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Tapias LF, Mercier O, Ghigna MR, Lahon B, Lee H, Mathisen DJ, Dartevelle P, Lanuti M. Validation of a scoring system to predict recurrence of resected solitary fibrous tumors of the pleura. Chest 2015; 147:216-223. [PMID: 25103552 DOI: 10.1378/chest.14-1180] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Solitary fibrous tumors of the pleura (SFTPs) are infrequent neoplasms with no standardized criteria to predict risk of recurrence after curative surgery. The aim of the present study is to validate a recently proposed recurrence score in a large European cohort of patients with SFTP. METHODS Validation of a previously published scoring system was assessed in a population of 113 patients who underwent complete resection of SFTPs. Patients were scored according to the pleural origin, morphology, size, hypercellularity, presence of necrosis or hemorrhage, and number of mitoses in their SFTPs. Receiver operating characteristic curves were plotted for the score. Time to recurrence analysis was performed using the Kaplan-Meier and Cox proportional hazards methods. RESULTS After a mean follow-up of 13.2 ± 7.3 years, there were nine recurrences (8.0%). Score performance to predict recurrence was as follows: sensitivity = 78%, specificity = 74%, positive likelihood ratio = 3.0, and negative likelihood ratio = 0.3. A cutoff of 3 points was used to classify 79 patients (69.9%) at low risk and 34 patients (30.1%) at high risk for recurrence. A high-risk classification was significantly associated with more recurrences during follow-up (P = .004), worse overall survival (P = .0008), more extensive lung resections (P = .001), and the use of adjuvant therapies (P = .009). The present score outperformed England's criteria (P = .049) and de Perrot classification (P < .001) when predicting SFTP recurrence. CONCLUSIONS The proposed scoring system, which combines common clinical and histologic features of resected SFTPs, remains predictive of recurrence in a separate patient population. The simple score may guide the postoperative surveillance of this uncommon tumor.
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Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Olaf Mercier
- The Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation Marie Lannelongue Hospital, Paris, France
| | - Maria R Ghigna
- The Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation Marie Lannelongue Hospital, Paris, France
| | - Benoit Lahon
- The Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation Marie Lannelongue Hospital, Paris, France
| | - Hang Lee
- Division of Thoracic Surgery, Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Philippe Dartevelle
- The Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation Marie Lannelongue Hospital, Paris, France
| | - Michael Lanuti
- Division of Thoracic Surgery, Biostatistics Center, Massachusetts General Hospital, Boston, MA
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Assessing the Multimodal Management of Advanced Solitary Fibrous Tumors of the Pleura in a Routine Practice Setting. J Thorac Oncol 2015; 10:309-15. [DOI: 10.1097/jto.0000000000000401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boddaert G, Guiraudet P, Grand B, Venissac N, Le Pimpec-Barthes F, Mouroux J, Riquet M. Solitary fibrous tumors of the pleura: a poorly defined malignancy profile. Ann Thorac Surg 2015; 99:1025-31. [PMID: 25620590 DOI: 10.1016/j.athoracsur.2014.10.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/08/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical characteristics and factors that influence the long-term outcomes of solitary fibrous tumors of the pleura. METHODS We conducted a retrospective study in 2 centers and reviewed 80 patients who underwent surgery between May 1984 and April 2011. RESULTS Of the 80 patients (29 male; median age, 60 years [33 to 85 years]), 47 were symptomatic (59%). The tumors originated from the visceral pleura in 62 cases (79%) and from the parietal pleura in 18 cases (22%). The tumors were pedunculated in 66 cases (83%) and sessile in 20 cases (17%). Surgical resection with histologically free margins was accomplished in 76 of 79 patients (93%). The tumors were classified as benign in 51 cases (65%) and as malignant in 28 (35%). The factors that were significantly associated with malignant tumors were the presence of symptoms (p = 0.03), a mean diameter 10 cm or greater (p = 0.0004), fibrous adherences (p = 0.003), pleural effusion (p = 0.003), and a Ki67 10% or greater (p = 0.003). The median follow-up was 69 months (range, 1 to 315). Local recurrence occurred in 3 cases. The overall 5- and 10-year survival rates were 90% and 86%, respectively, and the mean survival time was 255 ± 15 months. There were no differences between the benign and malignant tumors. CONCLUSIONS The recurrence rates are low after surgeries for both benign and malignant solitary fibrous tumors of the pleura. However, the factors that are predictive of recurrence have yet to be specified and require additional immunohistochemical and genetic investigations.
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Affiliation(s)
- Guillaume Boddaert
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Patrice Guiraudet
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Bertrand Grand
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Nicolas Venissac
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Françoise Le Pimpec-Barthes
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France
| | - Jérôme Mouroux
- Department of General Thoracic Surgery, Pasteur Hospital, Nice Sophia Antipolis University, Nice, France
| | - Marc Riquet
- Department of General Thoracic Surgery, Georges Pompidou European Hospital, Descartes University, Paris, France.
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Kugasia IR, Alkayem M, Patel JB. A rare case of β-hCG production by a solitary fibrous tumor of the pleura. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:518-22. [PMID: 25420430 PMCID: PMC4254348 DOI: 10.12659/ajcr.891171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Solitary fibrous tumors are rare tumors of mesenchymal origins, most commonly seen arising from the pleural lining of the lungs. These are generally benign tumors, which in rare cases have been identified to be associated with multiple para-neoplastic syndromes. CASE REPORT This is a case of a solitary fibrous tumor of the pleura in a 49 year old female which was found to be associated with elevated levels of serum beta human chorionic gonadotropin β-hCG). Due to the lack of plausible causes for elevated β-hCG in the patient, immune-histochemical staining of the tumor specimen for β-hCG was obtained. This confirmed the patient's solitary fibrous tumor as the source of the β-hCG. The patient was also found to have a possible paraneoplastic syndrome with irregular menstruation and hot flushes from the secreted β-hCG. CONCLUSIONS This is the first reported case of solitary fibrous tumors of the pleura producing {b-hCG. Multiple types of lung tumors have been associated with production of β-subunit of human chorionic gonadotropin. Production of β-hCG by these tumors has been associated with a poor prognosis. In this case, we find an aggressive form of solitary fibrous tumor associated with production of β-hCG and associated paraneoplastic syndrome secondary to the β-hCG. Further study is required to identify the frequency of this phenomenon and the implications of β-hCG production in the prognosis of the solitary fibrous tumors.
