1.

INTRODUCTION
Desmos Greek tendon like. Desmoid tumours, also known as aggressive fibromatosis. are extremely rare. They are slow growing but tend to be locally invasive although benign in histology. Arise from abdominal / muscular aponeurotic structures. Common extra-abdominal sites shoulder, chest wall, back, thigh and head neck. Extremity tumours, extremely rare.

2. HPE necessary for confirmation as in our case. They often mimic vascular neoplasms. Surgery,radiotherapy or both regarded as treatment of choice. It documents an extremity Desmoid tumour.

Discussion
Incidence -- 2 4 cases / million Typically derived from abdominal wall, bowel, mesentry. Extra abdominal cases very rarely originate from extremities. Possible risk factor Female Sex. H/O surgery/trauma/pregnancy Genetic predisposition.

3. HPE (Histopathology Examination) Dense collagenous lesions with inter twining bundle of spindle cells without epithelial components. Tumour cells are uniform, lack mitotic activity. No necrosis plemorphisn. Gross : Dense hard, rubbery, grayish white Total resection often impossible without compromising near by structures. Lower extremity tumours extremely rare Possibility of DT should be kept in mind while evaluating an extremity mass.

4. Case : A 14 year old female presented c a painless swelling over back of thigh for 1 year. No history of trauma / surgery. O/E : A firm, non-pulsatile, non-compressible swelling to underlying structures
c

deep tenderness, fixed

USG revealed an irregular outline of hypoechoic SOL in hamstring muscle. FNAC showed spindle cell tumour - differentiation b/w benign and malignancy could not be done.

5.

OT Note
Prone Position G.A. Longitudinal incision over back of thigh Mass found encasing the sciatic nerve The mass is dissected from the nerve Mass is excised along c fibres & tendon of muscles of the hamstring component (biceps femorois, semimembranosus) Negative suction drain is given 6. Skin is closed with Ethilion 2-0.

The post-op specimen

Gross Ovoid mass measuring 9 cm in its greatest axis. The cut surface has a greyish, trabeculated appearance. Microscopy Sections show lesion composed of interlacing bands of fibroblasts & collagen. The lesion has infiltrated the surrounding muscle tissue. Impression Desmoid Fibromatosis - right thigh

 These lesions are locally infiltrative & may recur after excision. They donot metastasize. 7. The post operative recovery period was uneventful & without any evidence of nerve damage. She did not opt for any radio or chemotheraphy. At 9 months to follow up she did not show any signs of recurrence.