Case report: Calcifying fibrous tumor presenting as an asymptomatic pelvic mass

Calcifying fibrous tumor of the ileum resected by single-port laparoscopic surgery: a case report

Background

Calcifying fibrous tumors (CFTs) are rare benign tumors. Because CFTs sometimes relapse, radical resection with adequate margins is necessary. We report a case of ileal CFT resected using single-port laparoscopic surgery.

Case presentation

A 33-year-old man presented with chief complaints of abdominal pain and vomiting. Computed tomography demonstrated a 45-mm-sized pelvic mass with partial calcification in the ileum. The patient was diagnosed with an ileal tumor, and partial resection of the ileum was performed using the single-port laparoscopic technique. Pathologic findings revealed hypocellular spindle cells with dense hyalinized collagen, interspersed calcification, and infiltration of lymphoplasmacytic cells. Immunohistochemical analysis showed that the factor XIIIa was positive and other tumor-specific markers were negative. Based on these findings, the tumor was finally diagnosed as a CFT.

Conclusions

Although CFT is benign, multifocal and recurrent CFTs have been reported. Therefore, careful intraperitoneal observation and curative resection are necessary. Single-port laparoscopic surgery is acceptable, both in terms of curability and minimal invasiveness.

Calcifying Fibrous Tumor: Review of 157 Patients Reported in International Literature

Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations of the human body. The aim of the present systematic review is to give a detailed account of all reported cases of CFT in the literature and to analyze the available data, to completely characterize the entity from epidemiological, medical, and surgical aspects.A bibliographic research was performed from 1988 until 2015. A database with the patients' characteristics was made, including sex, age, location of the tumor, symptoms, symptoms duration, size of the tumor, diagnostic methods, treatment, metastasis, and follow-up.A total of 104 articles were identified, reporting 157 cases of CFT. Mean age of patients was 33.58 years and the ratio between men and women was 1:1.27. The most common locations of CFT were stomach (18%), small intestine (8.7%), pleura (9.9%), mesentery (5%), and peritoneum (6.8%). Mean diameter of the tumor was estimated 4.6 cm. The correlations proceeded showed that as age increases, size decreases (P = 0.001) and that the tumor is larger in females (P = 0.027). Kruskal-Wallis test showed that the larger tumors appear in the neck and adrenal gland (P = 0.001). The percentage of asymptomatic patients was 30.57%. Computed tomography and biopsy were the most common tests for the diagnosis of CFT. Open surgical procedure was performed in the majority of cases. The median hospitalization was 6.06 days and the mean follow-up period was 29.97 months. Recurrences were mentioned in 10 of 96 patients with available data. No deaths owing to CFT were mentioned in the literature.CFT should be included in the differential diagnosis of enlarging mass revealed by clinical or imaging examination either incidentally or after specific acute or chronic symptomatology.

Calcifying Fibrous Tumor of the Gastrointestinal Tract

Calcifying fibrous tumor is a benign mass lesion classically described as a soft tissue tumor. However, a thorough review of the literature reveals that it can occur virtually anywhere, including the tubular gastrointestinal (GI) tract. Its clinical manifestations are variable in the GI tract, and its imaging findings are nonspecific. However, it has unique histologic and immunophenotypical features that must be recognized by GI pathologists to differentiate it from an assortment of other rare mesenchymal lesions of the abdomen and GI tract. Calcifying fibrous tumor is composed of a paucicellular collagen matrix, interspersed calcified bodies, and a sparse inflammatory infiltrate. Although calcifying fibrous tumor is benign, pathologists must be aware that it may occur in the GI tract to differentiate it from other potentially more aggressive, rare mesenchymal lesions.

Calcifying fibrous tumor: an unrecognized IgG4--related disease?

Calcifying fibrous tumor is a rare benign mass lesion characterized by bland spindle cells embedded in abundant collagenous matrix, interspersed dystrophic or psammomatous calcifications, and lymphoplasmacytic infiltrate. It shares several clinical and morphologic features with IgG4-related disease, a newly recognized fibroinflammatory disorder. Characteristic histologic features of IgG4-related lesions include dense fibrosis and abundant lymphoplasmacytic infiltrate, similar to calcifying fibrous tumor. They contain high numbers of IgG4-positive plasma cells in the tissue. Patients also often have elevated serum IgG4 levels. We report the case of a patient with an ileal calcifying fibrous tumor that contained 69 IgG4-positive plasma cells per high-power field and an IgG4-to-IgG ratio of 56% in lesional plasma cells. The patient's serum IgG4 level was 185 mg/dL, more than double the normal value. Altogether, these features suggest that calcifying fibrous tumor could be an unrecognized lesion of IgG4-related disease.

Calcifying fibrous tumor presenting as rectal submucosal tumor: first case reported in rectum

Calcifying fibrous tumor (CFT) is a recently recognized rare benign lesion characterized by dense hyalinized collagenous tissue with interspersed spindle cells and a lymphoplasmocytic infiltrate. Calcification is the hallmark of CFT and may present in the form of psammomatous bodies or dystrophic calcifications. CFT of the intestinal tract is uncommon and rectal CFT has never been reported. Recently, we experienced a case of CFT found in the rectum of a 36-year-old man. In this study, we described the characteristic histopathological findings with a review of the relevant literature. Although CFT of the intestinal tract as an intrinsic visceral lesion is unusual and clinically unexpected, CFT should be considered in the differential diagnosis of rectal submucosal tumor.