Desmoidtumor an DIEP-Lappen Anastomose Eine seltene Komplikation nach Mammarekonstruktion

Zusammenfassung

Desmoidtumore sind seltene, nicht-metastasierungsfähige, aber lokal aggressiv- und infiltrativ wachsende Tumore, die aus den Fibroblasten des Muskelgewebes, der Faszien und Aponeurosen proliferieren. Die Hauptlokalisation ist der Bauch.

Eine lokale Rezidivrate von bis zu 65% ist beschrieben.

Nach einer Brustrekonstruktion mittels einer Unterbauchhautfett-Lappenplastik (DIEP-Lappen) kam es zu einem progredienten Wachstum eines Desmoidtumors im Bereich der Gefäßana­stomose der DIEP-Lappenplastik. Im Bereich der Lappen-Hebestelle am Bauch war keine tumoröse Raumforderung nachweisbar. Aufgrund der Ausbreitung des Desmoidtumors konnte die Exzision nicht in sano erfolgen, ohne den Gefäßstiel der DIEP-Lappenplastik zu gefährden.

Ob ein primär lokales Wachstum im Anastomosenbereich oder eine Transposition dieser seltenen Tumorentität von abdominell ursächlich war, ist vor dem Hintergrund der Literatur zur diskutieren.

Bei dieser außergewöhnlichen Lokalisation eines Desmoidtumors kann es bei erneuter Größenzunahme notwendig werden, die DIEP-Lappenplastik zu resezieren, um eine R0- Situation zu erreichen.

Abstract

Abdominal desmoid tumors are so called non-metastatic tumors. They occur by proliferation of fibroblasts of muscle, fascia or aponeuroses. After breast reconstruction with a DIEP flap (Deep Inferior epigastric Artery Perforator Flap), a progressive growth of a desmoid tumor was seen around the DIEP-anastomosis. A total excision was not possible without compromising the vascular pedicle. With taking into account a recurrence rate up to 65% another operation is probably necessary. In this case the main vessels of the graft have to be cut out and a necrosis of the flap can or may appear.

Schlüsselwörter

Desmoidtumor - Mammarekonstruktion - DIEP Lappenplastik - Verlust freier Lappen - Gefäßanastomose

Key words

desmoid tumour - breast reconstruction - DIEP flap - free flap loss - vascular microanastomosis

• Literatur

• 1 Ferenc T, Sygut J, Kopczyński J et al. Aggressive fibromatosis (desmoid tumors): definition, occurrence, pathology, diagnostic problems, clinical behavior, genetic background. Pol J Pathol 2006; 57: 5-15
• 2 Rampone B, Pedrazzani C, Marrelli D et al. Updates on abdominal desmoid tumors. World J Gastroenterol 2007; 13: 5985-5988
• 3 Quinn SF, Erickson SJ, Dee PM et al. MR imaging in fibromatosis: results in 26 patients with pathologic correlation. AJR Am J Roentgenol 1991; 156: 539-542
• 4 Altmann S, Lenz-Scharf O, Schneider W et al. Therapeutic options for aggressive fibromatosis. Handchir Mikrochir Plast Chir 2008; 40: 88-93
• 5 Guadagnolo BA, Zagars GK, Ballo MT et al. Long-term outcomes for desmoid tumors treated with radiation therapy. Int J Radiat Oncol Biol Phys 2008; 71: 441-447
• 6 Roeder F, Timke C, Oertel S et al. Intraoperative electron radiotherapy for the management of aggressive fibromatosis. Int J Radiat Oncol Biol Phys 2010; 76: 1154-1160
• 7 Posner MC, Shiu MH, Newsome JL et al. The desmoid tumor. Not a benign disease. Arch Surg 1989; 124: 191-196
• 8 Smith AJ, Lewis JJ, Merchant NB et al. Surgical management of intra-abdominal desmoid tumours. Br J Surg 2000; 87: 608-613
• 9 Thomas F, DeLaney MD. Desmoid tumors. UptoDate. 2006; 15: 1
• 10 Goy BW, Lee SP, Eilber F et al. The role of adjuvant radiotherapy in the treatment of resectable desmoid tumors. Int J Radiat Oncol Biol Phys 1997; 39: 659
• 11 Mankin HJ, Hornicek FJ, Springfield DS. Extra-abdominal desmoid tumors: a report of 234 cases. J Surg Oncol 2010;
• 12 Janinis J, Patriki M, Vini L et al. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003; 14: 181-190
• 13 Okuno SH, Edmonson JH. Combination chemotherapy for desmoid tumors. Cancer 2003; 97: 1134-1135
• 14 Gega M, Yanagi H, Yoshikawa R et al. Successful chemotherapeutic modality of doxorubicin plus dacarbazine for the treatment of desmoid tumors in association with familial adenomatous polyposis. J Clin Oncol 2006; 24: 102-105
• 15 Hetzel D, Bauernhofer T. The role of tyrosine kinase inhibitors in the treatment of inoperable desmoid tumours. Diplomarbeit, Universitätsklinik für Innere Medizin; Graz:
• 16 Heinrich MC, Joensuu H, Demetri GD et al. Phase II, open-label study evaluating the activity of imatinib in treatment life-threatening malignancies known to be associated with imatinib-sensitive tyrosine- kinases. Clin Cancer Res 2008; 14: 2717-2725
• 17 Mace J, Biermann JS, Sondak V et al. Response to extraabddesmoid tumors to therapy with imatinib mesylate. Cancer 2002; 95: 2373-2379
• 18 Kaplan DB, Levine EA. Desmoid tumor arising in a laparoscopic trocar site. Am Surg 1998; 64: 388-390
• 19 Mazzocchi M, Onesti MG, Di Ronza S et al. Breast desmoid tumor after augmentation mammoplasty: two case reports. Acta Chir Plast 2009; 51: 73-78
• 20 Shimizu J, Kawaura Y, Tatsuzawa Y et al. Desmoid tumor of the chest wall following chest surgery: Report of a case. Surgery Today. 29: 945-947
• 21 Mátrai Z, Tóth L, Gulyás G et al. A desmoid tumor associated with a ruptured silicone breast implant. Plast Reconstr Surg 2011; 127: 1e-4e
• 22 Lewis JJ, Boland PJ, Leung DH et al. The enigma of desmoid tumors. Ann Surg 1999; 229: 866-872 discussion 872–873. 4^th ed. St Louis: Mobis, 2001: 641–693
• 23 Bruce JM, Bradley 3rd EL, Satchidanand SK. A desmoids tumor of the pancreas. Sporadic intra-abdominal desmoids revisited. Int J Pancreatol 1996; 19: 197-203
• 24 Clark SK, Phillips RK. Desmoids in familial adenomatous polyposis. Br J Surg 1996; 83: 1494-1504
• 25 Huang K, Fu H, Shi YQ et al. Prognostic factors for extra-abdominal and abdominal wall desmoids: a 20-year experience at a single institution. J Surg Oncol 2009; 100: 563-569
• 26 Abbas AE, Deschamps C, Cassivi SD et al. Chest-wall desmoid tumors: results of surgical intervention. Ann Thorac Surg 2004; 78: 1219-1223; discussion 1219-1223
• 27 Ballo MT, Zagars GK, Pollack A. Radiation therapy in the management of desmoid tumors. Int J Radiat Oncol Biol Phys 1998; 42: 1007-1014
• 28 Piza-Katzer H, Rhomberg M. Extra-abdominelle Fibromatose – extra-abdominelles Desmoid: Übersicht und eigene Erfahrung. Chirurg 2000; 71: 904-911