Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.

Calcifying fibrous tumor of the gastrointestinal tract: A clinicopathologic review and update

Calcifying fibrous tumor(CFT)is a rare mesenchymal lesion that has been documented throughout the gastrointestinal tract.Gastrointestinal CFTs may occur at virtually any age,with a predilection for adults and for females.They occur most commonly in the stomach and the small and large intestines.CFTs are most often found incidentally,cured by local resection,and have a low risk of recurrence.Histology shows three characteristic features:Spindle cell proliferations within a densely hyalinized stroma,scattered calcifications,and lymphoplasmacytic inflammation.CFTs are immunoreactive for CD34,vimentin and factor XIIIa,helping to distinguish them from other benign mesenchymal neoplasms.The differential diagnosis of CFTs includes sclerosing gastrointestinal stromal tumor,leiomyoma,schwannoma,solitary fibrous tumor,inflammatory myofibroblastic tumor,plexiform fibromyxoma,fibromatosis,sclerosing mesenteritis,and reactive nodular fibrous pseudotumor.The pathogenesis of CFTs remains unclear,but some have hypothesized that they may be linked to IgG4-related disease,inflammatory myofibroblastic lesions,hyaline vascular type Castleman disease,sclerosing angiomatoid nodular transformation of the spleen,or trauma.

Gastric calcifying fibrous tumor removed by endoscopic submucosal dissection

The World Health Organization describes calcifying fibrous tumors(CFTs) as rare, benign lesions characterized by hypocellular, densely hyalinized collagenization with lymphoplasmacytic infiltration. These tumors rarely involve the gastrointestinal(GI) tract. A routine endoscopic upper gastrointestinal screen detected a 10-mm submucosal tumor(SMT) in the lesser curvature of the lower corpus of the stomach of an apparently healthy, 37-year-old woman with no history of Helicobacter pylori infection. Endoscopic ultrasonography(EUS) localized the internally isoechoic, homogeneous SMT mainly within the submucosa. Malignancy was ruled out using endoscopic submucosal dissection(ESD). A pathological examination confirmed complete resection of the SMT, and defined a hypocellular, spindle-cell tumor with a densely hyalinized, collagenous matrix, scattered lymphoplasmacytic aggregates as well as a few psammomatous, dystrophic calcified foci. The mass was immunohistochemically positive for vimentin and negative for CD117(c-kit protein), CD34, desmin, smooth muscle actin(SMA) and S100. Therefore, the histological findings were characteristic of a CFT. To date, CFT resection by ESD has not been described. This is the first case report of a gastric calcifying fibrous tumor being completely resected by ESD after endoscopic ultrasonography.

Surgery for calcifying tendinitis of the shoulder: A systematic review

AIM To systematically search literature and determine a preferable surgical procedure in patients with failed conservative treatment of calcifying tendinitis of the shoulder.METHODS The electronic online databases MEDLINE(through PubMed), EMBASE(through OVID), CINAHL(through EBSCO), Web of Science and Cochrane Central Register of Controlled Trials were systematically searched in May 2016. Eligible for inclusion were all available studies with level Ⅱ and level Ⅲ evidence(LoE). Data was assessed and extracted by two independent review authors using a specifically for this study designed data extraction form.RESULTS Six studies(294 surgically treated shoulders) were included in this review. No significant differences between the three available treatment options(acromioplasty with the removal of the calcific deposits, acromioplasty or solely the removal of the calcific deposits) were detected regarding the functional and clinical outcome. The followup ranged from 12 mo to 5 years. Complication rates were low. No reoperations were necessary and the only reported complication was adhesive capsulitis, which in all cases could be treated conservatively with full recovery. CONCLUSION We found that all three available treatment options show good functional and clinical outcomes in the short and midterm. However, a favorable procedure is difficult to determine due to the lack of high-quality comparing studies.

Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis:Egg or hen?

Intraductal papillary mucinous neoplasm(IPMN)is an increasingly reported entity.Extensive pancreatic calcification is generally thought to be a sign of chronic pancreatitis,but it may occur simultaneously with IPMN leading to diagnostic difficulties.We report a case of a patient initially diagnosed with chronic calcifying pancreatitis who was later shown to have a malignant IPMN.This case illustrates potential pitfalls in the diagnosis of IPMN in the case of extensive pancreatic calcification as well as clues that may lead the clinician to suspecting the diagnosis.The possible mechanisms of the relation between pancreatic calcification and IPMN are also reviewed.