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Affiliation(s)
| | - Mohammad Alkayem
- Department of Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, USA
| | - Jigar B Patel
- Department of Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, USA
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Liu M, Liu B, Dong L, Liu B. Recurrent intrathoracic solitary fibrous tumor: Remarkable response to radiotherapy. Ann Thorac Med 2014; 9:245-7. [PMID: 25276246 PMCID: PMC4166074 DOI: 10.4103/1817-1737.140142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022] Open
Abstract
Solitary Fibrous Tumor of the Pleura (SFTP) is an uncommon neoplasm which grows slowly. For some cases, surgery is warranted. However, for unresectable ones, the standard strategy has not been established yet. We presented a rare case of recurrent malignant intrathoracic solitary fibrous tumor. It was impossible to resect the tumor. Radiotherapy alone achieved a significant improvement effect.
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Affiliation(s)
- Min Liu
- Department of Radiation Oncology, The First Hospital, Jilin University, Changchun, China
| | - Bin Liu
- Department of Hand Surgery, The First Hospital, Jilin University, Changchun, China
| | - Lihua Dong
- Department of Radiation Oncology, The First Hospital, Jilin University, Changchun, China
| | - Bailong Liu
- Department of Radiation Oncology, The First Hospital, Jilin University, Changchun, China
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Franzen D, Diebold M, Soltermann A, Schneiter D, Kestenholz P, Stahel R, Weder W, Kohler M. Determinants of outcome of solitary fibrous tumors of the pleura: an observational cohort study. BMC Pulm Med 2014; 14:138. [PMID: 25115286 PMCID: PMC4134113 DOI: 10.1186/1471-2466-14-138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 08/08/2014] [Indexed: 12/26/2022] Open
Abstract
Background Solitary fibrous tumors of the pleura (SFTP) are rare and their long-term outcome is difficult to predict, as there are insufficient data which allow accurate characterization of the malignant variant. Thus the aim of this study was to describe the outcome and possible determinants of malignant behavior of SFTPs. Methods Data were collected retrospectively from medical records of patients treated at the University Hospital Zurich from 1992 to 2012. Kaplan-Meier and Cox regression analysis were performed to define disease-free survival time (defined as survival without tumor-recurrence or tumor-related death) using the classical histo-morphological criteria (tumor size, localization, pedunculation, tumor necrosis or hemorrhage, mitotic activity and nuclear pleomorphism) and immunohistochemical parameters. Results 42 patients (20 males) with SFTP (median (IQR) age 62 (56–71) years) could be identified. SFTP were associated with symptoms in 50% of all cases. Complete resection was achieved by video-assisted thoracic surgery or thoracotomy in 20 and 22 patients, respectively. Three SFTP-related deaths (7.1%) and four tumor recurrences (9.5%) were observed. Mean disease-free survival time was 136.2 (±13.1) months, and 2-, 5- and 10-year disease-free survival was 91%, 84%, and 67%, respectively. Mean disease-free survival inversely correlated with the mean tumor diameter, number of mitotic figures and proliferation rate (Ki-67 expression). Other criteria (tumor necrosis, atypical localization, sessile tumor, and pleomorphism) were not statistically significant prognostic parameters. Conclusions Patients with large SFTP with a high mitotic index and high proliferation rate should be followed-up closely and over a prolonged time period in order to recognize recurrence of the SFTP early and at a treatable stage. Future research on this topic should focus on the prognostic role of immunohistochemistry including Ki-67 expression and molecular parameters.
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Affiliation(s)
- Daniel Franzen
- Division of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
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Solitary fibrous tumor of neck mimicking cold thyroid nodule in 99m tc thyroid scintigraphy. Case Rep Endocrinol 2013; 2013:805745. [PMID: 24194989 PMCID: PMC3806406 DOI: 10.1155/2013/805745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/28/2013] [Indexed: 11/17/2022] Open
Abstract
A 68-year-old man had a rapidly growing, painless neck mass, thought to be nodular goiter. Ultrasonography showed a giant, heterogeneous mass occupying the middle and superior poles and protruding outside of the left thyroid lobe. The results of the thyroid function tests were normal. Thyroid scintigraphy revealed a large hypoactive nodule in the left thyroid lobe. Complete surgical removal of tumor was performed and macroscopically demonstrated a well-demarked lesion outside the thyroid gland. Microscopically, the lesion was composed of fibroblast-like spindle cells in a patternless architecture and extensive stromal hyalinization. Immunohistochemistry showed positive reaction for CD34 in spindle cells and diffuse bcl-2 staining. The pathology was confirmed as solitary fibrous tumor. In the follow-up period after surgery, thyroid scintigraphy showed normal left thyroid lobe. Solitary fibrous tumor originated from or associated with thyroid gland is extremely rare. According to our knowledge, this is the first reported solitary fibrous tumor presenting like a cold thyroid nodule. This pathology must be considered for differential diagnosis of neck masses in the thyroid region.
