Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor–A Systemic Review

Abstract

Background and Objectives: Calcifying fibrous tumor (CFT) in the stomach is extremely rare and is easily misdiagnosed as a gastrointestinal stromal tumor (GIST). This study aims to determine the best method to differentiate between gastric CFT and GIST after a systemic review and meta-analysis. Materials and Methods: A systematic search of articles using electronic databases (MEDLINE, EMBASE, and LILACS) was conducted and resulted in 162 articles with 272 CFT cases published from January 1988 to September 2019. Results: Of these cases, 272 patients, 60 patients with gastric CFT (32 men and 28 women, mean age 49.2 years) were analyzed. The mean tumor size was 2.4 cm in patients with gastric CFT. Both endoscopic ultrasound (EUS) and computed tomography (CT) findings revealed well-defined (100% vs. 77.8%), heterogeneous (100% vs. 77.8%), iso-hypoechoic (71.4% vs. 33.3%), and calcified (85.7% vs. 77.8%) lesions, respectively. The majority of patients (53.3%) were symptomatic, with the most common symptom being abdominal discomfort (55.6%). None of the patients with gastric CFT showed recurrence after treatment, and most patients received nonendoscopic treatment (56%, n = 28/50). Both age and tumor size were statistically significant in patients with gastric CFT than GIST (49.2 vs. 65.0 years and 2.4 vs. 6.0 cm; both p < 0.001). The ratio of children among patients with CFT (5%) and GIST (0.05%) was also significantly different (p = 0.037). The calcification rates of gastric CFT had significantly higher calcification rates than GIST on images of EUS and CT (85.7% vs. 3.6% and 77.8% vs. 3.6%; both p < 0.001). Conclusions: Compared with patients with GIST, patients with gastric CFT were younger, had smaller tumor size, and were symptomatic. Furthermore, gastric CFT was well-defined, heterogeneous in the third layer, and had high calcification rates on the images.

Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

“…Prior to the resection, CFTs in the GI tract are easily misdiagnosed as GI stromal tumors[ 9 ]. A clear identification of CFTs is essential to distinguish benign tumors from other mesenchymal GI lesions, given their rarity in the GI tract.…”

“…To date, there have been few studies on the treatment of GI CFTs. A previous meta-analysis indicated that more than half of the patients received treatments other than endoscopy[ 9 ]. We reviewed all GI CFT cases from the same period at our hospital and found that all patients underwent endoscopic treatment rather than surgical resection.…”

Pulmonary Calcifying Fibrous Tumor in a Pediatric Patient: A Case Report

“…Imaging features of CFT usually present as a well-demarcated calcifying mass [10][11][12][13][14][15][16]. Calcifications are a distinctive feature [17,18]; however, they can exhibit variable calcification patterns and may even be absent, as in the cases of pulmonary CFT reported by Peachell et al and Özkan et al [1,3,9,19]. The enhancement pattern is variable and dependent upon the tumor composition and vascularity [18].…”

Omental calcified fibrous tumor with symptoms after COVID-19 infection

“…Calcified fibrous tumor (CFT) is a rare benign tumor of mesenchymal origin, which was first reported as a deep soft tissue tumor in children in 1988 and was accepted as an inflammatory or traumatic tumor [ 1 , 2 ] in 2003, named as fibrous calcified tumor [ 3 ]. Between 1988 and 2019, a total of 272 CFT cases were reported [ 4 ]. CFTs can be seen in all anatomical regions with soft tissue [ 5 , 6 ].…”