Physiological performance of three calcifying green macroalgae Halimeda species in response to altered seawater temperatures

The effects of seawater temperature on the physiological performance of three Halimeda species were studied for a period of 28 d.Five treatments were established for Halimeda cylindracea,Halimeda opuntia and Halimeda lacunalis,in triplicate aquaria representing a factorial temperature with 24°C,28°C,32°C,34°C and 36°C,respectively.The average Fv/Fm of these species ranged from 0.732 to 0.756 between 24°C and 32°C but declined sharply between 34°C(0.457±0.035)and 36°C(0.122±0.014).Calcification was highest at 28°C,with net calcification rates(Gnet)of(20.082±2.482)mg/(g·d),(12.825±1.623)mg/(g·d)and(6.411±1.029)mg/(g·d)for H.cylindracea,H.opuntia and H.lacunalis,respectively.Between 24°C and 32°C,the specific growth rate(SGR)of H.lacunalis(0.079%–0.110%d–1)was lower than that of H.cylindracea(0.652%–1.644%d–1)and H.opuntia(0.360%–1.527%d–1).Three Halimeda species gradually bleached at 36°C during the study period.Malondialdehyde(MDA)and proline levels in tissues of the three Halimeda were higher in 34–36°C than those in 24–32°C.The results indicate that seawater temperature with range of 24–32°C could benefit the growth and calcification of these Halimeda species,however,extreme temperatures above 34°C have negative impacts.The measured physiological parameters also revealed that H.cylindracea and H.opuntia displayed broader temperature tolerance than H.lacunalis.

Calcifying fibrous tumor originating from the gastrohepatic ligament that mimicked a gastric submucosal tumor: A case report

BACKGROUND Calcifying fibrous tumor (CFT) is a rare, benign soft tissue tumor usually occurring in children or young adults. Gastrohepatic ligament CFT with adhesion to the stomach is very rare. We present a case here. CASE SUMMARY A 25-year-old woman visited our hospital with abdominal pain. Computed tomography and endoscopy were performed, and a gastric submucosal tumor (SMT) with a size of 6.7 cm × 2.7 cm was detected, so endoscopic ultrasonography-guided fine needle biopsy was performed. The tumor was not diagnosed histologically, so surgical resection was planned and performed. The histopathologically confirmed mass size was 6.5 cm × 4.0 cm × 1.0 cm, and a calcified fibrous tumor that originated at the gastrohepatic ligament and adhered to the lesser curvature of the gastric antrum was identified. CONCLUSION Gastrohepatic ligament CFT is a very rare benign tumor. Since this disease may be confused with gastric SMT, the possibility of CFT should be kept in mind during clinical assessment of this disease.

Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible

We present an uncommon case （female patient aged 59 years） of the clear-cell variant of calcifying epithelial odontogenic tumor （CEOT） （also known as Pindborg tumor） in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.

COMPARATIVE STUDIES OF INORGANIC CARBON UTILIZATION IN EMILIANIA HUXLEYI AND SOME NON-CALCIFYING MARINE MICROALGAE

Inorganic carbon utilization in the non calcifying marine microalgae, Nannochloropsis oculata, Phaeodactylum tricornutum and Porphyridium purpureum was compared with high and low calcifying strains of Emiliania huxleyi grown in artificial seawater medium aerated with either air (0.03% V/V CO 2) or CO 2 free air. For high calcifying strain of E. oculata and P. tricornutem , similar growth patterns were observed in air and CO 2 free air grown cultures. P. purpureum showed a less final cell density in CO 2 free air than in air grown culture. However, low calcifying strain of E. huxleyi was able to grow only in air grown culture, but not in CO 2 free air grown culture. Measurements of alkalinity, pH, concentration of dissolved inorganic carbon (DIC) and free CO 2 showed different patterns of DIC utilization. With N. oculata, P. tricornutum and P. purpureum the pattern of DIC utilization was characterized by an increase of pH and a decrease of DIC but a constant alkalinity in the cultures aerated with air or CO 2 free air, suggesting that bicarbonate utilization was concomitant with an efflux of OH -. Both alkalinity and pH were maintained rather constant in air grown culture of low calcifying strain of E. huxleyi, suggesting that diffusive entry of CO 2 could meet the requirement of DIC for its photosynthesis and growth. High calcifying strain of E.huxleyi , however, showed a pattern of decrease of alkalinity and DIC but an almost constant pH , indicating that bicarbonate was the major form of inorganic carbon utilised by this organism and bicarbonate uptake is unlikely to be accompanied by an efflux of OH -. The final pH values reached by N. oculata, P. tricornutum and P. purpureum in a closed system were 10.75, 10.60 and 9.85 respectively, showing that bicarbonate utilisation is concomitant with an efflux of OH . While the final pH of 8.4 in high calcifying E. huxleyi suggests that bicarbonate utilization was not accompanied by an efflux of OH -.

