A 29-year-old female patient who presented with 8 months rapidly growing and initially painless tumor on the lower abdomen. It started as a small swelling at the edge of the previous cesarean section scar 6 months after the surgery. It became ulcerated 4 months before the presentation after applying the herbal medications. There was associated contact bleeding, especially during dressing [Figure 1]. There was associated history of weight loss but no jaundice, loss of appetite, change in bowel habit, or symptoms suggestive of tuberculosis. There was no history of similar tumor, bleeding per rectum, or cancer of the bowel in first-degree relatives.
On examination, the patient was a healthy looking young woman, apprehensive with ulcerated, nontender and firm mass on the lower anterior abdominal wall. The mass was extending from the suprapubic area just above the pubic bone to few centimeters below the umbilicus, measuring 19 cm by 12 cm with bleeding ulcer in the central aspect. The ulcer had raised edge and unhealthy granulation tissue and necrotic floor. It measures about 15 cm by 8 cm [Figure 1]. There were no ascites and organomegaly. Bowel sounds were normoactive. The surrounding skin was normal with prominent veins.
She had chest X-ray and abdominopelvic ultrasound scan done which shows no features of chest and abdominal metastases, and a mass on the anterior abdominal wall without any intraperitoneal extension [Figure 2]. The initial clinical diagnosis was ulcerated soft-tissue sarcoma (dermatofibrosarcoma).
The mass was adherent to the anterior rectus sheath down to the parietal peritoneum on the posterior surface on the central aspect. The mass was completely resected with 2 cm tumor-free margin macroscopically. The resultant defect was repaired with mesh, attaching it to the remnant rectus sheath. The excised tissue weighed 1.2 kg [Figures 3-5]. There was a postoperative wound infection which was managed with oral antibiotics and wound healed after 5 weeks. She was discharged home but lost to follow-up in the clinic [Figure 6].
The histopathology revealed a section of the anterior abdominal wall mass which shows a lesion composed of proliferating fibroblast and myofibroblast disposed within a myxocollagenous connective tissue stroma. Areas of congested thin to thick wall vessels, proliferating skeletal muscles, perivascular, and intercollagenous infiltrated with mainly lymphocytes with unremarkable overlying skin epithelium and dermis. The resection margin was free of infiltration. It was estrogen-receptor positive. There was no evidence of malignancy. The diagnosis of abdominal fibromatosis was made [Figure 7].