Giant mesenteric fibromatosis progresses despite targeted therapy and immunotherapy in case report

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Frontiers in Medicine Published June 3, 2026 Medically reviewed June 3, 2026 Study authors: Weihua Zheng, Junjie Lu, Shuai Jiang, Fan Zhang, Long Xia, Junjing Zhang DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider that giant mesenteric fibromatosis may progress despite targeted therapy and immunotherapy, with risk of complex fistulas.

This review presents a single case report of a patient with giant abdominal mesenteric fibromatosis who received targeted therapy combined with immunotherapy followed by radical resection and multidisciplinary team management. The tumor progressed rapidly despite the medical therapy. The patient developed delayed and complex multiple complications including duodenal fistula, vaginal fistula, and ureterorectal fistula. Ultimately, the patient recuperated with drainage tubes in place and was able to tolerate oral feeding.

The case illustrates the difficulty in treating giant mesenteric fibromatosis that continues to progress despite medical therapy. The authors note that this provides an important reference for managing such cases, but given it is a single case, the findings are not generalizable. No limitations were reported in the source.

Clinicians should be aware that aggressive multimodal treatment may not halt progression and can lead to significant complications. The practice relevance is limited to providing a reference for similar challenging cases.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Mesenteric fibromatosis (MF) is a rare, locally aggressive, borderline tumor with no metastatic potential, characterized by a high postoperative recurrence rate. This paper reports a complex case of aggressive MF. Despite receiving targeted therapy that was combined with immunotherapy, the tumor in our case progressed rapidly and symptoms of intestinal obstruction developed. Following a challenging radical resection, delayed and complex multiple complications ensued, including duodenal fistula, vaginal fistula, and ureterorectal fistula. Through personalized management under multidisciplinary team (MDT) collaboration—including adequate drainage to control infection, stepwise nutritional support (i.e., transitioning from total parenteral nutrition to enteral nutrition), and targeted management of a high-output enterostomy—the patient ultimately recuperated with drainage tubes in place, and she was able to tolerate oral feeding. This case suggests that for giant mesenteric fibromatosis that continues to progress despite medical therapy, close imaging surveillance (particularly vigilance for signs of "tension cystic change") should be employed to warn of serious complications, and a decisive, surgery-centered multidisciplinary comprehensive treatment strategy should be adopted. Postoperatively, reliance on a multidisciplinary team is essential for long-term vigilance against delayed complex fistulae triggered by factors such as infection. The diagnostic and therapeutic experience from this case provides an important reference for managing this highly challenging disease.