CT features of gastric calcifying fibrous tumors: differentiation from gastrointestinal stromal tumors

Calcifying fibrous tumors (CFTs) are rare benign tumors originating from fibroblastic cells. First described by Rosenthal in 1988 as childhood fibrous tumor with psammoma bodies [1], they were later reclassified by the World Health Organization as a new type of benign fibroblastic/myofibroblastic tumor and designated as CFTs [2]. Histologically, CFTs are characterized by an abundance of collagenous fibrous tissue, variable numbers of psammomatous bodies, dystrophic calcification, and chronic lymphoplasmacytic infiltration [3, 4]. These tumors grow gradually and may not present with any clinical symptoms; most gastric CFTs are incidentally discovered by imaging examination or endoscopy. Initially, CFTs were commonly identified in subcutaneous and deep soft tissues, such as the extremities, trunk, and head and neck regions. However, reports have increasingly indicated their presence throughout the body, with the stomach being the most frequent site [5‐10]. Gastric CFTs predominantly located in the submucosa and muscularis propria, where they can be easily mistaken for other gastrointestinal mesenchymal tumors, particularly gastrointestinal stromal tumors (GISTs). GISTs are the most common mesenchymal tumors of the stomach. The treatment and prognosis of CFTs differ significantly from those of GISTs. CFTs are benign tumors with great prognoses and low recurrence rates [3, 5]. The primary modality for treating CFTs is local surgical excision. However, Some have suggested that long-term follow-up is sufficient for patients with small, asymptomatic CFTs [11]. GISTs have variable malignant potential ranging from virtually benign tumors to aggressive sarcomas. GISTs with low malignant potential and small sizes can be removed or monitored, whereas GISTs that are 2 cm or larger should be excised. Preoperative targeted therapy can be carried out in high-malignant GISTs of special anatomic locations, such as the gastroesophageal junction and pylorus, to shrink the volume of tumors and facilitate resection [12‐14]. Therefore, correct identification is essential to avoid misdiagnosis and unnecessary interventions in clinical practice. Computed tomography (CT) is currently regarded as the primary imaging modality for detecting and discriminating gastrointestinal tumors. To the best of our knowledge, there were few studies [6, 15‐20] researching the CT features of gastric CFTs due to the low incidence, with most being case reports and reviews. Moreover, no original research has directly compared gastric CFTs with gastric GISTs. The lack of clarity on whether CFTs can be differentiated from GISTs using CT motivated this study. Considering the CT features and treatment of GISTs are closely associated with their malignant potential, the purpose of this study was to analyze the clinical and imaging features of gastric CFTs and to compare both the qualitative and quantitative CT features of gastric CFTs with those of gastric GISTs based on different malignant potential. …