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Son S, Lee SG, Jeong DH, Yoo CJ. Malignant solitary fibrous tumor of tandem lesions in the skull and spine. J Korean Neurosurg Soc 2013; 54:246-9. [PMID: 24278657 PMCID: PMC3836935 DOI: 10.3340/jkns.2013.54.3.246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/27/2013] [Accepted: 08/19/2013] [Indexed: 01/30/2023] Open
Abstract
A Solitary Fibrous Tumor (Sft) Is A Rare Neoplasm Originated From The Pleura, But They Can Occur In A Variety Of Extrathoracic Regions. Although Many Cases Of Primary Sft Have Been Reported, There Are Extremely Rare Repots To Date Of A Malignant Sft In The Spine Or Skull. A 54-year-woman Visited Our Hospital Due To Low Back Pain And Both Leg Radiating Pain. Several Imaging Studies Including Magnetic Resonance Imaging And Computed Tomography Revealed Expansive Enhanced Lesions In The Occipital Bone, T8, S1-2, And Ilium, With Neural Tissue Compression. We Performed Surgical Resection Of The Tumor In Each Site, And Postoperative Radiosurgery And Chemotherapy Were Performed. However, After Six Months, Tumors Were Recurred And Metastasized In Multiple Regions Including Whole Spine And Lung. The Authors Report Here The First Case Of Patient With Malignant Sft Of Tandem Lesions In The Various Bony Structures, Including Skull, Thoracic Spine, And Sacral Spine, With A Rapid Recurrence And Metastasis. Although Malignant Sft Is Extremely Rare, It Should Be Considered In The Differential Diagnosis And Carful Follow-up Is Needed.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
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59
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Wilky BA, Montgomery EA, Guzzetta AA, Ahuja N, Meyer CF. Extrathoracic location and "borderline" histology are associated with recurrence of solitary fibrous tumors after surgical resection. Ann Surg Oncol 2013; 20:4080-9. [PMID: 24046107 DOI: 10.1245/s10434-013-3241-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Most solitary fibrous tumors (SFTs) are cured by complete resection, but many recurrent and metastatic SFTs do not respond to treatment and are fatal. Malignant histology, defined by England's pathologic criteria, is strongly associated with recurrence, but some benign SFTs still behave aggressively. Several studies have suggested that extrathoracic SFTs have a worse prognosis. We reviewed thoracic and extrathoracic SFTs from our institution to determine if extrathoracic location is associated with recurrence, independent of malignant histology. METHODS With IRB approval, we retrieved patient pathology reports from the Johns Hopkins Surgical Pathology database between 1991 and 2011 and included 83 SFT patients in our analysis. Patient history and outcomes were obtained from the medical record and primary care physicians. Predictors of recurrence were analyzed by univariate and multivariate analysis and survival determined by the Kaplan-Meier method. RESULTS Of the 83 patients, 59 had extrathoracic SFTs in neurologic (n = 24), extremity or head/neck (n = 13), or visceral/intraabdominal (n = 22) sites. A total of 74 SFTs were classified benign and 9 as malignant. Of the 14 recurrences, 13 occurred in extrathoracic SFTs; only 7 were classified as malignant. Multivariate analysis confirmed that malignant histology had the strongest association with recurrence, but extrathoracic location also independently predicted recurrence. A total of 20 benign SFTs possessed 1 or more of England's criteria but to an insufficient degree for malignant classification. These "borderline" SFTs were more likely to recur than benign SFTs without these features. CONCLUSIONS Extrathoracic and "borderline" SFTs with any of England's criteria have a higher risk of recurrence.
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Affiliation(s)
- Breelyn A Wilky
- Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA,
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Zhu Y, Du K, Ye X, Song D, Long D. Solitary fibrous tumors of pleura and lung: report of twelve cases. J Thorac Dis 2013; 5:310-3. [PMID: 23825765 DOI: 10.3978/j.issn.2072-1439.2013.05.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/26/2013] [Indexed: 11/14/2022]
Abstract
PURPOSE Solitary fibrous tumors (SFTs) of pleura and lung are rare primary tumors that arise from the submesothelial tissue and usually show a benign clinical course. Immuno-histochemical analysis is used to make the diagnosis. We have reviewed our experience to obtain a better understanding of this disease. METHODS In this study, we reviewed 12 patients who had undergone a surgical resection for treatment of benign solitary fibrous tumors (SFTs) of pleura and lung during the period from 2006 to 2012. RESULTS Following excision, the most essential characteristic on histopathology was nonatypical spindle-shaped tumor cells on a collagenous background. Keloid-type collagen, hypocellular and hypercellular areas could be observed in all the cases. On immuno-histochemical analysis, we found that mesenchymal markers such as CD34, bcl-2 and vimentin were positive, and S-100 protein and desmin were negative. In addition, Ki-67 was positive in approximately 5% of the tumor cells, but C-kit protein was not detected. If the result for CD34 was negative, expression of bcl-2 was positive. Complete resection was performed through thoracotomy, including 8 cases that involved video-assisted thoracic surgery (VATS). The postoperative courses were uneventful, and there was no recurrence during 3-65 (mean 25) months of follow-up. CONCLUSIONS Complete resection of SFTs is usually curative. Morphological and pathological features are important in distinguishing them from other tumors and in predicting clinical behaviour.
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Affiliation(s)
- Youcai Zhu
- Department of Cardiothoracic Surgery, Chinese People's Armed Police Force, Zhejiang Corps Hospital, Jiaxing 314000, China
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Pusiol T, Scialpi M. Role of computed tomography in the preoperative diagnosis of giant benign solitary fibrous tumor pleura. Lung India 2013; 30:82-5. [PMID: 23661930 PMCID: PMC3644848 DOI: 10.4103/0970-2113.106128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Teresa Pusiol
- Department of Oncology, Institute of Anatomic Pathology, S. Maria del Carmine Hospital, Piazzale S. Maria 6, 38068, Rovereto - Trento, Italy. E-mail:
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Abstract
Primary pleural tumors other than mesothelioma account for fewer than 1% of all lung cancers, and consequently they pose diagnostic and management challenges. Their treatment must be targeted toward the specific tumor type and is often quite different from the treatment for mesothelioma or metastases. Despite the best efforts at diagnosing and treating these tumors, the prognosis associated with some of the benign and many of the malignant variants of these tumors remains poor. In this review, we describe the radiologic and pathologic features of the less common primary pleural tumors and propose a diagnostic approach to their evaluation.
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Affiliation(s)
- Christopher T Erb
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street, TAC S-441, New Haven, CT 06520, USA
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Solitary Fibrous Tumors of the Thorax: Nomenclature, Epidemiology, Radiologic and Pathologic Findings, Differential Diagnoses, and Management. AJR Am J Roentgenol 2013; 200:W238-48. [DOI: 10.2214/ajr.11.8430] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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65
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Aremu AA, Oyedeji OA, Asaleye CM, Adetiloye VA. An elusive chest coin in an African child: a pleural fibroma's long, tortuous path to freedom. Pan Afr Med J 2013; 14:16. [PMID: 23503999 PMCID: PMC3597858 DOI: 10.11604/pamj.2013.14.16.1874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 11/14/2012] [Indexed: 11/25/2022] Open
Abstract
Fibrous tumour of the pleural is rare and controversial tumor. Most of the reported cases is adults and the elderly. This case presentation is a solitary fibrous tumour in a fifteen year old girl, which to the best of our knowledge is the youngest report, who was sent for a psychiatric evaluation due to persistent complaint of “movement” in her chest, later referred to a tuberculosis clinic because of a chest radiograph report of loculated pleural effusion likely secondary to tuberculosis. She eventually had a chest computerized tomography and subsequent resection of the lesion. Histology confirmed the computerized tomography diagnosis of solitary fibrous tumour and there was no recurrence five years after excision. This report highlights the difficulty often encountered in developing countries where clinicians solely rely on clinical acumen for diagnosis and treatment due to poor patients’ financial status and scarcely available diagnostic resources.
