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  Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 58  |  Issue : 1  |  Page : 122-123
Calcifying fibrous tumor of the large intestine


1 Department of Pathology, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, 34710, Turkey
2 Department of General Surgery, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, 34710, Turkey

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Date of Web Publication11-Feb-2015
 

How to cite this article:
Senol S, Ayşe BC, Zemheri E, Arslan A. Calcifying fibrous tumor of the large intestine. Indian J Pathol Microbiol 2015;58:122-3

How to cite this URL:
Senol S, Ayşe BC, Zemheri E, Arslan A. Calcifying fibrous tumor of the large intestine. Indian J Pathol Microbiol [serial online] 2015 [cited 2019 Nov 12];58:122-3. Available from: http://www.ijpmonline.org/text.asp?2015/58/1/122/151213


Editor,

Calcifying fibrous tumors (CFTs) are solid, well-circumscribed, benign, mesenchymal tumors. [1] Involvement of internal organs in CFT is extremely rare. As a rare tumor of the gastrointestinal tract, only one case of CFT was reported in colon up to date. [2]

A 60-year-old male attended to the gastroenterology clinic with the complaints constipation and intermittent, colic, abdominal pain that does not resolve with oral analgesics. Magnetic resonance imaging revealed a mass that protrudes into the lumen [[Figure 1]a]. In the colonoscopic examination; a polypoid mass of 3 cm growing into lumen in the sigmoid colon was detected [[Figure 1]b]. The lesion was obstructing the lumen, so a colonic segment of 9 cm was resected laparoscopically. Macroscopically, a submucosal polypoid mass of 3.5 cm in diameter, protruding to the lumen with definitive margins was seen. The mass was solid and white in cross-section and thickening of the colonic wall did not see [[Figure 2]a]. In the microscopic examination, we saw rare fibroblasts under the mucosa within large collagenized, keloid-like areas, scarce areas of lymphoplasmocytic mononuclear infiltrate and psammomatous calcifications [[Figure 2]b and c]. Tumor was limited to submucosa and did not show any invasion to muscularis propria. Local and regional blood vessels were generally dilated, but lymphovascular invasion was not seen. Tissue specimen was immunoreactive only with vimentin. CD117, CD34, S100, smooth muscle actin (SMA), desmin and anaplastic lymphoma kinase (ALK) were negative [[Figure 3]a-c]. With these findings, patient was diagnosed as CFT.
Figure 1: (a) Polypoid luminal lesion in sigmoid colon, magnetic resonance imaging. (b) Endoscopic appearance of the polypoid extension of the tumoral mass into the intestinal lumen


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Figure 2: (a) Macroscopic appearance of the mass with regular borders, solid and fibrotic appearance which makes a polypoid extension into the intestinal lumen. (b) The mass under the colonic mucosa which has regular borders but no capsule (H and E, ×40). (c) Very low cellular sclerotic lesion which contains lymphoplasmocytic infiltrate and psammomatous basophilic calcifications (H and E, ×100)


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Figure 3: (a) Calcifying fibrous tumor of the large intestine showing vimentin positivity (immunohistochemistry [IHC], ×100), (b) negative for CD34 (IHC, ×200) and (c) CD117 (IHC, ×100)


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Calcifying fibrous tumors are tumors with unknown pathogenesis although trauma has been disputed in etiology. They tend to behave benign in the soft tissues with no metastasis but may rarely recurred. They were first named as "pseudotumors," but now are considered as "tumors." [2] In the last issue of "Tumors of Soft Tissue and Bone" by the World Health Organization, CFT was classified under "fibroblastic/myofibroblastic neoplasms" section. [3] Until date; few cases of gastric, small intestinal and ileocecal presentations in the gastrointestinal system were reported, but in the colon only one case was reported. [2],[3]

Calcifying fibrous tumor is characterized pathologically as an unencapsulated but well-circumscribed mass consisting of hyalinized collagen, bland spindle cells, lymphoplasmacytic infiltrate and psammoma bodies and/or dystrophic calcifications. Immunohistochemically, the spindle cells of CFTs are negative for CD117, CD34, platelet-derived growth factor receptor-alpha, S100, SMA, desmin and ALK. [1],[3],[4] Differential diagnosis of CFT includes inflammatory myofibroblastic tumor, reactive nodular fibrous pseudotumor, fibromatosis, calcifying aponeurotic fibroma, leiomyoma, gastrointestinal stromal tumor (GIST), lipoma, neuroendocrine cell tumors and amyloidoma. CFT is differentiated from GISTs, smooth muscular, vascular, adipose and neuronal mesenchymal lesions of the gastrointestinal tract, both morphologically and immunohistochemically. [1],[3],[4]

Calcifying fibrous tumors in the gastrointestinal tract can grow in the submucosa and form polypoid masses protruding into the lumen as observed in our case. They may cause disturbances during defecation, dyspepsia, constipation and abdominal pain. Some CFTs may have subserosal growth and can be resected with enucleation. [5]

However, local recurrences are reported in which resected from soft tissue CFTs; resection is generally curative for located in solid organ CFTs and postoperative follow-up or chemotherapy is not necessary in the light of today's data. [1],[4],[5]

It is important that CFT should be kept in mind with other mesenchymal tumors of the colon in the differential diagnosis of colonic masses. Also, the clinician must always take into account in the clinical assessment and endoscopical examination that CFTs can be seen as submucosal polypoid masses anywhere in the gastrointestinal tract.

 
   References Top

1.
Fetsch JF, Montgomery EA, Meis JM. Calcifying fibrous pseudotumor. Am J Surg Pathol 1993;17:502-8.  Back to cited text no. 1
    
2.
Shi Q, Xu MD, Zhong YS, Zhou PH, Wu HF, Yao LQ. The laparoscopic-endoscopic cooperative surgery for the colonic calcifying fibrous tumor: One case report. J Laparoendosc Adv Surg Tech A 2012;22:996-8.  Back to cited text no. 2
    
3.
Montgomery E. Fibroblastic/myofibroblastic tumours. In: Fletcher CD, Unni KK, Mertens F, editors. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone, 1 st ed. Lyon: IARC Press; 2002. p. 77-8.  Back to cited text no. 3
    
4.
Nascimento AF, Ruiz R, Hornick JL, Fletcher CD. Calcifying fibrous 'pseudotumor': Clinicopathologic study of 15 cases and analysis of its relationship to inflammatory myofibroblastic tumor. Int J Surg Pathol 2002;10:189-96.  Back to cited text no. 4
    
5.
Ogasawara N, Izawa S, Mizuno M, Tanabe A, Ozeki T, Noda H, et al. Gastric calcifying fibrous tumor removed by endoscopic submucosal dissection. World J Gastrointest Endosc 2013;5:457-60.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Serkan Senol
Goztepe Education and Research Hospital, Dr. Erkin Street, Kadikoy, Istanbul, 34710
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.151213

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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[Pubmed] | [DOI]



 

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