Calcifying fibrous tumor of the mesentery

Discussion:

Pathology report:
Mesentery of terminal ileum:
All slides show a lobulated and nodular mass that is unencapsulated and shows a hypocellular spindle cell proliferation embedded in dense collagenous stroma. The collagen is arranged in whorls and spindle cells are bland. There are scattered calcifications, many of which are psammomatous. There is abundant surrounding reactive tissue composed of myofibroblasts, chronic inflammatory infiltrate, blood vessels and myxoid stroma. Part of the lesion seems to have undergone torsion with thrombosed and congested blood vessels.
Immunostains show:
CD45 - positive in lymphocytes; c-Kit - positive in scattered mast cells; calretinin - positive in mesothelium; AE1/AE3, pankeratin - positive in mesothelium and myofibroblasts; desmin - focally positive in scattered cells; OCT3/4, HCG, CK5/6, CD99, S100, actin, EMA, CD31, CD34, CD68, HMB45, NSE, synaptophysin, chromogranin, WT1, GFAP, B-catenin, PLAP, S10, ALK, IgG4, caldesmon, DOG1, MUC4 - negative.

Conclusion:
The histological features and stains are consistent with a benign lesion and most compatible with calcifying fibrous tumor 1,2.

Calcifying fibrous tumor is a very rare lesion that has been reported in many locations throughout the body. It is usually asymptomatic and is therefore usually discovered incidentally at imaging. In this particular case of calcifying tumor of the mesentery 3, it was perhaps the vascular torsion seen at laparoscopy and on histopathology that elicited the abdominal pain.


Laparoscopy photo courtesy of Dr. Arie Pelta.

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