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Affiliation(s)
- Ademola Adegoke Aremu
- Radiology Department, Ladoke Akintola University Teaching Hospital, Osogbo, Osun State, Nigeria
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66
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A 39-year-old man with dyspnoea, low forced expiratory volume and a large mass of the left hemithorax. Contemp Oncol (Pozn) 2013; 17:324-6. [PMID: 24596524 PMCID: PMC3934071 DOI: 10.5114/wo.2013.35048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 01/28/2012] [Accepted: 02/15/2012] [Indexed: 11/17/2022] Open
Abstract
In patients with intrathoracic neoplasms, low forced expiratory volume (FEV1) can preclude surgical treatment. Here, we present a case of a giant solitary fibroma of the pleura (SFTP) successfully treated by surgical removal in spite of low FEV1. A 39-year-old male patient was referred to our hospital with dyspnoea and chest distress. Computed tomography (CT) showed a large mass in the left chest. Spirometry showed FEV1 1.4 L (39% of the expected value). Computed tomography scan-guided transcutaneous aspiration biopsy was performed on the patient, and microscopic examination of the specimen revealed spindle tumor cells with a background of abundant collagen. Complete surgical resection was accomplished. The tumor was large and encapsulated. It measured 28 cm × 20 cm × 18 cm. The definitive diagnosis obtained by histopathology after resection was benign SFTP. The patient felt no dyspnoea at discharge. Surgical treatment of SFTP should be considered even in patients with a huge tumor and with increased post-operative risk.
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67
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Tapias LF, Mino-Kenudson M, Lee H, Wright C, Gaissert HA, Wain JC, Mathisen DJ, Lanuti M. Risk factor analysis for the recurrence of resected solitary fibrous tumours of the pleura: a 33-year experience and proposal for a scoring system. Eur J Cardiothorac Surg 2012; 44:111-7. [PMID: 23233072 DOI: 10.1093/ejcts/ezs629] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Surveillance after resection of solitary fibrous tumours of the pleura (SFTP) remains undefined. This study reviews our experience with surgical treatment of SFTP to determine the specific risk factors to predict recurrence. METHODS A retrospective review of 59 patients surgically treated for SFTP during the years 1977-2010 was conducted. Clinico-pathological factors for recurrence were analysed by Kaplan-Meier and Cox proportional hazard methods. RESULTS The mean age was 57 ± 14 years. There were 32 (54%) men. Among 32 (54%) symptomatic patients, chest pain (22%), cough (19%) and dyspnoea (17%) were most frequent. The mean tumour size was 7.3 ± 6.7 cm, and 14 patients had SFTPs larger than 10 cm. An SFTP was pedunculated in 38 (67%) cases and had a visceral origin in 40 (68%). Paraneoplastic syndromes were observed in 3 (5%) patients. On histopathologic analysis, 4 (7%) presented ≥ 4 mitosis/10 high-power fields (HPFs), 8 (15%) atypia, 14 (24%) hypercellularity and 6 (10%) necrosis. After a mean follow-up of 8.8 ± 7.0 years, we observed 8 (14%) recurrences; median time to recurrence was 6 years (range 2-16 years). Two (3%) patients received adjuvant therapy. We constructed a predictive score for recurrence by assigning one point to each of the six variables: parietal (vs visceral) pleural origin, sessile (vs pedunculated) morphology, size >10 cm (vs <10 cm), the presence of hypercellularity, necrosis and mitotic activity ≥ 4/HPF (vs <4). A score of ≥ 3 best predicted recurrence (sensitivity: 100%, specificity: 92%, area under receiver operating characteristic curve = 0.966, P < 0.0001). With a score of ≥ 3, recurrence-free survival was 80%, 69, 23 and 23% at 3, 5, 10 and 15 years, whereas a score of <3 was 100% up to 15 years. Our scoring system was superior in predicting malignant behaviour and recurrence compared with England's criteria or de Perrot staging. CONCLUSIONS The proposed scoring system is simple, easily obtained from existing pathological description and reliably predicts recurrence in this patient population harbouring SFTP. The SFTP score may stratify patient risk and guide postoperative surveillance. We recommend validation in additional clinical series.
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Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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Malignant Solitary Fibrous Tumors of the Pleura: Retrospective Review of a Multicenter Series. J Thorac Oncol 2012; 7:1698-706. [DOI: 10.1097/jto.0b013e3182653d64] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bouyer B, Guedj N, Lonjon G, Guigui P. Recurrent solitary fibrous tumour of the thoracic spine. A case-report and literature review. Orthop Traumatol Surg Res 2012; 98:850-3. [PMID: 23092617 DOI: 10.1016/j.otsr.2012.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/05/2012] [Accepted: 05/21/2012] [Indexed: 02/02/2023]
Abstract
Solitary fibrous tumours (SFTs) are rare tumours originating in the soft tissues. SFT development in the spine is an exceedingly rare event about which little is known. We describe a case of SFT of the thoracic spine in a 56-year-old woman. She presented with neurological deficits that required emergency resection, which was incomplete. Two subsequent local recurrences prompted further surgical procedures. At last follow-up, 12 months after the last procedure, function was satisfactory and there was no evidence of tumour recurrence. The management of SFTs is not well standardised, and no proven adjuvant treatments are available to date. Complete excision is effective in controlling disease progression. Prolonged follow-up is mandatory.
