Calcifying fibrous tumor of the terminal ileum mesentery: Case report

A Ball in the Belly: Calcifying Fibrous Pseudotumor of Abdominal Cavity – A Rare Entity

Calcifying fibrous pseudotumor is a rare clinically benign tumor first reported by Rosenthal and Abdul-Karim in 1988. Although rare, the tumor occurs most commonly in children and adolescents. Here we present a case of a 47-year-old male who reported to our institution with vague complaints of intermittent abdominal discomfort which was of mild to severe intensity, diffuse in presentation for a duration of 6 months. The pain was associated with subjective feeling of a “Wandering Lump” in the lower abdomen. This case report presents how this entity was managed along with review of literature. The novelty in this case report was it was a very peculiar case in the sense of its vague presentation, as the patient complained that he feels a lump and discomfort in right lower quadrant of his abdomen in the morning which moves up in the epigastric region; by evening, it comes to lie in the right lower quadrant of abdomen. So, anybody can discard this vague presentation, but in this case, we showed very high index of suspicion and evaluated him. The laparotomy confirmed its vague but true presentation as the lump was actually a freely lying ball which was wandering freely in the abdomen probably by peristalsis and patient’s routine activities. Surgical specialists are therefore advised never to miss such vague presentations, and index of suspicion has to be kept at all times.

Calcifying Fibrous Tumor of the Mesentery: A Case Report and a Review of the Literature

Background:

Calcifying fibrous tumor (CFT) is a rare entity, with a distinctive histological presentation, initially reported as childhood fibrous tumor with psammoma bodies. It is a benign hypocellular fibrous neoplasm calcifications and lymphoplasmacytic infiltrate. The CFTs may involve many sites, including gastrointestinal tract, pleura, abdominal cavity, and neck. The diagnosis might be challenging due to histological overlaps with other mesenchymal tumors. The prognosis is good. We describe herein the case of a 53-year-old woman with an incidentally diagnosed CFT of the mesentery.

Case presentation:

A 53-year-old woman presented to the surgery department with a 2-year history of an anterior abdominal hernia. A computed tomographic scan of the abdomen failed to demonstrate any evidence of a mesenteric nodule. The patient underwent surgical treatment. Careful exploration during the excision of herniated sac revealed a solitary nodule of the mesentery. Local excision was performed. On gross, it was a well-demarcated nodule. Microscopically, the tumor consisted of an abundant paucicellular hyalinized collagen with calcifications; associated to a sparse mononuclear inflammatory infiltrate.

Conclusions:

Calcifying fibrous tumor is a benign lesion. The diagnosis is based on histology, because clinical and radiological features are nonspecific. Awareness of this entity is crucial to distinguish it from other mesenchymal tumors especially in the gastrointestinal tract.

Calcifying fibrous pseudotumor in the pelvic cavity: A case report and review of the literature

Calcifying fibrous pseudotumors (CFPs) are rare benign lesions mostly occurring in the limbs, necks and gastrointestinal tracts of young adults. In the present study, we report the first known case of a pelvic CFP in China in a 67-year-old male patient. The solitary tumor had an extremely regular shape and was in the vicinity of the sigmoid colon. Surgical resection was performed and the tumor was histologically diagnosed as CFP. We reviewed 64 cases of CFPs and discussed the clinical features of this disease in China and other countries. We found that the CFPs were most common in patients aged 18-60 and often had no obvious symptoms. They were immunoreactive for vimentin and factor XIIIa, while negative for CD117 and S100. In China, CFPs were mostly identified in the stomach, possibly associated with Chinese eating. The pathogenesis of this disease remains unclear. More research is needed to confirm the present results.

Calcifying fibrous tumor of the mediastinum: A case report

BACKGROUND

Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor that often occurs in deep soft tissue of children and young adults. CFT rarely occurs in the mediastinum.

CASE SUMMARY

In this paper, we describe a 31-year-old male patient with CFT in the mediastinum. The patient did not have any symptoms, and the posterior mediastinal lesion was unintentionally found during routine re-examination of thyroid cancer. The tumor had no adhesion to the surrounding tissue and was successfully and completely removed. Pathology showed a large amount of collagen-rich fibrous connective tissue. There was scattered dystrophic calcification and gravel in the fibrous tissue and a small amount of lymphocyte and plasma cell infiltration and lymphoid follicle formation in the interstitial fluid. In addition, findings showed 20 IgG4+ plasma cells per high-powered field of the diseased tissue, an IgG4+/IgG ratio of about 20%, and normal serum IgG4 levels. The final diagnosis was CFT of the mediastinum (CFTM). No evidence of tumor recurrence was observed by computed tomography at 3 mo after surgery.

CONCLUSION

IgG4+ plasma cell enlargement may occur in CFTM, but clinical manifestations and serological tests suggest that it is not IgG4-related disease. We speculate that it may be an independent tumor subtype.