Calcifying fibrous 'pseudotumor': clinicopathologic study of 15 cases and analysis of its relationship to inflammatory myofibroblastic tumor.

Abstract

Calcifying fibrous pseudotumor (CFP) has been postulated to be a "late" stage of inflammatory myofibroblastic tumor (IMT). We analyzed 15 cases (8 females and 7 males; aged 1 to 65 years). The anatomic distribution was wide, including 3 cases each in neck, mesentery/omentum, and GI tract and 2 cases each in mediastinum and paratesticular sites. Follow-up information was available in 10 patients (range 4 to 228 months). Local recurrence occurred in 3 patients and was repeated in 2. Tumor size ranged from 0.6 to 25 cm. Lesions were well-circumscribed hypocellular spindle cell proliferations with dense stromal collagen, a lymphoplasmacytic infiltrate, and stromal calcifications. Features of conventional IMT were not seen. Immunostaining showed CD34 positivity in most cases as well as rare cells positive for smooth muscle actin and desmin, and consistent negativity for ALK-1 and S-100 protein. These findings suggest that CFP is a distinctive benign mesenchymal neoplasm with a low risk for recurrence and, therefore, best labelled as "calcifying fibrous tumor." There is no convincing evidence to support an association between CFP and IMT.