Marginal resection preferred over radical resection for a large abdominal wall desmoid tumor during pregnancy: A case report

Abstract

Desmoid tumors are locally aggressive soft-tissue tumors known for their lack of metastatic potential but high recurrence rate after resection. Few cases of desmoid tumors during pregnancy have been reported, making treatment decisions more challenging.

This report presents the case of a woman with an abdominal wall desmoid tumor resected at 17 weeks of gestation. The large mass (13.4 cm × 7.4 cm) was compressing the uterus, which necessitated surgical intervention. Marginal resection of the tumor was performed with microscopically positive margins. The patient's postoperative course was uneventful, and she had a normal vaginal delivery at 38 weeks. No recurrence of the tumor was observed at 24-month follow-up. This case represents the largest pregnancy-related abdominal desmoid tumor (22 cm × 12 cm) resected marginally during pregnancy. The procedure allowed for a vaginal delivery rather than a cesarean section.

Surgical management of desmoid tumors in pregnancy should aim to remove the tumor while preserving function and anatomical integrity. While this approach is feasible for smaller tumors, larger tumors, as in this case, may result in loss of function and anatomical structure. This raises the question of whether marginal resection should be considered when preservation of function and structure is not feasible with radical resection. This case reinforces the fundamental surgical principle that when clear surgical margins cannot be achieved without compromising function and structure, marginal resection should be considered.