[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.

143]

Original Article

How to differentiate abdominal wall leiomyomas from

desmoid tumors?
Tommy Nai‑Jen Chang1,2, Ming‑Mo Hou2,3, Mohamed AbdelRahman1,2, Chih‑Wei Wang2,4, Li‑Jen Wang2,5,
Dennis S Kao1,2,6, Shao‑Chih Hsu2,7, Soo‑Ha Kwon1,2, Shih‑Yin Huang2,8, John Wen‑Cheng Chang2,3,
Chih‑Hung Lin1,2
Departments of 1Plastic and Reconstructive Surgery, 4Pathology, 5Medical Imaging and Intervention and 7Rehabilitation, Chang Gung
Memorial Hospital, 3Department of Internal Medicine, Division of Hematology‑Oncology, Chang Gung Memorial Hospital, 2College of
Medicine, Chang Gung University, Taoyuan, Taiwan, 8Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung,
6
Department of Plastic and Reconstructive Surgery, University of Washington Medical Center, Seattle, USA

Abstract Background: Desmoid tumor and leiomyoma are abdominal wall tumors with similar clinical, radiographic,
and histological features. However, differentiation between these two diseases is important because each
may be linked to different systemic diseases, and their managements are entirely different. We proposed
that misdiagnosis is possible in some cases.
Patients and Methods: Between 1983 and 2010, patients with a history of uterine surgeries and diagnosed
with either abdominal wall desmoid tumors or leiomyomas were studied. All the images reviewed by an
independent radiologist and surgical specimen were reexamined by immunohistochemistry (IHC) techniques
as a standard method to confirm the diagnoses.
Results: Fifteen female patients (desmoid tumors, n = 10; leiomyomas, n = 5) were included. The diagnosis
of IHC revealed that two cases initially thought to be leiomyomas were desmoid tumors, whereas the
remaining 13 cases maintained their initial diagnoses. The accuracy of hematoxylin and eosin staining
was 86.7%. All tumors excised without complications, except for one desmoid tumor that recurred and
underwent another excision.
Conclusion: Preoperative magnetic resonance imaging (MRI) can be considered to differentiate the two
diseases, as well as the elimination of other associated systemic diseases should be performed routinely. If
MRI is inaccessible or unavailable, preoperative fine‑needle biopsy is recommended. Optional IHC staining
is required if the primary histological assessment is equivocal or inconclusive.

Keywords: Abdominal wall leiomyoma, desmoid tumor, immunohistochemistry staining, magnetic resonance
imaging

Address for correspondence: Prof. Chih‑Hung Lin, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chia‑Yi Branch, No. 6,
West Chia‑Pu Road, Putz, Chia‑Yi, Taiwan.
E‑mail: profchlin@gmail.com
Received: 31‑Oct‑2018, Revised: 24‑Dec‑2018, Accepted: 26‑Mar‑2019

This is an open access journal, and articles are distributed under the terms of the Creative
Access this article online
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
Quick Response Code: remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
Website: is given and the new creations are licensed under the identical terms.
www.e‑fjs.org
For reprints contact: reprints@medknow.com

DOI: How to cite this article: Chang TN, Hou MM, AbdelRahman M, Wang CW,
10.4103/fjs.fjs_115_18 Wang LJ, Kao DS, et al. How to differentiate abdominal wall leiomyomas
from desmoid tumors?. Formos J Surg 2019;52:127-32.