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Affiliation(s)
- B Bouyer
- Paris Diderot Paris 7 University, Department of Orthopaedic and Trauma Surgery, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Abstract
PURPOSE OF REVIEW Solitary fibrous tumor of the pleura (SFTP) is a rare neoplasm of the pleura. Although an increasing number of case series have been reported in recent years, so far clinical behavior is still unpredictable. The following article presents a detailed review of the recent larger series of SFTP with particular attention to the clinical presentation, pathologic characteristics and surgical features in order to define more precisely the long-term outcome after treatment of this rare entity. RECENT FINDINGS Usually, after a complete surgical resection a very long survival could be expected in almost all cases. However, the preoperative detection and management of malignant SFTPs are still challenging issues. SUMMARY SFTP remains an enigmatic tumor. Clinical and radiological assessment is often unsatisfactory to obtain a definitive diagnosis. Benign SFTPs are almost always cured with complete surgical resection, and in cases of recurrence the re-do resection of benign recurrences is usually curative. Long-term survivals are also possible for malignant SFTPs, although a higher recurrence rate and higher tumor-related mortality can be expected in these cases. Histologic characteristics distinguishing benign from malignant variants are crucial in estimating the risk of recurrence and planning adjuvant therapies.
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71
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Milano MT, Singh DP, Zhang H. Thoracic malignant solitary fibrous tumors: A population-based study of survival. J Thorac Dis 2012; 3:99-104. [PMID: 22263072 DOI: 10.3978/j.issn.2072-1439.2011.01.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/17/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This study characterizes the overall survival (OS) and cause specific survival (CSS) of patients with thoracic malignant solitary fibrous tumors. METHODS Eighty-two patients with malignant solitary fibrous tumors of the lung, pleura or mediastinum, diagnosed from 2001-2007, were retrospectively analyzed using the population-based Surveillance, Epidemiology, and End Results database. RESULTS Among 77 patients with available staging information, 42% (n=32) had localized disease, 31% (n=24) had regional disease extension (without nodal involvement) and 27% had regional-nodal (n=2) or distant (n=19) metastases. Cancer-directed surgery was performed in 85%; radiation was performed in 16%. The 1-year, 5-year and median OS were 87%, 49% and 4.6 years respectively. The 1-year, 5-year and median CSS were 89%, 61% and 5.7 years respectively. Less advanced stage and undergoing cancer-directed surgery were favorable prognostic factors. For localized, regional and distant stage the median OS was: not reached at 6.3 years, 4.4 years and 2.0 years respectively (P=0.021); the median CSS was not reached at 6.3 years, 5.0 years and 2.4 years (P=0.068). For patients undergoing versus not undergoing surgery, the median OS was 4.9 vs 0.9 years (P=0.053) and median CSS was 5.7 vs 0.9 years (P=0.011). Tumor size was not significant. CONCLUSIONS From a population-based analysis of patients with thoracic malignant solitary fibrous tumors, stage and cancer-directed surgery had the greatest impact on OS and CSS. While being amenable to surgery likely reflects more indolent disease and/or better performance status and cardiopulmonary function, the significantly favorable impact of surgery also likely reflects a therapeutic benefit.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
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72
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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; 94:394-400. [DOI: 10.1016/j.athoracsur.2012.04.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/05/2012] [Accepted: 04/10/2012] [Indexed: 02/05/2023]
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73
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Zarrouk M, Chaouch N, Cheikhrouhou S, Ayadi A, Smadhi H, Racil H, Marnich K, Chabbou A. [Solitary fibrous tumour of the pleura: about five cases]. Rev Mal Respir 2012; 29:664-72. [PMID: 22682592 DOI: 10.1016/j.rmr.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 10/08/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pleural solitary fibrous tumour (PSFT) is a rare, usually benign tumour, with unpredictable behaviour. PATIENTS AND METHODS Five cases of PSFT were diagnosed in our department over a 12-year period from January 1999 to December 2010. Clinical, radiological, histological, therapeutic and follow-up information were provided in all cases. RESULTS Our series comprised four men and one woman. The mean age of the patients at presentation was 55 years. All patients were symptomatic. Radiologic investigations showed a pleural lesion with a mean size of 10.6cm ranging from 3 to 17cm. Histologic diagnosis was made from resected parietal pleura in three cases and visceral pleura in two cases. The histologic features were suggestive of malignancy in two cases and benign in three cases. Immunohistochemical study showed that the tumour cells expressed vimentin, CD34, CD99 and Bcl2. Complete resection was obtained in all patients. The evolution was marked in the two patients with malignant PSFT by the recurrence of the tumour after 6 and 21 months respectively. Both died from the condition. The three patients with a benign form are disease-free after 3, 11 and 2 and half years of follow-up. CONCLUSIONS PSFT is rare tumour, the diagnosis of which is based on histologic investigations. These tumours require long-term monitoring due to the possibility of local recurrence and malignant transformation.
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Affiliation(s)
- M Zarrouk
- Unité de recherche oncologie thoracique, service de pneumologie, hôpital A. Mami, Ariana, Tunisia.
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74
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Giaj Levra M, Novello S, Scagliotti GV, Papotti M, Le Cesne A. Primary pleuropulmonary sarcoma: a rare disease entity. Clin Lung Cancer 2012; 13:399-407. [PMID: 22673623 DOI: 10.1016/j.cllc.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Matteo Giaj Levra
- University of Torino, Department of Clinical and Biological Sciences, Division of Thoracic Oncology, S. Luigi Hospital, Orbassano, Italy.
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75
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Resection of a giant, invasive malignant solitary fibrous tumor of pleura. Gen Thorac Cardiovasc Surg 2012; 60:859-62. [PMID: 22627953 DOI: 10.1007/s11748-012-0100-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.
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76
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A case report of solitary fibrous tumor of the pleura: ultrasound diagnostic features. J Med Ultrason (2001) 2012; 39:97-100. [PMID: 27278850 DOI: 10.1007/s10396-011-0338-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Abstract
Solitary fibrous tumor of the pleura is a rarely encountered clinical entity. Although the majority of these neoplasms have a benign course, the malignant form has also been reported. We describe the case of a 57-year-old male smoker with diabetes who was incidentally diagnosed on chest X-ray with a large solitary mass of the left hemithorax. The diagnostic tests included computed tomography, ultrasound, and contrast-enhanced ultrasound. Radical surgical resection was performed and histological examination confirmed a malignant solitary fibrous tumor of the pleura. The novelty of the case is the use of contrast-enhanced ultrasound in the diagnostic workup.
