Solitary fibrous tumors of the pleura: clinical, radiological, surgical and pathological evaluation

[Solitary fibrous tumor of the prostate: case report]

La tumeur fibreuse solitaire est une tumeur mésenchymateuse souvent bénigne et rare décrite pour la première fois dans la plèvre, la localisation prostatique est exceptionnelle. Nous rapportons le cas d´un patient de 77 ans qui a consulté pour symptômes du bas appareil urinaire à type de dysurie et pollakiurie. Le scanner et l´imagerie par résonance magnétique (IRM) ont montré l´origine prostatique de la lésion et précisé les rapports de cette masse avec les structures adjacentes saines, élément important pour la résécabilité de la tumeur. La biopsie transrectale avec une étude immunohistochimie ont confirmés le diagnostic, les cellules tumorales exprimaient le CD34, Bcl2 et CD 99. Le traitement était chirurgical par prostatectomie radicale.

Solitary fibrous pleural tumor. A rare and challenging case

INTRODUCTION

Solitary fibrous tumor of the pleura (SFTP) is a rare tumor originating from mesenchymal tissue underlying the mesothelial pleural layer with only a limited number of reported cases. Benign and malignant SFTP usually appear as a well-defined, homogeneous, and rounded mass on imaging. Complete en bloc is usually the treatment of choice.

CASE PRESENTATION

44 years old gentleman presented with the unintentional weight loss and chest discomfort for 6 months. A CT scan of chest showed a 30 × 20 × 20 cm heterogeneously enhancing soft tissue mass involving the entire right hemithorax. PET scan showed a localized disease. Therefore, a complete right upper lobectomy and complete removal of mass was done, that resulted in complete expansion of the middle and lower lobe. The patient remains stable till date. Biopsy revealed a fibrous pleural tumor.

CONCLUSION

Complete surgical resection of the tumor is usually sufficient, but there are reported cases with recurrence. Wedge resection for complete excision can be carried out for tumors arising from visceral pleura. Extra pleural excision can be done without chest wall resection in tumors arising from the parietal pleura.

The Diagnosis of Pleural Tumors Other Than Mesothelioma

CONTEXT

- Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention.

OBJECTIVE

- To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis.

DATA SOURCES

- Review of relevant literature published via PubMed and other search engines.

CONCLUSIONS

- A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.

Thoracoscopy resection of a giant solitary fibrous tumor with double pedicles and double blood supply: a case report

Background

Solitary fibrous tumors are rare tumors derived from the pleura. A tumor generally has only one pedicle. Video-assisted thoracoscopic surgery is generally used when a tumor is small (< 10 cm), and traditional open surgery is often used when a tumor is large.

Case presentation

We report a 49-year-old male patient with a space-occupying lesion in the right chest. Three-dimensional reconstruction showed that the blood supply to the tumor originated from the right lower pulmonary artery and vein. The patient was treated with minimally invasive surgery. Intraoperative exploration revealed that the tumor had two tumor pedicles, and each pedicle has an independent blood supply. The special bagging and extraction of the specimen were applied. The size of the specimen was 18 × 12 × 6 cm. Postoperative pathological examination revealed a solitary fibrous tumor.

Conclusions

The solitary fibrous tumor with double pedicles and double blood supply is very rare, and it has not been reported before. Preoperative three-dimensional reconstruction plays an important role in understanding the blood supply to the tumor and the location of the tumor pedicles. After careful and comprehensive evaluation, endoscopic surgery can also be applied to the treatment of the larger fibroma (> 10 cm). The larger specimen can be extracted from the smaller incision by the “pulling carrot” method.

Pleural tumours and tumour-like lesions

There are various neoplasms and tumour-like conditions of the pleura. Mesothelioma is perhaps the most widely recognised; however, there are many others that are more common and should be considered. Understanding the similarities and differences can be helpful in managing the patient with a newly found pleural lesion. We will discuss clinical symptoms at presentation and describe the imaging findings associated with these tumours, starting with conventional radiology, and correlating with computed tomography and combined positron-emission tomography (PET)/computed tomography (CT). Finally, imaging characteristics that help differentiation between the benign and malignant varieties will be reviewed.

Giant solitary fibrous tumor of the pleura with high-grade sarcomatous overgrowth accompanied by lipid-rich, rhabdomyosarcomatous, and pleomorphic components: A case report

RATIONALE

Solitary fibrous tumors are mesenchymal tumors presenting as fibroblastic neoplasms with prominent branching vascular patterns, which are often generated from the pleura. Most solitary fibrous tumors are benign; however, some can turn malignant. High-grade sarcomas from solitary fibrous tumors include multidirectional histopathological components.

