Nevertheless, a progressive and invading tumour can result in a diffuse infiltration of the mesentery and bowel leading to intestinal ischemia or to the obstruction. The treatment modality in mesenteric fibromatoses is still controversial. The results of the treatment might be biased due to the unpredictable course of this disease with some tumours regress- ing or remaining stable without any treatment. The management of desmoids should be individual- ized and multimodal. The surgical resection should be performed only in localized tumours that do not invade the root of the mesentery. Intra-abdominal desmoids can be resected in 53-67% of cases.6 The aggressive surgical treatment of mesenteric desmoids may result in short bowel syndrome or multiple enterocutaneous fistulas requiring a long- term parenteral nutrition. Fibromatoses are locally aggressive tumours that tend to recur when in- completely resected. A high rate of recurrence after the surgical resection results from the incomplete resection, multicentric disease or surgical trauma as a new precipitating factor. Recent studies report comparable recurrence rates after R0 and R1 resec- tion in extra-abdominal desmoids.7,8 Nevertheless, there are no data to support a similar influence of microscopically positive margins on recurrence in intra-abdominal desmoids. Advanced and unresectable tumours or when the resection will result in short bowel syndrome are best treated within a clinical trial of cytotoxic chemotherapy or other experimental therapies. Radiotherapy is rarely used in intra-abdominal desmoids because of a high risk of radiation en- teritis. There are no established chemotherapy regimens used in fibromatoses. Most chemothera- peutic protocols use doxorubicin.9 Recently, a suc- cessful therapy of a desmoid tumour resistant to traditional chemotherapeutic regimens was report- ed with imatinib, a tyrosine kinase inhibitor that is successfully used in advanced gastrointestinal stromal tumours.10,11 In a series reported by Bertagnolli et al.9, 96% of patients with mesenteric desmoids had either a ra- diographically stable disease or no recurrence for a median of 50 months using a multimodal treat- ment combining watchful waiting, surgery and chemotherapy. The growth of desmoid tumours is usually lim- ited to the mesentery, but the infiltration of the ad- jacent bowel is not uncommon. MF may infiltrate the muscularis propria or even the submucosa.12 The diagnosis of mesenteric fibromatosis is usually straightforward in the cases without a concomi- tant intestinal involvement. On the other hand, Wronski M et al. / Mesenteric fibromatosis 61 FIGURE 3. Macroscopic view of the resected specimen: A - a mesenteric mass encroaching the bowell wall, B – cut surface of the desmoid tumour showing grayish and glistening, homogenous desmoid tumour. A tuber- cule attached to the bowel serosa and mimicking peritoneal tumour deposits proved to be a mesothelial cyst (arrow). FIGURE 4. Microscopic view of mesenteric fibromatosis: immunostaining for beta-catenin. Radiol Oncol 2011; 45(1): 59-63. A B