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77
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Taki M, Baba T, Mandai M, Suzuki A, Mikami Y, Matsumura N, Konishi I. Solitary fibrous tumor arising slowly in the vulva over 10 years: Case report and review. J Obstet Gynaecol Res 2012; 38:884-8. [DOI: 10.1111/j.1447-0756.2011.01792.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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79
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Maeda S, Sugita M, Sagawa M, Ueda Y, Sakuma T. Solitary fibrous tumor of the pleura suddenly induced hypoglycemia before surgical treatment. Ann Thorac Cardiovasc Surg 2011; 17:293-6. [PMID: 21697794 DOI: 10.5761/atcs.cr.10.01554] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 04/15/2010] [Indexed: 01/15/2023] Open
Abstract
We present a case of a solitary fibrous tumor of the pleura with sudden onset, recurrent hypoglycemia. A 76-year-old smoking male with type-II diabetes mellitus admitted to our hospital for dyspnea and general malaise. Radiological findings revealed a large tumor occupying the right hemithorax. After bronchoscopic examination, the patient developed a fever and began to wheeze. Treatment with antibiotics and several other drugs improved his symptoms. Percutaneous needle biopsy confirmed the diagnosis. After these medical interventions, the patient suddenly developed recurrent hypoglycemia. After the right pneumonectomy, the patient never experienced hypoglycemia again. We should consider the possible relation between hypoglycemia and solitary fibrous tumor of the pleura, even when the patient is not hypoglycemic during the initial examination.
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Affiliation(s)
- Sumiko Maeda
- Department of Thoracic Surgery, Kanazawa Medical University, Kahokugun, Ishikawa, Japan.
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80
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Thakkar RG, Shah S, Dumbre A, Ramadwar MA, Mistry RC, Pramesh CS. Giant solitary fibrous tumour of pleura -an uncommon intrathoracic entity- a case report and review of the literature. Ann Thorac Cardiovasc Surg 2011; 17:400-3. [PMID: 21881330 DOI: 10.5761/atcs.cr.10.01589] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 43-year-old woman presented to us with progressive breathlessness, dry cough and weight loss. A chest radiograph showed homogeneous opacification of the entire left hemithorax. A contrast enhanced computed tomography (CECT) scan of the thorax showed a large intrathoracic mass occupying almost the entire left hemithorax and appeared grossly inoperable. A transcutaneous CT guided tru-cut biopsy revealed a solitary fibrous tumour. We reviewed the CT scans based on the biopsy report, and, in retrospect, the mediastinal vessels seemed more stretched and pushed by the tumor rather than directly infiltrated by it. We performed an exploratory thoracotomy and to our surprise, were able to dissect the mass quite easily off the mediastinum. She had an uneventful postoperative recovery, and the final histopathology confirmed a solitary fibrous tumor. We report this case to emphasize that a cursory clinico-radiological interpretation can dissuade surgical intervention in these patients.
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Affiliation(s)
- Rohan G Thakkar
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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81
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Abstract
Solitary fibrous tumours of the pleura are rare pleural neoplasms that are distinct from mesothelioma. Most of them are benign, although some behave aggressively; morphological and pathological features are important in distinguishing them from mesothelioma and in predicting clinical behaviour. Solitary fibrous tumours often grow to a large size before causing symptoms, and are characteristically associated with hypertrophic pulmonary osteoarthropathy in up to 20% of cases. In cases of benign lesions, complete resection is usually curative. A case involving a 62-year-old woman who underwent surgical resection of a solitary fibrous tumour of the pleura measuring 25 cm in size is described.
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82
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83
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Németh T, Furák J, Wolfárd A, Géczi T, Tiszlavicz L, Lázár G. [Surgical treatment of primary pleural tumours in our department]. Magy Seb 2010; 63:67-74. [PMID: 20400397 DOI: 10.1556/maseb.63.2010.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The authors analyzed the results and outcome of surgical treatment of primary pleural tumors in patients treated in the last 11 years. METHODS 31 operations were performed for primary pleural tumors in 25 patients (17 males, 8 females). The tumors were classified into the following groups: benign local fibrous tumors (benign LFTP; n = 15), recurrent malignant fibrous tumors (recurrent malignant LFTP; n = 2) and malignant mesotheliomas (MPM; n = 12). 40% of patients with MPM were exposed to asbestos. Complete resections of benign LFTPs were performed, with additional resection of the chest wall and lobectomy in two cases. Completion pneumonectomy and lobectomy were done in recurrent malignant LFTP cases. Five biopsies and pleurodesis, and one open decortication were performed. In four cases, after the biopsy, two pleurectomies and decortications (P/D) and two pleuropneumonectomies (PPN)/extra-pleural pneumonectomies (EPP) were carried out. RESULTS There was no operative mortality. Pathological examination revealed seven epithelial, two sarcomatous and one biphasic malignant mesotheliomas. Survival was one (currently alive) and 49 months after malignant recurrent LFTP. Survival in MPM cases was 9,7 months (3-17) without resection and 17,3 months (5 (currently alive) - 29) in P/D or PPN (EPP) cases. CONCLUSIONS The PPN (EPP) and P/D are safe procedures providing relatively good survival when it is done as part of complete oncological treatment. In cases of recurrent LFTP, anatomical resections recommended with completion pneumonectomy or lobectomy.
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Affiliation(s)
- Tibor Németh
- Szegedi Tudományegyetem Sebészeti Klinika 6720 Szeged Pécsi u. 6
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84
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Bodtger U, Pedersen JH, Skov BG, Clementsen P. Giant solitary fibrous tumour of the pleura: a rare but usually benign intrathoracic neoplasm. CLINICAL RESPIRATORY JOURNAL 2010; 3:109-11. [PMID: 20298386 DOI: 10.1111/j.1752-699x.2008.00104.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low forced expiratory volume (FEV(1)) and low performance status usually preclude surgical treatment of lung neoplasms. Earlier case reports have suggested that curative, safe surgery is possible in extrapulmonal intrathoracic neoplasms. METHODS A case report of an 83-year-old women with progressing dyspnoea secondary to a huge left-side neoplasm. RESULTS Work-up reveal an FEV(1) of 0.4 L, and a giant solitary fibrous tumor of the pleura. The tumor was surgically removed in toto without complications: weighting approximately 3 kg, and benign histology. The patient was without dyspnoea at discharge and at 1-year follow-up. CONCLUSION Safe and curative surgery is possible in patients with extrapulmonal neoplasm despite poor FEV(1).
