Desmoid tumor in pregnancy complicated by deep vein thrombosis: A case report

Abstract

Desmoid tumor is a rare, locally aggressive soft-tissue neoplasm that primarily arises from the abdominal wall. Deep vein thrombosis is more common in pregnancy due to hypercoagulability. The coexistence of desmoid tumor and pregnancy complicated by deep vein thrombosis is extremely rare and poses unique diagnostic and therapeutic challenges.

A 29-year-old woman, gravida 2 para 1, with obesity, presented at 28 + 6 weeks of gestation for routine antenatal care. She had a history of left lower limb deep vein thrombosis and presented with progressive leg swelling. Ultrasonography revealed a 10.7 × 6.5 × 10.6 cm abdominal wall mass arising from the left rectus abdominis compressing the left external iliac vein consistent with chronic deep vein thrombosis. Because of financial constraints, warfarin was prescribed temporarily instead of low-molecular-weight heparin. At 38 + 5 weeks of gestation, elective cesarean delivery was performed with a modified surgical approach to avoid damage to the tumor. Resection was deferred due to the high risk of hemorrhage while on anticoagulation. A healthy female newborn was delivered. Postpartum biopsy confirmed desmoid-type fibromatosis with extension into adjacent muscles and iliac vessels. Radiotherapy was planned but delayed, again owing to financial constraints. Lifelong anticoagulation with warfarin and surveillance were planned for the patient.

The case highlights the importance of considering abdominal wall tumors as a potential cause of pregnancy-related deep vein thrombosis. It also demonstrates how financial considerations can shape clinical decisions and underscores the role of multidisciplinary planning in optimizing maternal and fetal outcomes.