CASE 361: TUMOR of MUSCLE RECTUS ABDOMINIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 33yo, 4 months after cesarian operation  detected a  mass near umbilicus on right side, fixed  palpation, 

Ultrasound.scanning of   this mass revealed  intra abdominal wall mass, from lower part of  rectus abdominis muscle. ( US 1, US 2, US 3 ( linear probe), video) . Video clip  shows this tumor  from anterior abdominal wall ).

On MRI, this tumor is solid, size of 12 cm, structure looked like  uterine  myoma.

( MRI1, MRI2, MRI3).

Discussion:

At first,  diagnosis from one  OBGY  doctor is endometriosis  post c-section. But  another  sonologist  from  Obgy hospital is pediculate fibroma of uterus. One  radiologist  looking  MRI  says tumor of rectus abdominis muscle  same as  fibromuscular mass.
Operation for remove this tumor; operator reported  this tumor was well bordered,  hard,
and developered from  rectus muscle, not  from the middle line if c-section.
Macroscopic view of  section surface look like  fibroma.

Discussion 2: In past history she had been first c-section for first delivery 3 years ago. During second pregnancy, this patient known having fibroma of uterus from doctor ObGyn. It is mistaken prenatal diagnosis. Her past history is very important issue for diagnosing today.

Discussion 3 from pathologist: based on HE staining slices, 3  pathologist professors say  surely that not  endometriosis, 2 prof say  maybe  a desmoid tumor  but one  is  say  fibroma. 

Microscopic result with imunohistochemistry  staining is desmoid tumor.

Reference: Desmoid tumor of abdominal wall.