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Image of the Month—Quiz Case
Patrick H. Hemmer, MD;
Clark J. Zeebregts, MD;
Joop van Baarlen, MD;
Joost M. Klaase, MD, PhD
From the Department of Surgery, Medisch Spectrum Twente (Drs Hemmer, Zeebregts, and Klaase), and Pathology Laboratory "Twente-Achterhoek" (Dr van Baarlen), Enschede, the Netherlands.
Arch Surg. 2004;139:223.
INTRODUCTION
A 34-year-old woman was admitted with abdominal pain predominantly at the right side and rectal bleeding of several days' duration. She had been diagnosed as having Gardner syndrome 2 years before. Among the manifestations of this disease were multiple osteomas and polyposis coli, for which a subtotal colectomy and ileorectal anastomosis had been performed. Physical examination findings revealed fullness of the abdomen with a nonmobile mass measuring approximately 30 cm in diameter. No source for the rectal bleeding could be detected at rectoscopy. Ultrasonography showed a very large, solid intra-abdominal tumor, which was confirmed by computed tomographic scanning. The tumor, measuring 23 x 15 cm, extended onto the left liver lobe and could not be distinguished from the abdominal wall (Figure 1). To obtain histologic characteristics, the abdomen was opened through a left pararectal incision. Immediately, it became clear that there was tumor infiltration into the left rectus muscle. A large biopsy specimen of this tissue was taken, as well as incisional biopsy specimens of tumor infiltrating the mesentery (Figure 2). The tumor was considered unresectable because of diffuse large- and small-bowel mesenteric invasion. The patient is currently being treated with tamoxifen citrate, 40 mg/d, and was responding well at this report, 7 months after the operation.
What is your diagnosis?
A. Gastrointestinal stromal tumor
B. Fibrosarcoma
C. Desmoid tumor
D. Ovarian carcinoma
Answer
SECTION EDITOR: GRACE S. ROZYCKI, MD
RELATED ARTICLE
Image of the Month—Diagnosis
Arch Surg. 2004;139(2):224.
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