PATIENT CONCERNS

We describe our experience of a giant high-grade sarcoma with mixed components generated from a solitary fibrous tumor of the pleura in a 67-year-old female patient presenting with cough and left-sided chest pain. The patient had been diagnosed with a pleural mass in the left chest by X-ray about 30 years earlier. However, the tumor was allowed to grow, without surgical intervention, for a long time.

INTERVENTIONS

Thoracic surgeons performed the removal of the giant pleural tumor; the tumor measured 18.0 × 14.5 × 10 cm in size, and was considered a giant tumor generated from the pleura of the left chest cavity.

DIAGNOSES

The surgically removed tumor was solid and light brownish, and included myxoid and arabesque pattern lesions. The tumor also showed hemorrhagic and necrotic lesions. Moreover, spindle cells with less atypia, resembling fibroblasts, were noted. These spindle tumor cells were CD34- and Stat6-positive, suggesting a solitary fibrous tumor. Some of the spindle tumor cells were surrounded by thick collagenous fibers. Considering that the tumor originated from the parietal pleura, the tumor was defined as a solitary fibrous tumor in origin. The tumor also comprised high-grade sarcomatous components; these included lipid-rich, rhabdomyosarcomatous, and pleomorphic components. The high-grade sarcoma component included bizarre tumor cells with severe atypia.

OUTCOMES

Tumor recurrence occurred in the left chest about 4 months after the surgery, and the patient died 8 months postoperatively.

LESSONS

The present case clearly demonstrates that a solitary fibrous tumor can develop into high-grade sarcomatous overgrowth, including lipid-rich, rhabdomyosarcoma, and pleomorphic sarcoma components, if left untreated for a prolonged period. This case provides profound insights about the natural history, histogenesis, differentiation, and malignant transformation of solitary fibrous tumors.

Doege-Potter syndrome: hypoglycaemic coma in a 90-year old due to a solitary fibrous tumour

Solitary fibrous tumour of the pleura (SFTP) is a rare primary tumour of the pleura associated with 4% of cases with a paraneoplastic hypoglycaemia, termed Doege-Potter syndrome (DPS). We report a case of DPS presenting with severe coma in a 90-year-old woman. The cause was a malignant SFTP treated with surgical resection, from which the patient made a full recovery with prevention of recurrent hypoglycaemia. Surgical resection of the SFTP presenting with symptomatic hypoglycaemia should be considered even in elderly patients.

Solitary fibrous tumor: A center's experience and an overview of the symptomatology, the diagnostic and therapeutic procedures of this rare tumor

Solitary Fibrous Tumor of the Pleura (SFTP) is a rare tumor of the pleura. Worldwide about 800 patients diagnosed with this oncological entity have been described in the existing literature. We report our center's 13 year experience. During this time three patients suffering from this rare disease have been treated in our department. All patients were asymptomatic and their diagnosis was initially triggered by a random finding in a routine chest x-ray. The diagnosis was set preoperatively through a needle biopsy under computer tomography (CT) guidance. The tumors were resected surgically though video-assisted thoracoscopic surgery (VATS) or thoracotomy. Because of the lack of specific guidelines due to the rarity of the disease a long-term, systematic follow-up was recommended and performed. Parallel an overview of the diagnostic and therapeutic procedures of the rare tumor is made.

Solitary fibrous tumor of the salivary gland: A case report

Solitary fibrous tumors (SFTs) are rare soft-tissue tumors of mesenchymal origin. Occasionally, these lesions have been indicated to associate with the salivary glands. Through the analysis of magnetic resonance imaging sequences, the present study reports a case of a solitary salivary gland lesion, demonstrating a well-circumscribed, soft-tissue tumor with marked signal changes and homogenous enhancement. SFT should be considered as a differential diagnosis when a solid mass exhibiting hypointensity on T1-weighted images and hyperintensity on T2-weighted images has been detected in the salivary gland. Due to the potentially malignant nature of SFTs, it is necessary for radiologists to improve their understanding of such lesions.

Solitary fibrous tumor of the spermatic cord: A case report and literature review

A 31-year-old male patient with a six-year history of left inguinoscrotal swelling was admitted to the Second Xiangya Hospital (Changsha, China). The mass was not found to be associated with intraperitoneal pressure. Ultrasonography and computed tomography examinations demonstrated several solid, botryoidal masses involving the spermatic cord, with limited capacity of mobility. The demarcation between the masses and the left testicle was clear; thus, the masses were removed by a left spermatic cord tumor resection via a left inguinal approach, under epidural anesthesia. Positive staining of the tumor markers, CD34⁺, CD99⁺ and Bcl-2⁺, was confirmed by pathological examination following surgery, and a solitary fibrous tumor of the spermatic cord was diagnosed. No recurrence and metastasis were observed in the patient during the subsequent 25-month follow-up period.

Recurrent intrathoracic solitary fibrous tumor: Remarkable response to radiotherapy

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.