Increased light availability enhances tolerance against ocean acidification-related stress in the calcifying macroalga Halimedaopuntia

Although the adverse impacts of ocean acidification(OA)on marine calcifiers have been investigated extensively,the anti-stress capabilities regulated by increased light availability are unclear.Herein,the interactive effects of three light levels(30μmol photons/(m^(2)·s),150μmol photons/(m^(2)·s),and 240μmol photons/(m^(2)·s)combined with two pCO_(2)concentrations(400 ppmv and 1400 ppmv)on the physiological acclimation of the calcifying macroalga Halimeda opuntia were investigated using a pCO_(2)-light coupling experiment.The OA negatively influenced algal growth,calcification,photosynthesis,and other physiological performances in H.opuntia.The relative growth rate under elevated pCO_(2)conditions significantly declined by 13.14%−41.29%,whereas net calcification rates decreased by nearly three-fold under OA conditions.Notably,increased light availability enhanced stress resistance through the accumulation of soluble organic molecules,especially soluble carbohydrate,soluble protein,and free amino acids,and in combination with metabolic enzyme-driven activities,OA stress was alleviated.The carotenoid content under low light conditions increased markedly,and the rapid light curve of the relative electron transport rate was enhanced significantly by increasing light intensities,indicating that this new organization of the photosynthetic machinery in H.opuntia accommodated light variations and elevated pCO_(2)conditions.Thus,the enhanced metabolic performance of the calcifying macroalga H.opuntia mitigated OA-related stress.

A Large Calcifying Cystic Odontogenic Tumor Occupying the Maxillary Sinus: A Case Report and Review of Literature

Calcifying cystic odontogenic tumor (CCOT) is an uncommon benign cystic neoplasm of the jaw that develops from the odontogenic epithelium. It is clinically characterized as a painless—slow-growing tumor that affects the maxilla as well as the mandible, and generally occurs in young adults in the third or fourth decade of life. Herein, we present the case of a 16-year-old Japanese boy who showed a CCOT in the maxillary sinus. Panoramic radiography showed a unilocular lesion in the left maxillary sinus. Computed tomography showed an approximately 5-cm well-defined unilocular expansile lesion with multiple radiopaque calcific specks, arising from the left maxillary alveolar ridge. The lesion was surgically removed, under general anesthesia, and the patient was followed up for 3 years after the surgery, and there have not been any signs of recurrence.

Calcifying cystic odontogenic tumour manifesting in the maxillary antrum: Case report

A case is presented of a 15-year-old boy who manifested the calcifying cystic odontogenic tumour (CCOT) in the left maxillary antrum of an unknown duration. In addition, the patient had a high arched palate and multiple impacted teeth of the normal series and supernumerary type including mesiodens as demonstrated in an orthopantomograph.

Calcifying fibrous tumor of the mediastinum: A case report

BACKGROUND Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor that often occurs in deep soft tissue of children and young adults.CFT rarely occurs in the mediastinum.CASE SUMMARY In this paper,we describe a 31-year-old male patient with CFT in the mediastinum.The patient did not have any symptoms,and the posterior mediastinal lesion was unintentionally found during routine re-examination of thyroid cancer.The tumor had no adhesion to the surrounding tissue and was successfully and completely removed.Pathology showed a large amount of collagen-rich fibrous connective tissue.There was scattered dystrophic calcification and gravel in the fibrous tissue and a small amount of lymphocyte and plasma cell infiltration and lymphoid follicle formation in the interstitial fluid.In addition,findings showed 20 IgG4+ plasma cells per high-powered field of the diseased tissue,an IgG4+/IgG ratio of about 20%,and normal serum IgG4 levels.The final diagnosis was CFT of the mediastinum (CFTM).No evidence of tumor recurrence was observed by computed tomography at 3 mo after surgery.CONCLUSION IgG4+ plasma cell enlargement may occur in CFTM,but clinical manifestations and serological tests suggest that it is not IgG4-related disease.We speculate that it may be an independent tumor subtype.

