PATHOPHYSIOLOGY OF DESMOID TUMOR

Desmoid tumor is a benign fibrous neoplasm. It comes Greek word “desmos” means tendon-like. It is
infiltrative, usually well-differentiated, firm overgrowths of fibrous tissue, and they are locally aggressive.

Precipitating factors:
Predisposing factors:  Stress (According to Karch, when the sympathetic nervous
 Gender: Female (According to Schwartz, desmoid tumor are system is overstimulated due to chronic response to stress,
twice more common in females than in males) this may lead to system overload and a variety of diseases)
 Age: 26 years old (According to Schwartz, this condition is more  Diet: she loves to eat grilled fish and chorizo (According to
common in people aging 10 – 40 years old) Smeltzer, et. al, these foods contain carcinogens)
 Status: Postpartum (According to Schwartz, desmoid tumor  Repeated trauma: patient had 3 successive pregnancies with
occurs most commonly in women after birth) the interval of only months (According to Karch, repeated
trauma to a tissue may cause genetic mutation)

Activation of oncogenes wherein these are mutant genes that causes the transformation of normal cells into tumor cells (genetic mutation)

Failure of immune system to respond promptly to abnormal cells

Activated oncogenes can also cause abnormal cells to survive and proliferate instead of apoptosis (programmed cell death of normal cells)

Mutant ras, a protein, stimulates cell growth even when growth factors are missing

Autonomy: independence from normal cellular controls

Angiogenesis takes its place wherein there will be formation of new blood vessels regulated by growth factors such as vascular growth factor

As cells grow and divide, more
glucose, oxygen and estrogen
are needed by the tumor
Decreased supply of nutrients
and oxygen to other body parts
weight loss,
dizziness, pallor
Paracetamol, Tramadol, antibiotics
Noticed a palpable, solid, hard, nontender, and
Growth of tumor movable mass approx.. 3 X 4 cm at the RLQ of her
abdomen, 2 inches below her past appendectomy site
At age 20: Irregular Body recognizes the
antigen thus, there’ll be an
activation of its response
Activation of inflammatory response Activation of humoral
and cellular response
Release of prostaglandins,
histamine, leukotrienes Cytotoxic T cells, which Suppressor T cells Helper T cells will
are classified as will suppress or slow stimulate B cells to
20 months PTA: interferon, interleukins the reaction of be more aggressive
Fever, pain at and tumor necrosis helper T cells to and responsive,
the abdominal factor, will react against prevent injury to and secrete
area
tumor antigens normal cells antibodies
Interleukins, which are Interferon has Tumor-necrosis factor, which
primarily produced by both antiviral are naturally produced by
lymphocytes and and antitumor macrophages, lymphocytes
monocytes, has properties and microglial cells of the
antitumor properties brain, has direct-tumor-killing
activity
Immune response of the body will slowly decline

Biopsy: calcifying fibroma, negative for malignancy
Immunosuppression
Increase abdominal mass size 8cm.
Movable solid & nontender  abdominal
mass, 12 cm solid, hard, slightly movable &
Continuous growth of the tumor nontender  abdominal mass, 20cm

Hct: 30% (NV: 37 - 47

Wound exposed to the environment LMP : August 2009, amenorrhea
for 11 months (Sept 2009-present),
weight loss: 5 kg, dizziness, pallor
Entry of opportunistic pathogens
vol. %), Hgb: 10%
As the tumor continues to grow, (N.V: 12 - 16 gms %)
immunosuppression worsens, and oxygen, nutrient
and estrogen supply continue to decrease
Blood transfusion

Diphenhydramine
Bacterial attachment Deep-seated tumor
and colonization Infiltration to adjacent muscle bundles Inhalation of mycobacterium tuberculosis
Compression of nerve endings

UTZ OF WHOLE
ABDOMEN:
Local invasion Large solid mass appears in result Pain at the
the lower abdomen breaking abdominal
through the abdominal wall, Body can't mount an effective defense if resistance is l
area
at least 12cm deep and
Triggered immune response 7.6cm wide. Tramadol

Exudates Transmission of the mycobacterium tuberculosis through air

Cefuroxime
CT scan: Huge fairly to well defined lobulated
Wound dressing and nodular solid mass in the right abdomino-
pelvic compartment crossing the anterior
2 tabs HRZEBacteria will move and multiply to the alveoli
abdominal wall and extending and projecting
Exacerbation of tumor growth every 4hours
out to the abdominal surface.

Extra-abdominal mass: 11.50 Inflammatory reaction: phagocytes engulf the bacteria, TB specific lymphocytes destroy ba
x 7.50 x 11.20 cm Extra-abdominal mass: 11.50 x 7.50 x 11.20 cm

1. Exploratory laparotomy, wide excision of the abdominal

wall mass
2. Abdomnal wall repair: prolene mesh for fascial repair
and bipedicle vertical abdominal skin flap with STSG.
 Chest Xray: Granulomas, new tissue masses of live and dead bacilli
PTB, bilateral are surrounded by macrophages which form a protective
wall around it
Legend:

Necrotic degeneration occurs (production of cavities filled with cheese-

Disease process like mass of tubercle bacilli, dead WBCs, necrotic lung tissue)

Signs and symptoms

manifested by the
patient Accumulation of exudates at alveoli

Diagnostics
Drainage of necrotic materials into the tracheobronchial tree

Medications

Interventions (medical Cough for 1 week Airborne spread of infection

or nursing) received
by the patient
Lesions may calcify (Ghon’s Complex) and
form scars and may heal over a period of time

Laboratory results

Dormant (no progression of active disease)

Operation done