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Affiliation(s)
- Uffe Bodtger
- Department of Chest Medicine, Copenhagen University Hospital, Gentofte, Niels Andersens vej 2, Hellerup, Denmark.
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85
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Giant tumor of the pleura. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-009-0023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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86
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Video-Assisted Thoracoscopic Surgery (VATS) for Patients with Solitary Fibrous Tumors of the Pleura. J Thorac Oncol 2010; 5:240-3. [DOI: 10.1097/jto.0b013e3181c6b6b2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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87
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Cardillo G, Carbone L, Carleo F, Masala N, Graziano P, Bray A, Martelli M. Solitary Fibrous Tumors of the Pleura: An Analysis of 110 Patients Treated in a Single Institution. Ann Thorac Surg 2009; 88:1632-7. [DOI: 10.1016/j.athoracsur.2009.07.026] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 07/21/2009] [Accepted: 07/21/2009] [Indexed: 12/21/2022]
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88
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Kalebi AY, Hale MJ, Wong ML, Hoffman T, Murray J. Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome. J Cardiothorac Surg 2009; 4:45. [PMID: 19689813 PMCID: PMC2739517 DOI: 10.1186/1749-8090-4-45] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 08/18/2009] [Indexed: 01/22/2023] Open
Abstract
The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing.
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Affiliation(s)
- Ahmed Y Kalebi
- Department of Anatomical Pathology, National Health Laboratory Service [NHLS], Johannesburg, South Africa
| | - Martin J Hale
- Department of Anatomical Pathology, National Health Laboratory Service [NHLS], Johannesburg, South Africa
| | - Michelle L Wong
- Division of Pulmonology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tessa Hoffman
- Division of Pulmonology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jill Murray
- School of Public Health, National Institute of Occupational Healths, Johannesburg, South Africa
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89
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Bini A, Brandolini J, Davoli F, Dolci G, Sellitri F, Stella F. Solitary Fibrous Tumor of the Pleura: Surgery and Clinical Course in 18 Cases. Asian Cardiovasc Thorac Ann 2009; 17:378-81. [DOI: 10.1177/0218492309338103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solitary fibrous tumors of the pleura are very rare neoplasms that can sometimes present with malignant features. Between 1984 and 2007, 18 cases were treated in our institution. There were 7 men and 11 women, with a median age of 56 years (range, 33-77 years). All patients underwent surgical treatment. Except for one case with hemangiopericytic features, all tumors were histologically the fibrous type of pleural mesothelioma. Resections were radical and there were no recurrences. There was no perioperative mortality. The outcome was excellent, and all patients have been followed up continuously. Survival rates at 3, 5, and 10 years were calculated as 86.7%, 75%, and 66.7%. One patient died after 18 months (malignant type of solitary fibrous tumor), and 2 died of unrelated disease after 24 and 53 months. Surgery is the treatment of choice, and careful long-term clinical follow-up is required.
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Affiliation(s)
- Alessandro Bini
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
| | - Fabio Davoli
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
| | - Giampiero Dolci
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
| | - Francesco Sellitri
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
| | - Franco Stella
- Department of Thoracic Surgery University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy
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Harrison–Phipps KM, Nichols FC, Schleck CD, Deschamps C, Cassivi SD, Schipper PH, Allen MS, Wigle DA, Pairolero PC. Solitary fibrous tumors of the pleura: results of surgical treatment and long-term prognosis. J Thorac Cardiovasc Surg 2009; 138:19-25. [PMID: 19577049 PMCID: PMC2930758 DOI: 10.1016/j.jtcvs.2009.01.026] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 12/17/2008] [Accepted: 01/13/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We sought to define the long-term outcome of surgically treated solitary fibrous tumors of the pleura. METHODS We performed a retrospective review from December 1972 through December 2002. RESULTS There were 84 patients (39 men and 45 women) with a median age of 57 years (range, 34-83 years). Forty-six patients were symptomatic. Surgical resection included pulmonary wedge excision in 62 patients, lobectomy in 4 patients, segmentectomy in 2 patients, chest wall resection in 3 patients, isolated pleural resection in 7 patients, and chest wall resection with pulmonary wedge excision, lobectomy, or pneumonectomy in 3, 2, and 1 patients, respectively. Tumors were polypoid in 57 patients, sessile in 20 patients, and intrapulmonary in 7 patients. Histopathology was benign in 73 and malignant in 11 patients. Nine (82%) patient with malignant tumors and 37 (54%) patients with benign tumors were symptomatic (P = .11). The median tumor diameters for malignant and benign tumors were 12.0 and 4.5 cm, respectively (P = .001). Operative mortality and morbidity occurred in 3 (3.6%) and 7 (8.1%) patients, respectively. Median follow-up in survivors was 146 months (range, 23-387 months). Median survival for patients with benign and malignant tumors was 284 and 55 months, respectively, and 5-year survival was 88.9% and 45.5%, respectively (P = .0005). Eight (9.5%) patients had recurrent solitary fibrous tumors of the pleura. Recurrences were malignant in 6 and benign in 2 patients. Localized chest recurrences occurred in 3 patients, all of whom had reresection, with 2 patients again having recurrence. CONCLUSION Resection of benign solitary fibrous tumors of the pleura carries an excellent prognosis. Larger tumors are more likely to be malignant. Both benign and malignant tumors can recur. Although prolonged survival after resection of malignant tumors is possible, recurrence is common.
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Affiliation(s)
| | | | | | - Claude Deschamps
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minn
| | | | - Paul H. Schipper
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minn
| | - Mark S. Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minn
| | - Dennis A. Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minn
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91
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Saint-Blancard P, Bonnichon A, Margery J. [Solitary fibrous tumour of the pleura: five cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:153-158. [PMID: 19524804 DOI: 10.1016/j.pneumo.2009.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 02/14/2009] [Accepted: 02/17/2009] [Indexed: 05/27/2023]
Abstract
Solitary fibrous tumours are unusual mesenchymatous tumours, most often found on the pleura. The authors report five cases hospitalised between 1998 and 2003. With the greatest occurrence in the fifth decade, they are often accidentally found but sometimes associated with a paraneoplastic syndrome such as refractory hypoglycaemia. The diagnosis is based on computed tomography and complete surgical resection is the best treatment. Adjuvant therapy is proposed for the histologically aggressive forms. Because of the possibility of local or distant recurrence and malignant transformation, long-term monitoring is strongly recommended.