A unique case of a calcifying cystic odontogenic tumor

The calcifying odontogenic cyst was first reported by Gorlin et al. in 1962. At that time, it was classified as a cyst related to the odontogenic apparatus, although it was later renamed as a calcifying cystic odontogenic tumor by the WHO calcification in 2005 due to its histological complexity, morphological diversity and aggressive proliferation [2]. Here, we describe a case of a calcifying cystic odontogenic tumor in a 4- year-old boy. The lesion was surgically removed, and the histopathological examination revealed it to be a cystic tumor with ghost cells, a stellate reticulum and small amount of dentinoid tissue in the cystic wall.

Extension of Calcifying Epithelial Odontogenic Tumor to the Maxillary Sinus: A Case Report

The calcifying epithelial odontogenic tumor (CEOT) is a rare and benign odontogenic epithelial neoplasm. This tumor accounts for less than 1% of all odontogenic tumors. It normally affects patients between 30 and 50 years old, and it is typically located in the posterior region of the mandible. Involvement of the maxillary sinus has previously been published only in six cases. This report presents a single case of CEOT that invades the maxillary sinus in a 69-year-old male. We performed a left partial maxillectomy and immediate reconstruction of the defect with a temporalis muscle flap. A comprehensive immunohistochemical study was reported. No recurrences have been found after 8 years of follow-up.

Calcifying Odontogenic Cyst of the Oral Cavity: A Clinical Case and Current Updates on the Ethiopathogenesis

Background: The calcifying odontogenic cyst (COC) is a rare pathological entity. It falls into a group of lesions with calcifications that present benign and sometime malignant tumor variants. Case Presentation: In the present study, we report on a case of intraosseous/intrasinusal COC with impacted maxillary canine and dentinoid structures odontoma-like. The clinical, radiographical, histopathological, and molecular characteristics of this pathological entity are discussed in relation also to the problems of differential diagnosis, treatment, and prognosis. Conclusion: The true COC is a rare entity in the oral cavity and represents about less than 1% of all odontogenic lesions. Careful clinical, instrumental and histological analysis must be performed for odontogenic cysts in order to accomplish the correct surgical act and to avoid recurrence.

Does erroneous differentiation of tendon-derived stem cells contribute to the pathogenesis of calcifying tendinopathy？

Calcifying tendinopathy is a tendon disorder with calcium deposits in the mid-substance presented with chronic activity-related pain, tenderness, local edema and various degrees of incapacitation. Most of current treatments are neither effective nor evidence-based because its underlying pathogenesis is poorly understood and treatment is usually symptomatic. Understanding the pathogenesis of calcifying tendlinopathy is essential for its effective evidence-based management. One of the key histopathological features of calcifying tendinopathy is the presence of chondrocyte phenotype which surrounds the calcific deposits, suggesting that the formation of calcific deposits was cellmediated.Although the origin of cells participating in the formation of chondrocyte phenotype and ossification is still unknown, many evidences have suggested that erroneous tendon cell differentiation is involved in the process. Recent studies have shown the presence of stem cells with self-renewal and multi-differentiation potential in human,horse, mouse and rat tendon tissues. We hypothesized that the erroneous differentiation of tendon-derived stem cells （TDSCs） to chondrocytes or osteoblasts leads to chondrometaplasia and ossification and hence weaker tendon, failed healing and pain, in calcifying tendinopathy. We present a hypothetical model on the pathogenesis and evidences to support this hypothesis. Understanding the key role of TDSCs in the pathogenesis of calcifying tendinopathy and the mechanisms contributing to their erroneous differentiation would provide new opportunities for the management of calcifying tendinopathy. The re-direction of the differentiation of resident TDSCs to tenogenic or supplementation of MSCsprogrammed for tenogenic differentiation may be enticing targets for the management of calcifying tendinopathy in e future.

