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Shen J, Li M. Solitary fibrous tumor of the testes: A rare case report. Asian J Surg 2024:S1015-9584(24)01583-5. [PMID: 39069419 DOI: 10.1016/j.asjsur.2024.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Jiacheng Shen
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Mengjuan Li
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
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2
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Dörr NM, Krüger M, Möller M, Zinne N, Toennies M, Schega O, Ritter C, Decker S, Hölsken A, Schütte W, Biancosino C. Solitary fibrous tumours of the pleura: do we need a different perspective on malignancy? Eur J Cardiothorac Surg 2024; 65:ezae096. [PMID: 38479834 DOI: 10.1093/ejcts/ezae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Solitary fibrous tumours of the pleura (SFTP) are historically considered to be benign soft tissue neoplasms. However, a clinical relevant number of these neoplasms have malignant histological features. The objective of this study was to evaluate the percentage of SFTP presenting unfavourable clinical behaviour in order to predict negative long-term outcome. METHODS A retrospective review of 74 patients treated at 4 hospitals between 1990 and 2013 was performed. The median follow-up was 10 years (range: 1-20 years). Risk of tumour recurrence and metastases (unfavourable clinical behaviour) with regard to histology using the Kaplan-Meier and Cox proportional hazards methods. RESULTS The mean age was 61 years (SD 12.75 years). There were 31 male patients (58%) and 43 female patients (42%). Tumour size ranged from 1 to 30 cm (mean 9.09 cm; SD 6.22 cm). Complete resection (R0) was achieved by minimally invasive thoracoscopic resection in 29% and thoracotomy in 57%; 25% of SFTPs showed histological evidence of malignancy, according to England criteria. Recurrence occurred in 21% and 10% of patients had metastases; 83% of patients with metastases and 39% of patients with recurrence died within 5 years. The median recurrence-free survival for histologically benign SFTP was not reached, compared to 8 years for malignant SFTP. The five-year overall survival rate was 84%. Mitotic rate ≥1/10 HPF, high cellularity, nuclear atypia, Ki-67 level >5% and poorly circumscribed (sessile) growth pattern were associated with poor long-term outcome. CONCLUSIONS Pathological differentiation of SFTP morphology into pedunculated, well circumscribed and poorly circumscribed (sessile) growth pattern is recommended. Due to the misleading classification into histologically benign and malignant, all unpedunculated SFTP should be classified as potentially aggressive. Lifelong follow-up is mandatory.
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Affiliation(s)
- Niels Michael Dörr
- Department of Thoracic Surgery, Martha-Maria Hospital Halle-Dölau, Halle, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle, Germany
| | - Marcus Krüger
- Department of Thoracic Surgery, Martha-Maria Hospital Halle-Dölau, Halle, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, University Hospital Halle, Halle, Germany
| | - Miriam Möller
- Department of Pneumology, Martha-Maria Hospital Halle-Dölau, Halle, Germany
| | - Norman Zinne
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mario Toennies
- Department of Thoracic Surgery, HELIOS Hospital Emil von Behring, Berlin, Germany
| | - Olaf Schega
- Department of Thoracic Surgery, Johanniter Hospital Treuenbrietzen, Germany
| | | | - Steffen Decker
- Department of Thoracic Surgery, Heinrich-Braun Hospital Zwickau, Germany
| | - Antje Hölsken
- Department of Pathology, Martha-Maria Hospital Halle-Dölau, Halle, Germany
| | - Wolfgang Schütte
- Department of Pneumology, Martha-Maria Hospital Halle-Dölau, Halle, Germany
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3
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Lachmann E, Bennett B, Ramli R, Sharma S. Solitary pleural fibroma causing IGF-2-mediated hypoglycaemia in a non-diabetic patient. BMJ Case Rep 2024; 17:e255537. [PMID: 38453223 PMCID: PMC10921516 DOI: 10.1136/bcr-2023-255537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
A patient without a diagnosis of diabetes mellitus presented to the hospital due to a fall and hypoglycaemia on admission. The patient was found to have recurrent nocturnal fasting hypoglycaemia. CT revealed a large lung mass consistent with a solitary pleural fibroma, a rare tumour associated with insulin-like growth factor 2 (IGF-2) production. This case is an important reminder that potential causes of hypoglycaemia should be considered in non-diabetic patients.
