Surgery Service of Hospital Universitário Antônio Pedro (HUAP) at Universidade Federal Fluminense (UFF). Medical records of 100 patients with abdominal wall endometriosis and other types of abdominal wall tumors were analyzed. Age, color, previous history of cesarean section or abdominal surgery and histopathological data were verified. The patients were classified as young adults (aged between 18 and 28 years and 11 months) and adults. The SPSS program was used for data analysis, Fisher's test with a significance level of 0.05. abdominal wall endometriosis with histopathological confirmation was found in 22%, the mean age was 52.28 ± 18.66 which was lower when compared to other diagnoses. There was an association between previous cesarean section and abdominal wall endometriosis (p <0.005). the women with a diagnosis of abdominal wall endometriosis had undergone previous cesareans (the majority) and were in an active reproductive age. Although the brown skin women were the most frequent, there was no statistical difference.

Desmoid tumor of lateral abdominal wall (transverse muscle): a case with infiltration of margins and size greater than 10cm.

Desmoid tumor of lateral abdominal wall (transverse muscle): a case with infiltration of margins and size greater than 10cm.

Regenerated silk fibroin (RSF) electrostatic spun fibre composite with polypropylene mesh for reconstruction of abdominal wall defects in a rat model

Abdominal wall defects are associated with abdominal wall surgery, infection and tumour resection. Polypropylene (PP) mesh, which has excellent mechanical strength, is currently the primary clinical repair material. In repairing the abdominal wall, the mesh can erode the bowel and cause other problems. Constructing a barrier that induces a weak inflammatory response and promotes rapid recovery of the peritoneum is important. We used electrospinning technology to construct a silk fibroin coating on the abdominal surface of a PP patch. A rat model was used to compare the inflammatory responses, regeneration of peritoneal tissue, and antiadhesion effects of electrospun regenerated silk fibroin (RSF) coatings, polycaprolactone (PCL) coatings, and noncoated PP meshes. The inflammatory responses, antiadhesion fractions, and areas of RSF and PCL were better than those of PP at 6 weeks. RSF was associated with complete peritoneal regeneration, in contrast to PCL. At 12 weeks, the structure of the PCL peritoneum was unstable, and the adhesion fraction and area were significantly higher than those of RSF. The intact peritoneum could not be effectively regenerated. The RSF group exhibited lower IL-6 levels than the PCL and PP groups but higher VEGF, IL-10 and TGF-β levels, making RSF more conducive to the regeneration of peritoneal and abdominal wall tissues.

Borderline malignancy solitary fibrous tumor of abdominal wall

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating in the pleura or at virtually any site in the soft tissue. Although they are commonly thought of as intrathoracic tumors, 50% to 70% of SFTs arise outside the thorax. Approximately 78% to 88% of SFT are benign and 12% to 22% are malignant. The most common sign/symptom of intraabdominal SFT is a palpable abdominal mass with pain and weight loss. Compression symptoms, including dysuria, urinary retention, hydronephrosis, constipation, incontinence, or vomiting have also been reported. However, an intraabdominal SFT located abdominal wall was asymptomatic in this case presentation.