Calcifying fibrous pseudotumor of the adrenal gland: A rare case report

Adrenal Tuberculosis: A Case Report and Literature Review

Adrenal tuberculosis (TB) is a rare disease, which is difficult to diagnose because of its atypical symptoms. We reported a 41-year-old female who was admitted to hospital due to a left adrenal tumor, which was found in health examination without any symptoms. Abdominal CT showed a mass in her left adrenal. The results of blood test were normal. A retroperitoneal laparoscopic adrenalectomy was carried out, and adrenal TB was finally pathologically diagnosed. Following this, examinations focusing on TB were conducted which revealed negative results except for T-cell enzyme-linked immunospot. After the operation, the hormone level was normal. However, a wound infection occurred, which was recovered after antituberculosis treatment. In conclusion, even if there is no evidence of TB, we should be alert when diagnosing adrenal masses. Examinations of pathology, radiography, and hormone play important roles in determining the definite diagnosis of adrenal TB.

Calcifying fibrous tumor: a rare case in the foot

Calcifying fibrous tumor is a rare fibroblastic tumor with distinctive histological presentation that shows benign characteristics. To our knowledge, there are no prior reports that have documented imaging findings of calcifying fibrous tumor in the distal lower extremity. We report the case of a 25-year-old man who presented with a mass in the medial aspect of the right foot that was first noted 4 years earlier. Medical attention was sought due to perceived increase in size as well as increasing pain in the right foot. The patient had no limitations in activity but reported worsening discomfort while walking. An anteroposterior radiograph obtained at first presentation demonstrated a large calcified soft mass in the medial aspect of the foot. Contrast-enhanced MRI showed a mildly enhancing 6.5 cm × 2.5 cm × 8.5 cm mass, hypointense on T1- and T2-weighted images, infiltrating the adjacent abductor hallucis and flexor digitorum brevis muscles. Histopathology demonstrated multiple irregular fragments of white-tan firm tissue with a gritty cut surface, positive for CD34 on immunohistochemistry and consistent with calcifying fibrous tumor. Although rare in the extremities, this diagnosis should be considered in patients with a calcifying soft tissue mass. Low signal intensity with low-grade enhancement on MRI as well as stable disease course could prompt a diagnosis of calcifying fibrous tumor even in previously unmanifested locations.

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.

Cross-sectional imaging features of unusual adrenal lesions: a radiopathological correlation

The detection rates of adrenal masses are increasing with the common and widespread use of cross-sectional imaging. Adrenal adenomas, myelolipomas, metastases, pheochromocytomas, and adrenocortical tumors are well-known and relatively common adrenal tumors. However, there are many less-known neoplastic and nonneoplastic adrenal diseases that might affect the adrenal glands in addition to these common lesions. These rare entities include, but are not limited to, hydatid cysts, congenital adrenal hyperplasia, Wolman disease, adrenal tuberculosis, primary adrenal lymphoma. This article aims to present imaging findings of these unusual lesions in accordance with their pathologic characteristics. We think that the simultaneous presentation of the pathological findings with the imaging features may facilitate the learning process and may potentially enhance the recognition of these entities.

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.

Gastric calcifying fibrous tumor suspected to be complicated with immunoglobulin G4-related disease treated by laparoscopy and endoscopy cooperative surgery: a case report

Background

Calcifying fibrous tumor (CFT) is a rare benign soft tissue lesion.

Case presentation

A 30-year-old woman was admitted to our hospital with complaints of epigastralgia. A 15-mm submucosal tumor was identified in the greater curvature of the superior body of the stomach by upper gastrointestinal endoscopy. Endoscopic ultrasonography revealed a hypoechoic lesion with an acoustic shadow consistent with calcification. Computed tomography showed a gastric tumor with calcification. A gastrointestinal stromal tumor was diagnosed, and gastric wedge resection was performed by laparoscopy and endoscopy cooperative surgery. On pathological examination, the tumor was identified to be a CFT. Postoperative serum IgG4 levels were 26.0 mg/dl, which supported the diagnosis of probable immunoglobulin G (IgG) 4-related disease, according to the comprehensive diagnostic criteria of IgG4-related disease. The patient was discharged on postoperative day 7 and remains well with no evidence of tumor recurrence for 2 years after resection.

Conclusion

We herein reported a patient with a gastric CFT suspected to be complicated with immunoglobulin G4-related disease that was successfully treated by laparoscopy and endoscopy cooperative surgery.

IgG4-related disease in endocrine practice

IgG4-related disease is a set of symptoms resulting from a chronic, usually multiple organ inflammatory condition which affects various organs. It consists of lymphoplasmacytic infiltrations with attendant fibrosis and deep vein thrombosis. Frequently observed tissue lesions are accompanied by elevated IgG4 levels in serum. The etiopathogenesis of the lesions is of multifactor character and the clinical manifestation of the disease is highly diverse. The diagnostic process is based on the patient's medical history, clinical examination and additional tests, including a histopathological examination of the infected organ's tissues. Almost forty different locations of the disease have been reported, including disorders of the endocrine system. IgG4-related endocrinopathies are quite rare. However, it is likely that the diagnosis is under-reported due to lack of awareness of this clinical entity. Despite increasing interest in the subject, there are not enough reliable studies evaluating the link between IgG4-RD and endocrine disorders.

Whole-exome sequencing identifies unique mutations and copy number losses in calcifying fibrous tumor of the pleura: report of 3 cases and review of the literature

Calcifying fibrous tumor of the pleura (CFTP) is a rare mesenchymal tumor of unknown pathogenesis. The diagnosis often requires exclusion of other common entities. Our aim was to determine if genomic changes were associated with CFTP that could contribute to mechanisms underlying tumorigenesis. Three cases of CFTP with their corresponding uninvolved control lung tissue were identified. Two patients were male, and 1 was female (age range, 21-32 years). Tumors were multifocal in 2 cases and solitary in 1. Immunohistochemistry for STAT6, BCL-2, CD34, cytokeratin AE1/AE3, calretinin, desmin, S100, ALK, and β-catenin was used. All immunohistochemistries were negative in CFTPs. DNA was isolated from all 3 pairs of CFTPs and matching normal lungs for whole-exome sequencing. Damaging, tumor-specific, coding variants were identified in 3 genes including multiple heterozygotic, de novo mutations in the Zinc Finger Protein 717 (ZNF717), fascioscapulohumeral muscular dystrophy-1 (FRG1) and cell division cycle 27 (CDC27) genes. Whole-exome sequencing revealed statistically significant, focal, tumor-specific copy number losses among all CFTPs including a large (302 kb) loss at 6p22.2 comprising 32 genes of the histone cluster 1 family and the hemochromatosis (HFE) gene. This is the first study to evaluate the molecular pathogenesis of CFTP and to identify novel deleterious mutations in ZN717, FRG1, and CDC27 genes as well as significant copy number losses on 8 chromosomes with a large loss common to all samples on chromosome 6. These mutations deleteriously altered coding domains in a manner predicted to be damaging to protein function and may contribute to CFTP tumorigenesis.