Differentiation of intra-abdominal desmoid tumor from peritoneal seeding based on CT and/or 18F-FDG PET-CT in patients with history of cancer surgery



To investigate differential imaging features of intra-abdominal desmoid tumors and peritoneal seeding in patients with history of cancer surgery.


Thirty-two patients who had a single pathologically proven intra-peritoneal lesion that developed after cancer surgery were enrolled between January 2000 and June 2019. There were 16 desmoid tumors and 16 peritoneal seeding lesions. Portal phase CT and/or 18F-FDG PET findings were analyzed by two radiologists in consensus for the following items: location, size, shape, margin, contour, homogeneity, necrosis, adjacent organ invasion, calcification, intra-lesional fat, peritoneal infiltration, mass effect, and degree of enhancement. Hounsfield units (HU) and maximum standardized uptake values (SUVmax) of the lesions were measured. Imaging findings were compared using the Chi square test, Fisher’s exact test, and student t test.


Desmoid tumors frequently showed well-defined margins (9/16) and smooth contours (12/16), whereas peritoneal seeding had ill-defined margins (13/16) and lobulated contours (11/16) (P = 0.028 and 0.013, respectively). Intra-lesional fat was found more frequently in desmoid tumors (7/16) than peritoneal seeding (1/16) (P = 0.014). Desmoid tumors showed iso-attenuation (13/16) compared to psoas muscle in portal phase, while peritoneal seeding depicted high attenuation (12/16) (P = 0.002). Mean HU was significantly lower in desmoid tumors (64.3) than peritoneal seeding lesions (95.1) (P = 0.001). However, the mean SUVmax of desmoid tumors (4.1) did not significantly differ from peritoneal seeding lesions (5.2) (P = 0.519).


Several CT features including iso-attenuation in portal phase and presence of intra-lesional fat can be helpful in differentiating desmoid tumors from peritoneal seeding in patients with history of intra-abdominal cancer surgery.

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  1. 1.

    Ganeshan D, Amini B, Nikolaidis P, Assing M, Vikram R (2019) Current Update on Desmoid Fibromatosis. J Comput Assist Tomogr 43(1):29-38. https://doi.org/10.1097/RCT.0000000000000790

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Shinagare AB, Ramaiya NH, Jagannathan JP, Krajewski KM, Giardino AA, Butrynski JE, Raut CP (2011) A to Z of Desmoid Tumors. AJR Am J Roentgenol 197(6):W1008-W1014. https://doi.org/10.2214/AJR.11.6657

    Article  PubMed  Google Scholar 

  3. 3.

    Winant AJ, Vora A, Ginter PS, Levine MS, Brylka DA (2014) More Than Just Metastases: A Practical Approach to Solid Mesenteric Masses. Abdom Imaging 39(3):605-621. https://doi.org/10.1007/s00261-014-0090-4

    Article  PubMed  Google Scholar 

  4. 4.

    Reitamo JJ, Hayry P, Nykyri E, Saxen E (1982) The Desmoid Tumor. I. Incidence, Sex-, Age- And Anatomical Distribution in the Finnish Population. Am J Clin Pathol 77(6):665-673. https://doi.org/10.1093/ajcp/77.6.665

  5. 5.

    Walker EA, Petscavage JM, Brian PL, Logie CI, Montini KM, Murphey MD (2012) Imaging Features of Superficial and Deep Fibromatoses in the Adult Population. Sarcoma 2012:215810. https://doi.org/10.1155/2012/215810

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Burke AP, Sobin LH, Shekitka KM, Federspiel BH, Helwig EB (1990) Intra-abdominal Fibromatosis. A Pathologic Analysis of 130 Tumors With Comparison of Clinical Subgroups. Am J Surg Pathol 14(4):335-341

  7. 7.

    Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD (2007) Pathologic and MR Imaging Features of Benign Fibrous Soft-Tissue Tumors in Adults. Radiographics 27(1):173-187. https://doi.org/10.1148/rg.271065065

    Article  PubMed  Google Scholar 

  8. 8.

    Martin D, Muradbegovic M, Andrejevic-Blant S, Petermann D, Di Mare L (2018) Omental Fibromatosis Treated by Laparoscopic Wide Surgical Resection. Intractable Rare Dis Res 7(1):51-53. https://doi.org/10.5582/irdr.2018.01011

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Faria SC, Iyer RB, Rashid A, Ellis L, Whitman GJ (2004) Desmoid Tumor of the Small Bowel and the Mesentery. AJR Am J Roentgenol 183(1):118. https://doi.org/10.2214/ajr.183.1.1830118

    Article  PubMed  Google Scholar 

  10. 10.