Solitary fibrous tumours of the pleura: report of two cases and literature review

BACKGROUND

Solitary fibrous tumours of the pleura (SFTPs) are rare pleural mesenchymal neoplasms with distinct clinicopathological and immunohistochemical features, accounting for less than 5 % of all neoplasms involving the pleura.

METHODS

We present two cases of SFTP with a review of the current literature.

RESULTS

Clinical presentation varies according to size and intrathoracic localisation. The molecular pathology of SFTPs is largely unknown. Complete surgical resection is recommended with long-term clinic and radiographic follow-up due to its malignant potential.

CONCLUSIONS

This is a summary of available literature outlining current clinical practice in the diagnosis, management, and treatment of SFTPs in Ireland.

Solitary fibrous tumors of the pleura

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.

Giant solitary fibrous tumor of the pleura

Fibrous tumors of the pleura are rare, accounting for <5% of all pleural neoplasms. Although over 80% of pleural fibrous tumors have a benign course, local recurrence postsurgery and occasional malignant transformation have been reported; complete excision of the tumor together with postsurgery follow-up of all patients is therefore recommended. We report on a solitary fibrous tumor of the pleura measuring 30 cm and weighing 3560 g.

Solitary fibrous tumors of the soft tissues: review of the imaging and clinical features with histopathologic correlation

OBJECTIVE

Solitary fibrous tumors are rare soft-tissue tumors of submesothelial origin with variable malignant potential. Most of these tumors originate within the thoracic cavity, but they can occur in a variety of sites, including the abdomen, pelvis, and soft tissues and muscles. The purpose of this study was to review the imaging findings with clinicopathologic correlation in 34 cases.

CONCLUSION

The finding of a large, solid, vascular tumor, particularly with prominent feeding vessels or a visible fatty component, should alert the radiologist to the possible diagnosis of solitary fibrous tumor. Percutaneous biopsy carries minimal risk and should be used for definitive diagnosis of these lesions, which in many cases are curable with surgery. The prognosis is good for patients with benign tumors but variable for those with malignant tumors.

[Solitary fibrous tumour of the pleura: five cases]

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.

Radiologic signs in thoracic imaging: case-based review and self-assessment module

OBJECTIVE

Chest imaging remains one of the most complicated sub-specialties of diagnostic radiology. The successful interpretation of thoracic imaging studies requires the recognition and understanding of the radiologic signs that are characteristic of many complex disease processes.

CONCLUSION

The educational objectives for this case-based self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of important thoracic radiologic signs that are useful in establishing the diagnosis of particular diseases of the chest.

Solitary benign fibrous tumors of the pleura

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.

Hypoglycemia in a patient with a huge malignant solitary fibrous tumor of the pleura

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.

Giant solitary fibrous tumour of the liver

Background

Solitary fibrous tumour (SFT) is an uncommon mesenchymal neoplasm that most frequently affects the pleura, although it has been reported with increasing frequency in various other sites such as in the peritoneum, pericardium and in non-serosal sites such as lung parenchyma, upper respiratory tract, orbit, thyroid, parotid gland, or thymus. Liver parenchyma is rarely affected. Clinically, SFTs cause symptoms after having reached a certain size or when vital structures are involved. In recent years, SFTs are more often identified and distinguished from other tumours with a similar appearance due to the availability of characteristic immunohistochemical markers.

Case presentation

In this manuscript we report the case of a large tumour of the liver, which was histologically diagnosed as a SFT, and showed involvement of a single hepatic segment. Because of the patient's presentation and clinical course, it may represent a radiation-induced lesion.

Conclusion

When a SFT has been diagnosed, surgery is the treatment of choice. The small number of patients with a SFT of the liver and its unknown natural behaviour creates the need to a careful registration and follow-up of all identified cases

Solitary fibrous tumor in the thigh: review of the literature

Solitary fibrous tumors (SFT) of extremities, especially the thighs are very rare. Despite SFTs are generally benign, well-circumscribed soft tissue tumors new cases should be presented and followed up carefully to monitor their biological behavior. In general for tumor classification a biopsy is state of the art. Histological including immunohistochemical patterns for SFTs are defined. MRI and ultrasound are not sufficient for differential diagnosis. Once property identified and defined by size and location, resection with intact tumor capsule may result in full recovery of the patient. Reviewing the literature there are no validated reasons for a wider resection. The current patient was a 41-year-old male. Four years after an arthroscopy of the left knee the patient has been suffering an ongoing swelling of the lateral thigh. Because MRI scan data suggested a synovial sarcoma a biopsy was performed. The tumor was classified as a benign SFT. The diagnosis based on histological findings and the presence of the positive immunohistochemical markers Vimentin, CD34, and CD99. The complete tumor resection with intact capsule was achieved in a final operation. Clinical and in MRI after 54-month outcome period there were no local recurrences.