A 62-year-old male with a history of non-insulin dependent diabetes mellitus and left knee arthrosis.
She came to the emergency room due to nonspecific abdominal pain, weight loss and asthenia of about 2 months of evolution, casually occupying the arch during the clinical evaluation, the existence of a tumor in the left abdominal flank, well-defined cost.
The reason why the patient consults late is a certain degree of mental handicap, although it is independent for activities of daily living.
Preoperative laboratory tests showed a C-reactive protein (CRP) of 60 with the rest of acute phase reactant markers within normal limits.
Abdominal CT scan showed a poorly defined, vascularized, 11 x 5 x 16 cm mass of heterogeneous appearance, located in the thickness of the left lateral abdominal wall, which presents an irregular nodular advance of approximately 3.8 x empty left colon adjacent descending colon.
The adjacent fat is slightly affected and no significant lymphadenopathy is observed.
Radiological findings suggest leiomyosarcoma.
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We found multinucleated giant cells, myocytes and isolated cells with a reactive mesothelial aspect in needle aspiration (FNA).
The nonspecific result recommended performing a core needle biopsy (BAG or trucut) and a paraffin-embedded study in the context of clinical manifestations consistent with desmoid tumor.
Without a defined histological diagnosis that would allow us to rule out the presence of sarcoma, we performed the surgical intervention.
In conjunction with the General Surgery Department, we opted for en bloc removal of the mass of the left abdominal wall, including the parietal, visceral and mesocolon peritoneum, dissecting it from the descending colon.
For reconstruction of the abdominal wall we used a Gore Dual Mesh® mesh (Gore Medical, USA) 15 x 19 cm in diameter, adapted to the defect of the iliac wall and an orifice transfixed to the abdominal wall
Cutaneous coverage was achieved with a large medial rotation and umbilical base flap of 23 cm wide x 30 cm high.
