Introduction
Desmoid tumors are benign fibrous entities developed from connective tissue, and they result from muscle fascia or aponeurosis. Surgical excision is the main pillar of treatment.
Case report
A 29-year-old female patient presented with a left postero-lateral cervical swelling that had been evolving for 11 months. Cervical MRI showed a mass at the expense of the trapezium muscle measuring 41 × 68 × 81 mm. A biopsy of the mass was performed, concluding a desmoid tumor. The patient underwent a large resection of the tumor involving the left trapezius muscle. An immunohistochemistry staining was performed, demonstrating cytoplasmic labeling with anti AML antibody, and nuclear labeling of tumor cells with anti-beta-catenin antibody. The case was analyzed by a multidisciplinary committee, and it was decided to follow the patient for surveillance.
Discussion
The localization of desmoid tumors in the trapezius muscle is extremely rare. The main risk of these benign lesions is infiltration of surrounding tissue leading to morbidity and mortality. Recurrence is a main feature of these tumors, even if complete excision has been performed. Unresectable desmoid tumors require medical and non-surgical treatment such as hormone therapy (tamoxifen), and chemotherapy with vinblastine and methotrexate.
Conclusion
Desmoid tumor of trapezius muscle is classified as benign without metastatic power, and the main risk is infiltration of surrounding tissue.
Internal hernias through the foramen of Winslow are considered as rare events. A 66-year-old female patient presented to our emergency department with epigastric and right upper quadrant pain associated with abdominal distention, nausea and vomiting and signs of shock. A computed tomography scan showed bowel strangulation with distended loops identified within the lesser sac. The diagnosis was confirmed by a midline laparotomy procedure. The ileum, the caecum and the ascending colon were found to herniate into the foramen of Winslow. A right hemicolectomy with a resection of the necrotic segment was performed. The patient recovered well postoperatively and was discharged on 10th day after surgery. The diagnosis and management of this rare disease remains challenging. Cross-sectional imaging with reconstruction is considered as the diagnostic modality of choice. Moreover, right hemicolectomy is a preferred procedure in order to decrease the rate of recurrence.
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