    Levy AD, Shaw JC, Sobin LH (2009) Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features With Pathologic Correlation. Radiographics 29(2):347-373. https://doi.org/10.1148/rg.292085189

    Article  Google Scholar 

  11. 11.

    Diop AD, Fontarensky M, Montoriol PF, Da Ines D (2014) CT Imaging of Peritoneal Carcinomatosis and Its Mimics. Diagn Interv Imaging 95(9):861-872. https://doi.org/10.1016/j.diii.2014.02.009

    CAS  Article  Google Scholar 

  12. 12.

    Walkey MM, Friedman AC, Sohotra P, Radecki PD (1988) CT Manifestations of Peritoneal Carcinomatosis. AJR Am J Roentgenol 150(5):1035-1041. https://doi.org/10.2214/ajr.150.5.1035

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS (2003) The Pharmacological Treatment of Aggressive Fibromatosis: A Systematic Review. Ann Oncol 14(2):181-190. https://doi.org/10.1093/annonc/mdg064

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Skubitz KM (2017) Biology and Treatment of Aggressive Fibromatosis or Desmoid Tumor. Mayo Clin Proc 92(6):947-964. https://doi.org/10.1016/j.mayocp.2017.02.012

    Article  PubMed  Google Scholar 

  15. 15.

    Lee JH, Song KD, Cha DI, Hyun SH (2018) New Intra-Abdominal Mass After Operation for Colorectal Cancer: Desmoid Tumor Versus Peritoneal Seeding. Abdom Radiol (NY) 43(11):2923-2927 https://doi.org/10.1007/s00261-018-1567-3

    Article  Google Scholar 

  16. 16.

    Tan CH, Pua U, Liau KH, Lee HY (2010) Mesenteric Desmoid Tumour Masquerading as a Fat-Containing Cystic Mass. Br J Radiol 83(994):e200-e203. https://doi.org/10.1259/bjr/68468861

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Zhu H, Chen H, Zhang S, Peng W (2013) Intra-abdominal Fibromatosis: Differentiation From Gastrointestinal Stromal Tumour Based on Biphasic Contrast-Enhanced CT Findings. Clin Radiol 68(11):1133-1139. https://doi.org/10.1016/j.crad.2013.06.009

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Basu S, Nair N, Banavali S (2007) Uptake Characteristics of Fluorodeoxyglucose (FDG) in Deep Fibromatosis and Abdominal Desmoids: Potential Clinical Role of FDG-PET in the Management. Br J Radiol 80(957):750-756. https://doi.org/10.1259/bjr/53719785

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Kasper B, Dimitrakopoulou-Strauss A, Pilz LR, Strauss LG, Sachpekidis C, Hohenberger P (2013) Positron Emission Tomography as a Surrogate Marker for Evaluation of Treatment Response in Patients With Desmoid Tumors Under Therapy With Imatinib. Biomed Res Int 2013:389672. https://doi.org/10.1155/2013/389672

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Kasper B, Dimitrakopoulou-Strauss A, Strauss LG, Hohenberger P (2010) Positron Emission Tomography in Patients With Aggressive Fibromatosis/Desmoid Tumours Undergoing Therapy With Imatinib. Eur J Nucl Med Mol Imaging 37(10):1876-82. https://doi.org/10.1007/s00259-010-1498-x

    Article  PubMed  Google Scholar 

  21. 21.

    Fakih MG, Padmanabhan A (2006) CEA Monitoring in Colorectal Cancer. What You Should Know. Oncology 20(6):579-587.

    PubMed  Google Scholar 

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This research was supported by Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT& Future Planning (NRF-2019R1F1A1060131) and by Seoul National University Hospital Research Fund No. 03-2019-0070.

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Correspondence to Se Hyung Kim.

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This retrospective study was approved by the Institutional Review Board of Seoul National University Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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The Institutional Review Board of Seoul National University Hospital approved this retrospective study and waived the requirement for patients’ informed consent.

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Suh, J., Kang, H. & Kim, S.H. Differentiation of intra-abdominal desmoid tumor from peritoneal seeding based on CT and/or 18F-FDG PET-CT in patients with history of cancer surgery. Abdom Radiol (2020). https://doi.org/10.1007/s00261-020-02620-5

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  • Desmoid tumor
  • Intra-abdominal fibromatosis
  • Peritoneal seeding
  • Multidetector computed tomography
  • Positron emission tomography