© 2019 Formosan Journal of Surgery | Published by Wolters Kluwer - Medknow 127

[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.143]
Chang, et al.: Abdominal wall leiomyomas and desmoid tumors
INTRODUCTION
Abdominal wall leiomyomas are extremely rare and
are thought to originate from ectopic implantation of
uterine tissue after uterine surgery, such as cesarean
section (C/S), hysterectomy, or uterine myomectomy. On
the other hand, most abdominal wall tumors are desmoid
tumors.[1‑4] Clinically, they both occur predominantly in
females, especially during their reproductive years, and in
association with a history of abdominal or pelvic surgery.
Radiologically, both magnetic resonance imaging (MRI) and
computed tomography (CT) are useful in the evaluation
of the size, extent, and the relation of these lesions to
the adjacent structures. Although MRI can effectively
differentiate desmoid tumors from leiomyomas, its
high‑cost and time‑consuming nature may block it to
become a routinely ordered screening test.[5] Histologically,
leiomyomas come from the overgrowth of smooth muscle
cells, whereas desmoid tumors originate from clonal
proliferation of fibroblasts. At times, it can be difficult to
distinguish desmoid tumors from leiomyomas based on cell
morphology alone using hematoxylin and eosin (H and E)
stain because they look extremely similar; consequently,
misdiagnosis may occur. Immunohistochemical (IHC) stain
can be a helpful verification test because leiomyomas stain
results positive for smooth muscle actin, whereas desmoid
tumors stain negative. Although studies of these two stains
are critical in the diagnosis of these two rare diseases, they
are not routinely performed in clinical practice due to
cost‑effectiveness.
Any misdiagnosis may have significant clinical implications
because both abdominal wall leiomyomas and desmoid
tumors may present as part of a systemic disease. Desmoid
tumors can be sporadic or a part of familial adenomatous
polyposis (FAP), and abdominal wall leiomyomas can also
be a part of hereditary leiomyomastosis and renal cell
cancer syndrome (HLRCCS), leiomyomastosis peritonealis
disseminate (LPD), and human immunodeficiency
virus (HIV) infection.[6‑8] Therefore, diagnosis must be
made accurately because the clinical course, treatment,
and outcome are completely different between these two
diseases. Even if desmoid tumors or leiomyomas are
proven to be the sporadic type, their treatments are still
different. Although surgical resection is the gold standard
for both diseases, desmoid tumors usually require a much
wider margin of resection to ensure tumor clearance and
to minimize recurrence because they tend to infiltrate into
the adjacent fascia and muscle.[9] Adjuvant therapy such as
radiotherapy, chemotherapy, and endocrine therapy can
be used to treat local recurrences, or positive resection
margin if operation is not indicated.[10,11] On the other hand,
128
abdominal wall leiomyomas only require simple excision
without the need for any adjuvant therapy.[12]
To the best of our knowledge and research, there is no
published literature discussing the similarity and the
difficulty in differentiating between these two diseases.
In order to confirm the diagnoses of these two diseases,
we performed IHC stain as the final diagnoses comparing
with the H and E stain. We also reviewed the medical
history of the enrolled patients, including the interval
of diagnosed abdominal wall leiomyomas or desmoid
tumors to abdominal intervention and type, and the clinical
outcomes. In this article, we share our clinical experience
and try to figure out the best way to deal with these two
abdominal tumors.
PATIENTS AND METHODS
Between 1983 and 2010, all patients with diagnosed
abdominal wall desmoid tumor or leiomyoma (by
H and E stain) were enrolled in the study at Chang‑Gung
Memorial Hospital. However, in order to equalize the
condition between these two groups, only females with
a history of uterine surgery were selected in the study.
A total of ten patients with desmoid tumors and five
patients with leiomyomas were included in our study.
Demographic data including sex, age, timing and the type
of previous uterine intervention, the results of H and E
staining, related systemic diseases, and clinical outcome
were all collected. The types of uterine interventions
included C/S, myomectomy, and hysterectomy. All
pathologic specimens were re‑examined by IHC staining
to compare with the previous diagnosis made by H and E
stain.
RESULTS
Fifteen female patients with a median age of 31 years
(range, 26–56 years) were enrolled in the study and
their characteristics are shown in Table 1. On CT
scan, leiomyomas are typically well defined with
strong enhancement after contrast administration,
but desmoid tumors may be hypodense, isodense,
or hyperdense to muscle densities both before and
after contrast administration [Figure 1]. All surgical
specimens confirmed the diagnoses by IHC. The
desmoid tumors were composed of slender spindle cells
but did not contain smooth muscle actin, with bland
nuclei in a collagenous stroma. Furthermore, they are
usually poorly circumscribed with infiltrative borders
as shown in Figure 2a. On the other hand, leiomyomas
were composed of spindle cells that contain smooth
Formosan Journal of Surgery | Volume 52 | Issue 4 | July-August 2019
[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.143]

Chang, et al.: Abdominal wall leiomyomas and desmoid tumors

Table 1: Detailed demographic data of the reported cases

Case Sex Age Previous surgical Interval of previous intervention Systemic Diagnosis on IHC stain
intervention and this event disease H and E stain verification
1 Female 36 C/S twice 76 and 51 months FAP Desmoid tumor Same
2 Female 27 C/S twice Unknown No Desmoid tumor Same
3 Female 42 Abdominal total hysterectomy 24 months No Desmoid tumor Same
4 Female 29 C/S twice Unknown No Desmoid tumor Same
5 Female 35 C/S twice Unknown No Desmoid tumor Same
6 Female 26 C/S once Unknown No Desmoid tumor Same
7 Female 31 C/S three times 84, 60, and 6 months No Desmoid tumor Same
8 Female 33 C/S once 24 months No Desmoid tumor Same
9 Female 31 C/S once 3 months No Desmoid tumor Same
10 Female 29 C/S once 18 months No Desmoid tumor Same
11 Female 31 C/S once 12 months No Leiomyoma Desmoid tumor
12 Female 36 Myomectomy once 55 months No Leiomyoma Same
13 Female 36 Myomectomy twice 105 and 60 months No Leiomyoma Same
14 Female 29 C/S once Unknown No Leiomyoma Desmoid tumor
15 Female 56 Abdominal total hysterectomy, 150 months (ATH) LPD Leiomyoma Same
C/S 4 times
FAP: Familial adenomatous polyposis, LPD: Leiomyomatosis peritonealis disseminate, ATH: Abdominal total hysterectomy,
IHC: Immunohistochemistry, C/S: Cesarean section, H and E: Hematoxylin and eosin

a b
Figure 2: The histological examination of case 2. (a) The tumor is
composed of slender spindle cells. It shows an infiltrative border with the
adjacent skeletal muscles (hematoxylin and eosin, ×200). (b) The spindle
cells are negative for smooth muscle actin (immunohistochemical,
a ×200). The diagnosis was confirmed of desmoid tumor