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Affiliation(s)
- P Saint-Blancard
- Service d'anatomie-pathologique, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France.
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Saynak M, Bayir-Angin G, Kocak Z, Oz-Puyan F, Hayar M, Cosar-Alas R, Karamustafaoglu A, Yurut-Caloglu V, Caloglu M, Yoruk Y. Recurrent solitary fibrous tumor of the pleura: significant response to radiotherapy. Med Oncol 2009; 27:45-8. [DOI: 10.1007/s12032-009-9168-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/08/2009] [Indexed: 02/01/2023]
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Brief Report: Activity of Imatinib in a Patient with Platelet-Derived-Growth-Factor Receptor Positive Malignant Solitary Fibrous Tumor of the Pleura. J Thorac Oncol 2008; 3:938-41. [DOI: 10.1097/jto.0b013e3181803f08] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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95
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Perna V, Rivas F, Morera R, Saumench J, Ramos R, Macia I, Ureña A, Escobar I, Villalonga R, Moya J. Localized (solitary) fibrous tumors of the pleura: an analysis of 15 patients. Int J Surg 2008; 6:298-301. [PMID: 18579460 DOI: 10.1016/j.ijsu.2008.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Localized fibrous tumors of the pleura (LFTPs) are rare neoplasms, which are considered to originate from submesothelial connective tissue. The aim of this article is to present 15 new cases because of their different clinical behaviors and to discuss the treatment of choice of such neoplasms. METHODS The records of 15 consecutive patients with LFTP operated at our Institution between 1995 and 2006 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all patients. Neoplasms were considered to be malignant if one or more of the following histologic features were present: increasing mitotic activity; high cellularity with crowding and overlapping of nuclei; necrosis; and pleomorphism. RESULTS No operative mortality was reported. The mean follow-up time was 76 months. Malignant transformation was seen in 1 patient 26 months after resection of a benign tumor. Six cases were pathologically considered to be malignant: 2 patients developed local recurrence. One of these underwent redo-surgery and required pneumonectomy; in the other one surgery is not indicated because at the time of diagnosis the patient was 85 years. Currently, all patients are alive and 13 disease-free. CONCLUSIONS For histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients. For malignant cases, complete surgical resection may be insufficient for the cure: further study should be performed to identify reliable prognostic factors to indicate and evaluate the effectiveness of systemic treatment.
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Affiliation(s)
- Valerio Perna
- Hospital Universitario de Bellvitge, Thoracic Surgery Department, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
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96
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Regal MA, Al Rubaish AM, Al Ghoneimy YF, Hammad RI. Solitary benign fibrous tumors of the pleura. Asian Cardiovasc Thorac Ann 2008; 16:139-42. [PMID: 18381873 DOI: 10.1177/021849230801600212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solitary benign fibrous tumors of the pleura are very rare. Seven patients (mean age, 52 years) who presented between 1995 and 2005 were studied retrospectively. They had nonspecific chest symptoms and no history of asbestos exposure or smoking. Chest radiography showed a large opacity occupying most of the affected hemithorax, with clear costophrenic angles. Computed tomography of the chest showed a large well-delineated heterogeneous mass directly related to the lateral chest wall. Needle biopsy suggested the benign nature of the lesion. Surgery was performed through a posterolateral thoracotomy. Five tumors arose from visceral pleura, and 2 from parietal pleura. The mean tumor diameter was 7.5 cm (range, 8-14 cm). Complete surgical excision was carried out in all cases. Histopathology and immunohistochemical staining confirmed the benign nature of the tumors. There was no mortality or major complication. The mean follow-up period was 4 years (range, 1-10 years). All patients remained tumor-free during follow-up. Wide local excision, including pulmonary and pleural resection, is recommended as the best therapeutic option.
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Affiliation(s)
- Mohamed A Regal
- Department of Cardiothoracic Surgery, Mansoura University, Mansoura, Egypt.
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97
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Sergew A, Merrick D, Chan ED. A 64-year-old man with joint swelling and an abnormal chest radiograph. Chest 2008; 133:805-8. [PMID: 18321909 DOI: 10.1378/chest.07-2062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amen Sergew
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Health Sciences Center, Denver, CO 80262, USA.
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98
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Miyoshi K, Okumura N, Kokado Y, Matsuoka T, Kameyama K, Nakagawa T. Solitary fibrous tumor of the pleura with a minute malignant component and diaphragmatic vascular supply: Report of a case. Surg Today 2008; 38:344-7. [DOI: 10.1007/s00595-007-3618-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 06/05/2007] [Indexed: 11/24/2022]
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99
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Chang JC, Su KY, Chao SF, Hsu YH, Yang GG, Chang BS. Hypoglycemia in a patient with a huge malignant solitary fibrous tumor of the pleura. Pathol Int 2008; 57:791-3. [PMID: 17988280 DOI: 10.1111/j.1440-1827.2007.02175.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Solitary fibrous tumor of the pleura (SFTP) is rare. A 73-year-old man, without past history of diabetes mellitus, was admitted to hospital with profound hypoglycemia, loss of consciousness and respiratory failure. CT indicated a huge heterogenous mass lesion (12 x 12 x 17 cm) at the right thoracic cavity with total atelectasis of the right lower lung. He underwent a standard thoracotomy with complete excision of the tumor. Pathology indicated malignant SFTP with insulin-like growth factor-binding protein-2 production. There were no further incidences of hypoglycemia or respiratory failure after excision of the tumor. Hypoglycemia resulting from a solitary fibrous tumor is uncommon. Standard thoracotomy and complete resection of this giant tumor provided a good result for the present patient.
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Affiliation(s)
- Jui-Chih Chang
- Division of Thoracic and Cardiovascular Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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100
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Park HS, Kwak HJ, Park DW, Koo TY, Kim HY, Park SY, Ahn SE, Kim SH, Kim TH, Sohn JW, Chung WS, Yoon HJ, Shin DH, Park SS. A Case of a Solitary Fibrous Tumor of the Pleura Presenting as Pneumonia and Acute Respiratory Failure. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.4.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Jung Kwak
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tai Yeon Koo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Young Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - So Yeon Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Eun Ahn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Won Sang Chung
- Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Soo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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