Surgical trauma, which is one of the most important etiologic factors for desmoid, can induce desmoid growth [6
]. However, desmoid tumor originating from the jejunal pouch, which had been interposed for reconstruction after total gastrectomy for improvement of early postoperative eating capacity, body weight and quality of life has not been reported before. The desmoid tumor originated from mesentery of reconstructed jejunal pouch, which has not been affected surgical manipulation. Although anastomotic leakage, abscess, wound infection, and fistula are the known complications of total gastrectomy, occurrence of desmoid tumor is rare [7
]. In our case, there were no postoperative complications, and there was no intra-abdominal inflammatory lesion that could have led to formation of desmoid tumor.
Mesenteric desmoid tumor is rare and has few symptoms associated with this tumor, thus it is difficult to diagnose these lesions early. In this case identification of a solid mass at the intra-abdominal site after total gastrectomy, possibility of a tumor recurrence was first considered and later was considered as a solitary recurrent lymph node metastasis, the diagnosis of desmoid was never considered. Surgery is the treatment of choice for desmoid tumors.
The incidence of recurrence is reported to be 40%, with surgical excision alone the recurrence rate of 77% in mesenteric desmoid tumors have been reported [8
]. Surgical margin has been reported as an important factor for the recurrence of desmoid, the 10-year recurrence rate for the patients with negative surgical margins is reported to be 27%, whereas it is 54% for patients with positive surgical margins [9
]. Use of adjuvant radiotherapy has improved relapse rate for the patients with positive surgical margins and unresectable desmoid tumors [9
]. It is suggested that if surgical resection is not possible due to some reason the patients should be treated by radiotherapy.
A significant 3.5-fold increased risk for the development of desmoid tumors among females has been reported, particularly during or after pregnancy [4
]. An increased risk for the female gender is consistent with the observation that desmoid cells may express estrogen receptors and are inhibited in their in vitro proliferation by antiestrogen compounds [11
]. Tamoxifen has antiestrogen activity and it is possible to be effective in desmoid tumors [2
The dogma prevalent in medical oncology has been that low-grade tumors with no known metastatic potential do not kill patients and may not respond to chemotherapy [12
]. In this case, the patient was kept on observation alone as i) the surgical margin was negative and ii) advanced age of the patient. However, it was demonstrated that desmoid tumors respond to chemotherapy. Surgery was planned in this case as gastric cancer was early stage, and the recurrence are rare. If the gastric cancer had been advanced stage to begin with, we might have planned chemotherapy with the diagnosis of recurrent gastric cancer.