H and E stain (by the different appearance of their

b
Figure 1: Abdominal CT images of desmoid tumors and leiomyomas. (a)
Enhanced abdominal CT shows an enhanced mass (arrowhead)
of the left lateral abdominal wall beneath the left external oblique
muscle. The radiological impression was leiomyomas; however, the
final histological diagnosis shifted to desmoid tumor (case 11). (b)
Enhanced abdominal CT shows a heterogeneous mass (arrowhead)
with strong enhancement in the left external oblique abdominal muscle.
The radiological impression from CT scan showed leiomyoma, and the
histological examinations confirmed it as well (case 12). CT: Computed
tomograph
muscle actin, with blunt‑ended nuclei and eosinophilic
cytoplasm without a collagenous stroma. They are also
usually well circumscribed [Figure 3a]. Although these
two tumors can be usually distinguished using routine
Formosan Journal of Surgery | Volume 52 | Issue 4 | July-August 2019
spindle cell morphology and stroma), some cases contain
morphological characteristics of both tumors, rendering
the correct diagnosis difficult, as demonstrated in the case
shown in Figure 4a. Desmoid tumors, which stain negative
for smooth muscle actin [Figure 2b], can readily be
distinguished from leiomyomas, which stain positive for
smooth muscle actin [Figure 3b]. In our series, two cases
of previously diagnosed leiomyomas were overturned
after IHC stain verification [Figure 4b]. The IHC staining
revealed that two out of the five “diagnosed” leiomyomas
by previous H and E stain were overturned and verified to
be desmoid tumors after IHC stain validation. Meanwhile,
after IHC staining, all the ten cases of desmoid tumors
maintained their initial pathological diagnoses. Out of
the ten desmoid tumor cases, only one was FAP, whereas
all others were of sporadic type. In addition, only one
case of abdominal wall leiomyoma was LPD, with the
remainder being of sporadic type. All patients underwent
excision with clear surgical margins and no immediate
postoperative complications. One case of desmoid tumor
recurred and underwent another surgical excision.
129
[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.143]
Chang, et al.: Abdominal wall leiomyomas and desmoid tumors
a b
Figure 3: The histological examination of case 12. (a) The tumor is
well circumscribed and composed of spindle cells showing blunt‑ended
nuclei and eosinophilic cytoplasm (H and E, ×200). (b) The spindle cells
are positive for smooth muscle actin (immunohistochemical, ×200).
The diagnosis was confirmed of leiomyoma
DISCUSSION
To the best of our knowledge, the references of abdominal
wall leiomyomas in the English literature are limited. Before
2011, among the eight cases reported in the literature, only
three cases were verified using IHC stain. Therefore, it may
be reasonable to realize that the misdiagnoses occurred in
our past practice. Abdominal wall leiomyoma and desmoid
tumor are thought to be relatively minor diseases without
much research interest, thereby limiting our understanding
of their pathogenesis. In addition, the lack of preoperative
systemic surveys of patients and the rare usage of IHC
staining in previous case reports significantly increased
the likelihood of misdiagnoses, as witnessed in the
retrospective review of cases at our institutional study.
Over the years, many authors have reported that past
history of C/S and uterine myotomy operations are both
risk factors for the development of leiomyomas.[3,4,12] This
is theoretically attributed to the uterine smooth muscle
tissue being ectopically implanted into the adjacent
structures during surgery, hence growing to form tumors
in many sites such as the broad ligaments, ovaries, vagina,
and inferior vena cava. Thus, previous claims of C/S
being a risk factor for the development of abdominal
leiomyomas maybe solely based on histological diagnosis
using H and E staining (as opposed to IHC stain), which
may be inaccurate. However, such a claim would need more
case reports and studies with a larger sample population
to be confirmed.[13‑16]
It is difficult to differentiate between desmoid tumors
and leiomyomas by cell morphology; however, IHC
stain (which stains for smooth muscle actin) can offer a
definite diagnosis.[3] In our study, there was a misdiagnosis
of desmoid tumor as abdominal wall leiomyoma because
of using H and E staining only. It is because IHC was not
available at our institute at that moment. More advanced,
molecular diagnosis should be applied in selective cases.
On the molecular level, desmoids are characterized
130
a b
Figure 4: The histological examination of case 14. (a) The tumor is
composed of spindle cells showing blunt‑ended nuclei and eosinophilic
cytoplasm. An infiltrative border with the adjacent skeletal muscles
is seen (H and E, ×200). (b) The spindle cells are negative for
smooth muscle actin, the corrected diagnosis overturned to desmoid
tumor (immunohistochemical, ×200)
by mutations in the catenin gene, CTNNB1, or the
adenomatous polyposis coli gene (APC). Proof of a
CTNNB1 mutation may be useful when the pathological
differential diagnosis is difficult and location might be
predictive of disease recurrence.[17] Preoperational biopsy
should be performed in cases with uncertain diagnosis.
Retrospective revision of final diagnosis does not make
any sense and could not help the patients. Furthermore,
it is crucial to rule out any systemic disease association,
as the management of leiomyomas and desmoid tumors
in such instances can be very complicated. Patients with
desmoid tumors should be thoroughly investigated for
FAP, including family history, examination for polyps in
the gastrointestinal tract, as well as APC gene mutations
because patients with FAP have an increased risk for
developing colorectal cancer during their early adult life.[8]
Similarly, abdominal wall leiomyomas can be part of a
systemic disease or syndrome such as HLRCCS, LPD, and
HIV infection.[8]
On CT, leiomyomas are typically well defined with strong
enhancement after contrast administration, but desmoid
tumors may be hypodense, isodense, or hyperdense to muscle
densities both before and after contrast administration; the
nonspecific appearance of desmoid tumors on CT scan
may make this modality less useful.[5,12,18,19] On the other
hand, using MRI, leiomyomas usually appear isointense
on T1‑weighted images (T1WIs) and with low signal
intensity on T2‑weighted images (T2WIs) as compared
to the myometrium.[20] The MRI appearance of desmoid
tumors varies according to their three stages as described
by Vandevenne et al. At the first stage, desmoid tumors
have low signal intensity on T1WI and predominantly
high signal intensity on T2WI. At the second stage, they
become more heterogeneous in signal intensity on T2WI
by increased low signal intensity parts. The presence of
high signal intensity of desmoid tumors in Stage I or II
differs from the low signal intensity of leiomyomas on
T2WI. At the third stage, desmoid tumors have low signal
Formosan Journal of Surgery | Volume 52 | Issue 4 | July-August 2019
[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.143]

