A diaphragmatic tumor mimicking gastric neoplasm: a clinical case report

Cover Page

Cite item

Abstract

The vast majority of patients with tumors arising from the diaphragm do not have any specific clinical symptoms, therefore, computed tomography (CT) and magnetic resonance imaging (MRI) are the techniques required for the diagnosis. This is particularly relevant when a  pathological mass has grown to an extent producing a “mass effect” on the adjacent organs. In some cases, clinical symptoms of arise due to the local invasion of the neoplasm to the adjacent tissues or distant metastases. We present a rare clinical case of a mesenchymal diaphragmatic tumor in a  34-year-old patient. After a  review of her clinical status and imaging of the abdomen, including CT and MRI, the preliminary diagnosis of the gastric neoplasm of uncertain behavior (D37.1) was made, despite the initial diagnostic assumption of the exogastric location of the mass based on MRI. After careful consideration of the diagnostic assessment results, a  multidisciplinary decision was made to perform laparoscopic resection of the mass. The intraoperative finding was a  tumor originating from the left diaphragmatic cupula with no involvement of the stomach. The patient's recovery was uneventful. Pathological examination revealed a solitary calcifying fibrous tumor of the diaphragm. This clinical case shows that a  mass arising from the diaphragm can mimic one arising from the gastric fundus, leading to an incorrect diagnosis and subsequent inappropriate management.

About the authors

P. A. Burko

National Medical Research Center of Rehabilitation and Balneology

Author for correspondence.
Email: pavelburko@gmail.com
ORCID iD: 0000-0002-1344-9654

Pavel A. Burko – MD, Radiologist, Department of Diagnostic Radiology

32 Novyy Arbat ul., Moscow, 121099

Russian Federation

M. G. Fedorova

Penza State University

Email: fedorovamerry@gmail.com
ORCID iD: 0000-0003-4177-8460

Mariya G. Fedorova – MD, PhD, Associate Professor, Head of Chair of Morphology, Institute of Medicine

40 Krasnaya ul., Penza, 440026

Russian Federation

R. R. Iliasov

Clinic for Diagnostics and Management on Izmaylova

Email: diamonddoctor@mail.ru
ORCID iD: 0000-0003-0873-1804

Ruslan R. Iliasov – MD, Surgeon, Department of Surgery

71 Izmaylova ul., Penza, 440023

Russian Federation

I. N. Mozhzhukhina

Penza Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education

Email: mogira1972@yandex.ru
ORCID iD: 0000-0002-0777-1604

Irina N. Mozhzhukhina – MD, PhD, Associate Professor, Head of Chair of Radiology

8A Stasova ul., Penza, 440060

Russian Federation

References

  1. Gierada DS, Slone RM, Fleishman MJ. Imaging evaluation of the diaphragm. Chest Surg Clin N Am. 1998;8(2):237–280.
  2. Baldes N, Schirren J. Primary and Secondary Tumors of the Diaphragm. Thorac Cardiovasc Surg. 2016;64(8):641–646. doi: 10.1055/s0036-1582256.
  3. Weksler B, Ginsberg RJ. Tumors of the diaphragm. Chest Surg Clin N Am. 1998;8(2):441– 447.
  4. England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;13(8):640– 658. doi: 10.1097/00000478-198908000-00003.
  5. Brunnemann RB, Ro JY, Ordonez NG, Mooney J, El-Naggar AK, Ayala AG. Extrapleural solitary fibrous tumor: a clinicopathologic study of 24 cases. Mod Pathol. 1999;12(11):1034–1042.
  6. Grancher M. Tumeur végétante du centre phrénique du diaphragme. Bull Soc Anat Paris. 1868;43:385.
  7. Cheng Y, Zhang C, Gao Y, Dong S. [Rare solitary fibrous tumor of diaphragmatic pleura: a case report]. Zhongguo Fei Ai Za Zhi. 2012;15(1): 59–61. Chinese. doi: 10.3779/j.issn.1009-3419.2012.01.13.
  8. Kita Y. [Pleural solitary fibrous tumor from diaphragm, being suspected of liver invasion; report of a case]. Kyobu Geka. 2012;65(4):338– 340. Japanese.
  9. Ge W, Yu DC, Jiang CP, Ding YT. Giant solitary fibrous tumor of the diaphragm: a case report and review of literature. Int J Clin Exp Pathol. 2014;7(12):9044–9049.
  10. Liu D, Wang Y, Zheng Y, Zhang HL, Wang ZH. Massive malignant solitary fibrous tumor of the diaphragm: A case report. Medicine (Baltimore). 2020;99(5):e18992. doi: 10.1097/MD.0000000000018992.
  11. Liu CC, Wang HW, Li FY, Hsu PK, Huang MH, Hsu WH, Hsu HS, Wang LS. Solitary fibrous tumors of the pleura: clinicopathological characteristics, immunohistochemical profiles, and surgical outcomes with long-term follow-up. Thorac Cardiovasc Surg. 2008;56(5):291–297. doi: 10.1055/s-2007-965767.
  12. Lahon B, Mercier O, Fadel E, Ghigna MR, Petkova B, Mussot S, Fabre D, Le Chevalier T, Dartevelle P. Solitary fibrous tumor of the pleura: outcomes of 157 complete resections in a single center. Ann Thorac Surg. 2012;94(2):394–400. doi: 10.1016/j.athoracsur.2012.04.028.
  13. Ota H, Kawai H, Yagi N, Ogawa J. Successful diagnosis of diaphragmatic solitary fibrous tumor of the pleura by preoperative ultrasonography. Gen Thorac Cardiovasc Surg. 2010;58(9): 485–487. doi: 10.1007/s11748-009-0551-9.
  14. Enon S, Kilic D, Yuksel C, Kayi Cangir A, Percinel S, Sak SD, Gungor A, Kavukcu S, Okten I. Benign localized fibrous tumor of the pleura: report of 25 new cases. Thorac Cardiovasc Surg. 2012;60:468–473. doi: 10.1055/s-0031-1295519.

Copyright (c) 2021 Burko P.A., Fedorova M.G., Iliasov R.R., Mozhzhukhina I.N.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies