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Aggressive Fibromatosis of the Pancreas: A Rare Cause of Incomplete Duodenal Obstruction.

To the Editor: A ggressive fibromatosis (AF), also known as desmoid tumor or desmoid-type fibromatosis, is nonmetastatic, locally aggressive neoplasm with high postoperative recurrence rates. The pancreas is an extremely rare location for AF, and the preoperative diagnosis of pancreatic AF is rather difficult. A 26-year-old man was referred to our hospital with a 3-week history of abdominal distension, intermittent abdominal pain, nausea, and vomiting. He had no history of abdominal surgery, trauma, or chronic hepatitis virus infection, nor did he ever suffer from pancreatitis. He denied any symptom of hematemesis, melena, diarrhea, or fever. Laboratory blood analyses including serum tumor markers, such as α-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9, were all within normal limits. The contrastenhanced computed tomography scan showed a solidmass (Fig. 1A, arrow), approximately 3 4 cm in size, located in the uncinate process of pancreas. The mass was hypodense in the arterial phase (Fig. 1A), isodense in the portal phase (Fig. 1B), and hyperdense in the delayed phase (Fig. 1C). The mass invaded and compressed the descending and horizontal part of the underlying duodenum (Fig. 1B, arrow) and caused the dilatation of the descending duodenum (Fig. 1C, arrow). Colonoscopy examination excluded signs of polyposis. Malignant pancreatic tumor was suspected, and operation was performed. During the surgery, a solid mass, which invaded the adjacent duodenum, was detected within the uncinate process of pancreas. Pancreaticoduodenectomy was performed successfully, and the patient recovered uneventfully. Grossly, the mass was 4.5 3.5 cm, grayish, firm, dense, free of capsule, and