Chang, et al.: Abdominal wall leiomyomas and desmoid tumors

intensity on both T1WI and T2WI, in contrast to isointense
appearances of leiomyomas on T1WI.[5,21‑23]
In order to clarify these two diseases in clinic, we summarized
the similarities and differentiations of desmoid tumor and
abdominal wall leiomyoma in Table 2. We also proposed
an algorithmic approach to help the management of these
two diseases [Figure 5]. It addresses the presentation,
differentiation, and detailed management of both tumors.
The algorithm is meant to provide a simple and clear
method of differentiation between these two tumors
and provide a general guidance for their management.
Upon encountering an abdominal wall tumor, desmoid
tumors should always be in the differential diagnosis.
Nevertheless, the differentiation between desmoid tumor
and abdominal wall leiomyoma as well as the elimination
of other associated systemic diseases should be performed
routinely. This can be established through imaging via MRI.
If MRI is not accessible, preoperative fine‑needle aspiration
or incisional biopsy should be performed (for H and E
stains, and optional IHC staining to rule out the presence of
muscular actin). In addition, every patient should undergo
a thorough preoperative systemic survey to rule out any
associated systemic diseases and syndromes that these
tumors can be part of them.
The limitation of this article is small number of patients;
a lot of clinical data were unavailable because the patients
were traced retrospectively and the diseases were thought
to be of minor intensity. Besides, although from literature
review we identified that MRI can efficiently differentiate
between these two diseases, the MRI study was scarce
in our series. Although this is a retrospective study and
we found that the previous interventions between these
two diseases are the same, we found that these two
diseases have a possible link to other systemic diseases
and the misconduct may become the disaster toward the
patient.   Furthermore, complications were not present in
our series; even though the cases overturn the diagnosis
after IHC stain confirmation, we still prefer more detailed
systemic studies for these two diseases for the accurate
diagnosis and treatment in future.

Figure 5: The proposed algorithm to the differentiation and management
of desmoid and abdominal wall leiomyomas. Preop: Preoperative,
MRI: Magnetic resonance imaging, ICH: Immunohistochemistry,
FAP: Familial adenomatous polyposis, HLRCCS: Hereditary
leiomyomatosis peritonealis disseminate, HIV: Human immunodeficiency
virus
CONCLUSION
While patients are diagnosed with leiomyomas or desmoid
tumors, IHC stain and MRI can be considered to
differentiate the diagnosis of the two morphologies – similar
tumors – whenever possible. It is important to differentiate

Table 2: Characteristics of desmoid tumor and abdominal wall leiomyoma clinically, radiologically, and histologically
Desmoid tumor Abdominal wall leiomyoma
Clinical
Characteristics Predominantly in females, especially during their reproductive years, and in association with a history of
abdominal or pelvic surgery
Radiological
CT (compared with muscle densities)
Without enhancement Maybe hypodense, isodense, or hyperdense to muscle Hypodense or isodense
With enhancement Well defined with strong enhancement
MRI (compared to the myometrium)
T1WI 1st stage: Hypointensity Isointense
2nd stage: Hypointensity
3rd stage: Hypointensity
T2WI 1st stage: Hyperintensity Hypointensity
2nd stage: Heterogeneous (increased low signal intensity parts)
3rd stage: Hypointensity
Histological
H and E stain Difficult to distinguish in between
IHC stain Negative for smooth muscle actin Positive for smooth muscle actin
CT: Computed tomography, MRI: Magnetic resonance imaging, T1W1: T1‑weighted image, T2W1: T2‑weighted image, H and E: Hematoxylin and
eosin, IHC: Immunohistochemistry