Isogeometric Analysis of Hyperelastic Material Characteristics for Calcified Aortic Valve

This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcatheter heart valve replacement(TAVR)procedures.In order to facilitate this exploration,it derives pertinent formulas for 3D multi-material isogeometric hyperelastic analysis based on Hounsfield unit(HU)values,thereby unlocking foundational capabilities for isogeometric analysis in calcified aortic valves.A series of uniaxial and biaxial tensile tests is executed to obtain an accurate constitutive model for calcified active valves.To mitigate discretization errors,methodologies for reconstructing volumetric parametric models,integrating both geometric and material attributes,are introduced.Applying these analytical formulas,constitutive models,and precise analytical models to isogeometric analyses of calcified valves,the research ascertains their close alignment with experimental results through the close fit in displacement-stress curves,compellingly validating the accuracy and reliability of the method.This study presents a step-by-step approach to analyzing themechanical characteristics of patient-specific valves obtained fromCT images,holding significant clinical implications and assisting in the selection of treatment strategies and surgical intervention approaches in TAVR procedures.

Nucleus Pulposus Cells from Calcified Discs Promote the Degradation of the Extracellular Matrix through Upregulation of the GATA3 Expression

Objective Disc calcification is strongly associated with disc degeneration;however,the underlying mechanisms driving its pathogenesis are poorly understood.This study aimed to provide a gene expression profile of nucleus pulposus cells(NPCs)from calcified discs,and clarify the potential mechanism in disc degeneration.Methods Primary NPCs were isolated from calcified and control discs(CAL-NPC and CON-NPC),respectively.The proliferation and extracellular matrix(ECM)metabolism capacities of the cells were evaluated using MTT and Western blotting,respectively.RNA sequencing was used to identify differentially expressed genes(DEGs)in the CAL-NPCs.The biological functions of the DEGs were analyzed using the Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)databases.The transcription factor database and Cytoscape software were used to construct the transcription factor-DEGs regulatory network.The role of the verified transcription factor in NPC proliferation and ECM metabolism was also investigated.Results The CAL-NPCs exhibited a lower proliferation rate and higher ECM degradation capacity than the CON-NPCs.In total,375 DEGs were identified in the CAL-NPCs.The GO and KEGG analyses showed that the DEGs were primarily involved in the regulation of ribonuclease activity and NF-kappa B and p53 signaling pathways.GATA-binding protein 3(GATA3)with the highest verified levels was selected for further studies.Overexpression of GATA3 in the CON-NPCs significantly inhibited their proliferation and promoted their ECM degradation function,while the knockdown of GATA3 in the CAL-NPCs resulted in the opposite phenotypes.Conclusion This study provided a comprehensive gene expression profile of the NPCs from the calcified discs and supported that GATA3 could be a potential target for reversing calcification-associated disc degeneration.

Ankle and toe weakness caused by calcified ligamentum flavum cyst: A case report

BACKGROUND Ligamentum flavum cysts,which are most common in mobile junctional levels of the spine,can be a rare cause of spinal stenosis.There have been several case reports of ligamentum flavum cysts.However,there is yet to be a documented case report of a calcified ligamentum flavum cyst.Herein,we report the first case of a calcified ligamentum flavum cyst causing ankle and toe weakness.CASE SUMMARY A 66-year-old male visited our hospital complaining of claudication as well as thigh and calf pain in his left leg,all beginning two weeks prior.Physical examination revealed motor weakness of the left ankle dorsiflexion and great toe dorsiflexion.Lumbar spinal computed tomography scans showed spinal stenosis combined with a calcified mass at the left side of the L4-5 level.Magnetic reso-nance imaging showed dural sac compression caused by the calcified mass at the left ligamentum flavum of the L4-5 level.We performed decompressive laminectomy and excision of the calcified mass combined with posterior lumbar interbody fusion at the L4-5 level.Intra-operatively,we found a firm and nodule like mass originating from the ventral surface of ligamentum flavum.Pathological examination suggested a calcified pseudocyst without a capsular lining.After the operation,the patient’s motor weakness in the ankle and great toe improved gradually.CONCLUSION The patient’s ankle and great toe weakness were improved successfully after surgical removal of the calcified cyst.