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Chest wall desmoid tumor after double lung transplantation

Matthew P Fahrenkopf, John P Kelpin, Edward T Murphy, Ewa Komorowska-Timek

Desmoid tumors pose a number of unique challenges to treating physicians. They have an unpredictable clinical course, aggressive nature, and predilection for recurrence after resection. They frequently develop in areas of previous trauma and have also been thought to be sensitive to hormonal stimuli. Conservative management is often recommended as a primary therapeutic option. Surgery becomes necessary for those patients with symptomatic and/or progressively enlarging lesions. Complete resection is often considered the “gold standard”, but surgeons should always consider minimizing morbidity and maximizing function. There are a limited number of reports in the literature describing desmoid tumors after solid organ transplantation. Here, we report a 66-year-old gentleman who was found to have a mass on his right chest wall two years after lung transplantation. The patient was initially monitored with serial radiographic imaging. Rapid growth prompted a tissue biopsy, revealing a desmoid tumor. Continued expansion and invasion of the lesion into the surrounding osteocutaneous structures required surgical intervention. En bloc resection of the mass with immediate chest wall reconstruction was performed. New lesions developing after transplantation must be monitored with scrutiny. Desmoid tumors, though rare, should be considered in this differential diagnosis. Early diagnosis may decrease patient morbidity by reducing the extent of resection.