Desmoid tumor of the stomach.

A 56-year-old manwas referred to our department for evaluation of a gastric mass. His medical history revealed that he had undergone distal gastrectomy for an early gastric carcinoma 18 months previously. Abdominal computed tomography (CT) demonstrated a well-defined, contrastenhancing mass, 3.3cm in diameter, with uniform inner structure in the stomach (●" Fig.1). Esophagogastroduodenoscopy (EGD) showed a 3.0-cm, submucosal tumor in the greater curvature of the remnant stomach (●" Fig.2a). Endoscopic ultrasound (EUS) of this lesion showed it to be a hypoechoic mass with a sharp boundary in the fourth layer (●" Fig.2b). A clinical diagnosis of gastrointestinal stromal tumor (GIST) of the stomach was made. There was no evidence of further metastatic lesions in other organs, so the patient underwent a completion resection of the remnant stomach. Gross examination of the resected specimen revealed a round tumor measuring 4.0×4.0cm (●" Fig.3a). Histologically, the tumor was composed of sheets of spindle-shaped cells with bland nuclear morphology and fine chromatin (●" Fig.3b). Furthermore, immunohistochemistry revealed that the tumor cells were positive for beta-catenin (●" Fig.3c). The pathologic diagnosis was therefore desmoid tumor of the stomach and the patient remains alive, with no signs of disease recurrence, 1 year after the operation. To our knowledge, this is the first report of a patient with a desmoid tumor of the stomach that was treated with gastrectomy. Desmoid tumors, which were first described by John Macfarlane in 1832, are rare, slow growing, benign fibrous neoplasms with no metastatic potential but a strong tendency to invade locally and recur [1,2]. The occurrence of desmoid tumors is reported to be associated with female sex, familial adenomatous polyposis (FAP), estrogen therapy, and occasionally with surgical trauma [3]. In our case amanwith no family history of FAP but a history of gastrectomy for early gastric carcinoma presented with a desmoid tumor of the remnant stomach, although this was situated in a different part of the stomach and well away from the resection line of the previous gastric surgery. Complete surgical resection with negativemargin remains the only curative treatment option for desmoid tumor [4].