Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2018; 10(8): 90-94
Published online Nov 27, 2018. doi: 10.4240/wjgs.v10.i8.90
Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature
Sami Akbulut, Mehmet Yilmaz, Saadet Alan, Mehmet Kolu, Nese Karadag
Sami Akbulut, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 244280, Turkey
Mehmet Yilmaz, Department of Surgery, Inonu University Faculty of Medicine, Malatya 244280, Turkey
Saadet Alan, Nese Karadag, Department of Pathology, Inonu University Faculty of Medicine, Malatya 244280, Turkey
Mehmet Kolu, Department of Radiology, Inonu University Faculty of Medicine, Malatya 244280, Turkey
Author contributions: Akbulut S designed the report, analyzed the data and wrote the paper; Akbulut S and Yilmaz M performed the surgical procedure and collected the patient’s clinical data; Alan S and Karadag N provided histopathological information; Kolu M provided radiological information.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare no potential conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Sami Akbulut, MD, Associate Professor, FACS, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410036
Received: July 6, 2018
Peer-review started: July 6, 2018
First decision: July 29, 2018
Revised: August 5, 2018
Accepted: October 17, 2018
Article in press: October 17, 2018
Published online: November 27, 2018
Processing time: 144 Days and 9.9 Hours
Abstract

Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximal jejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised en-bloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.

Keywords: Duodenal wall; Hydatid cyst; Aggressive fibromatosis; Intra-abdominal fibromatosis; Desmoid tumor; Desmoid-type fibromatosis

Core tip: Fibromatosis can be categorized into two broad categories depending on their localization: superficial and deep (aggressive fibromatosis or desmoid tumor). Desmoid-type fibromatoses can be categorized into three groups depending on their localization, namely extra-abdominal, abdominal wall, and intra-abdominal fibromatosis. Intra-abdominal desmoid-type fibromatosis may develop from the small intestinal mesentery, omentum, retroperitoneum, pelvis, and very rarely, the intestinal wall (such as our case). We aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and the invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected.