An Unusual Intra-abdominal Calcification in a Plain Film

Abstract

A65-year-old woman with a history of hypertension visited the orthopedic clinic for chronic low back pain. The physical examination showed nothing remarkable. A lateral spine radiograph revealed only slight degenerative changes of the lumbar spine but incidentally disclosed a huge calcification over the paraspinal region (Figure 1A, arrow). An abdominal computed tomography with contrast enhancement showed a 4.0 × 3.1 × 3.6-cm-sized soft tissue mass with a lobulated contour, heterogeneous enhancement, and thick and irregular calcifications, which was attached to the posterior wall of the gastric fundus, with loss of the intervening fat plane (Figure 1B, arrow). Meanwhile, a right hepatic cyst was also noted (Figure 1B, asterisk). The calcified mass depicted on the plain film was initially mistaken as a retroperitoneal lesion. The subsequent abdominal computed tomography confirmed its location in the stomach. Upper gastrointestinal endoscopy showed a smooth surfaced submucosal lobulated mass larger than 3 cm in the fundus without ulceration. Therefore, laparoscopic partial gastrectomy was performed. The pathology of the resected tumor revealed spindle-shaped neoplastic cells with low risk of malignancy and thick calcifications (Figure 2). 1. Fletcher C.D. Berman J.J. Corless C. et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002; 33: 459-465 Abstract Full Text Full Text PDF PubMed Scopus (2843) Google Scholar The tumor cells showed positive reactivity for CD117 and CD34 but showed negative reactivity for smooth muscle actin and S-100. The pathology confirmed the diagnosis of gastrointestinal stromal tumor (GIST). Figure 2 View Large Image Figure Viewer