Formosan Journal of Surgery | Volume 52 | Issue 4 | July-August 2019 131

[Downloaded free from http://www.e-fjs.org on Sunday, December 13, 2020, IP: 125.165.49.143]
Chang, et al.: Abdominal wall leiomyomas and desmoid tumors
between abdominal wall leiomyoma and desmoid tumors, as
the management and possible associated systemic diseases
are quite different. The proposed algorithm is a useful guide
to minimize the misdiagnosis in clinic.
Ethical approval
This study has been approved by Chang Gung Medical
Foundation Institutional Review Board (IRB No.:
201801523B0C501), the duration of the approval was
between January 18, 2019, and May 11, 2019. The IRB is
organized and operates in accordance with Good Clinical
Practice and the applicable laws and regulations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Stewart EA. Uterine fibroids. Lancet 2001;357:293‑8.
2. Stojadinovic A, Hoos A, Karpoff HM, Leung DH, Antonescu CR,
Brennan MF, et al. Soft tissue tumors of the abdominal wall: Analysis
of disease patterns and treatment. Arch Surg 2001;136:70‑9.
3. Garrido Oyarzún MF, Saco A, Castelo‑Branco C. Anterior abdominal
wall parasitic leiomyoma: Case report. Gynecol Endocrinol
2018;34:103‑6.
4. Yorita K, Tanaka Y, Hirano K, Kuwahara M, Nakatani K, Fukunaga M,
et al. Multilocular cystic leiomyoma of the anterolateral abdominal
wall: A case report and literature review. Medicine (Baltimore)
2017;96:e8971.
5. Teo HE, Peh WC, Shek TW. Case 84: Desmoid tumor of the abdominal
wall. Radiology 2005;236:81‑4.
6. Bekkers RL, Willemsen WN, Schijf CP, Massuger LF, Bulten J,
Merkus JM, et al. Leiomyomatosis peritonealis disseminata: Does
malignant transformation occur? A literature review. Gynecol Oncol
1999;75:158‑63.
7. Chadwick EG, Connor EJ, Hanson IC, Joshi VV, Abu‑Farsakh H,
Yogev R, et al. Tumors of smooth‑muscle origin in HIV‑infected
children. JAMA 1990;263:3182‑4.
8. Toro JR, Nickerson ML, Wei MH, Warren MB, Glenn GM, Turner ML,
132
et al. Mutations in the fumarate hydratase gene cause hereditary
leiomyomatosis and renal cell cancer in families in North America.
Am J Hum Genet 2003;73:95‑106.
9. Khorsand J, Karakousis CP. Desmoid tumors and their management.
Am J Surg 1985;149:215‑8.
10. Mullen JT, Delaney TF, Kobayashi WK, Szymonifka J, Yeap BY,
Chen YL, et al. Desmoid tumor: Analysis of prognostic factors and
outcomes in a surgical series. Ann Surg Oncol 2012;19:4028‑35.
11. Couto Netto SD, Teixeira F, Menegozzo CA, Leão‑Filho HM,
Albertini A, Ferreira FO, et al. Sporadic abdominal wall desmoid type
fibromatosis: Treatment paradigm after thirty two years. BMC Surg
2018;18:37.
12. Moon HS, Koo JS, Park SH, Park GS, Choi JG, Kim SG, et al. Parasitic
leiomyoma in the abdominal wall after laparoscopic myomectomy.
Fertil Steril 2008;90:1201.e1‑2.
13. Lahat G, Nachmany I, Itzkowitz E, Abu‑Abeid S, Barazovsky E,
Merimsky O, et al. Surgery for sporadic abdominal desmoid
tumor: Is low/no recurrence an achievable goal? Isr Med Assoc J
2009;11:398‑402.
14. Legrand M, Monami B, Honoré P, Dekoster G, Jacquet N.
Leiomyosarcoma of the inferior vena cava: Literature review and
surgical treatment. Apropos of 2 retrohepatic localizations. Acta Chir
Belg 1991;91:11‑6.
15. Muffly T, Vadlamani I, Weed JC. Massive leiomyoma of the broad
ligament. Obstet Gynecol 2007;109:563‑5.
16. Seims AD, Lube MW. Incarceration of a sessile uterine fibroid in an
umbilical hernia during pregnancy. Hernia 2009;13:309‑11.
17. Kasper B, Ströbel P, Hohenberger P. Desmoid tumors: Clinical
features and treatment options for advanced disease. Oncologist
2011;16:682‑93.
18. Lalor PF, Uribe A, Daum GS. De novo growth of a large preperitoneal
lipoleiomyoma of the abdominal wall. Gynecol Oncol 2005;97:719‑21.
19. Ostrzenski A. Uterine leiomyoma particle growing in an abdominal‑wall
incision after laparoscopic retrieval. Obstet Gynecol 1997;89:853‑4.
20. Ozkavukcu E, Aygün S, Erden A, Savaş B. Pelvic retroperitoneal
angioleiomyoma mimicking a uterine mass. Diagn Interv Radiol
2009;15:262‑5.
21. Vandevenne JE, De Schepper AM, De Beuckeleer L, Van Marck E,
Aparisi F, Bloem JL, et al. New concepts in understanding evolution of
desmoid tumors: MR imaging of 30 lesions. Eur Radiol 1997;7:1013‑9.
22. Cassidy MR, Lefkowitz RA, Long N, Qin LX, Kirane A, Sbaity E, et al.
Association of MRI T2 signal intensity with desmoid tumor progression
during active observation: A retrospective cohort study. Ann Surg 2018.
doi: 10.1097/SLA.0000000000003073. [Epub ahead of print].
23. Khanna M, Ramanathan S, Kambal AS, Al‑Berawi M, Yadav S,
Kumar D, et al. Multi‑parametric (mp) MRI for the diagnosis of
abdominal wall desmoid tumors. Eur J Radiol 2017;92:103‑10.
Formosan Journal of Surgery | Volume 52 | Issue 4 | July-August 2019