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Affiliation(s)
- Emily Lachmann
- Internal Medicine, Cambridge University Hospitals, Cambridge, UK
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4
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Leivaditis V, Ehle B, Papatriantafyllou A, Mulita F, Koletsis E, Verras GI, Tasios K, Antzoulas A, Charokopos N, Dahm M, Katsakiori PF, Grapatsas K. Addressing recurrent hypoglycaemia through thoracic surgical intervention: understanding Doege-Potter syndrome, a rarity in syndromes. Arch Med Sci Atheroscler Dis 2024; 9:e33-e40. [PMID: 38846055 PMCID: PMC11155461 DOI: 10.5114/amsad/183433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 06/09/2024] Open
Abstract
Doege-Potter syndrome (DPS), a rare paraneoplastic phenomenon characterised by non-islet cell tumour hypoglycaemia (NICTH), presents clinicians with intricate diagnostic and therapeutic challenges. This comprehensive review consolidates current understanding, clinical presentations, diagnostic modalities, therapeutic interventions, and emerging trends in managing DPS. The pathophysiology of DPS revolves around dysregulated insulin-like growth factors (IGF), particularly IGF-2, produced by mesenchymal tumours, notably solitary fibrous tumours (SFT). Clinical manifestations encompass recurrent hypoglycaemic episodes, often distinct from typical hypoglycaemia, with implications for insulin and counterregulatory hormone levels. Diagnosis necessitates a multidisciplinary approach integrating biochemical assays, imaging studies, and histopathological confirmation of the underlying neoplasm. Surgical resection remains the cornerstone of treatment, complemented by adjunctive therapies to manage persistent hypoglycaemia. Prognosis is influenced by successful tumour resection and long-term surveillance for recurrence. A patient-centred approach, incorporating supportive services and multidisciplinary care, is essential for optimal outcomes in individuals affected by DPS.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | | | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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5
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Naylor A, Raptis DA, Bhalla S. Focal Pleural Lesions. Semin Roentgenol 2023; 58:411-419. [PMID: 37973270 DOI: 10.1053/j.ro.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Adam Naylor
- Clinical Fellow, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Demetrios A Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.
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6
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Wang C, Cao T, Hu G, Min B, Hu H, Liu B, Wang Y, Zuo X. Recurrence of solitary fibrous tumor of the pleura with hypoglycemia (Doege-Potter Syndrome): a case report description. Front Oncol 2023; 13:1245289. [PMID: 37823058 PMCID: PMC10562620 DOI: 10.3389/fonc.2023.1245289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Hypoglycemia has multiple causes, but the most common is a complication of insulin treatment. In addition to insulin therapy, tumors such as insulinomas of pancreatic origin and extrapancreatic tumors causing paraneoplastic syndromes should also be considered. Solitary fibrous tumors of the pleura (SFTP) is rare tumor, which when associated with hypoglycemia causes Doege-Potter syndrome. This article reports a case of a 69-year-old man with Doege-Potter syndrome and underwent the first surgical resection for SFTP. However, the tumor recurred 9 years later with hypoglycemic symptoms and implant metastasis. This recurrent tumor originated from the visceral pleura, was more aggressive and invaded the diaphragm and parietal pleura. After the second surgical removal of the tumor, the hypoglycemic symptoms disappeared.
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Affiliation(s)
- Chuxu Wang
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Tingting Cao
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Guodong Hu
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Bo Min
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Haibo Hu
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Bing Liu
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Yaqin Wang
- Department of Thoracic Surgery, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
| | - Xiaohua Zuo
- Department of Pain Management, Huai’an Second People’s Hospital, The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, Jiangsu, China
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7
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Watanabe T, Suzuki E, Yoshii N, Kohama T, Iguchi K, Takeuchi S, Nakamura M, Endo T, Tanahashi M. Multiple solitary fibrous tumors of the pleura with multicentric and unilateral involvement: a case report. Surg Case Rep 2023; 9:134. [PMID: 37491539 PMCID: PMC10368611 DOI: 10.1186/s40792-023-01717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor of the pleura (SFTP) is a mesenchymal tumor. Patients with SFTP generally have only one lesion. We herein report an extremely rare case of multiple SFTPs that were multicentric and unilateral. CASE PRESENTATION The patient was a 21-year-old asymptomatic young man who was referred to our hospital due to abnormal shadows on a chest X-ray. Computed tomography showed 6 tumors of heterogeneous sizes in the left thoracic cavity. The tumors were suspected to be multiple benign or low-grade malignant thoracic tumors, and tumor resection was performed. The tumors had almost the same appearance, with uniform fibroblastic spindle cell proliferation, and arose from the pleura in microscopy. Immunohistochemical staining revealed that the tumor cells were positive for CD34, CD99, Bcl-2, and STAT6. Based on these findings, the tumors were diagnosed as multiple SFTPs with multicentricity. At 1 year and 6 months after the first surgery, 2 new lesions were found above the diaphragm, and these were resected. These tumors were arose from the pleura with a fibrous capsule structure. Their pathological findings were identical to the initial tumor without evidence of malignant transformation. CONCLUSION We experienced an extremely rare case of multiple SFTPs with multicentric and unilateral lesions.
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Affiliation(s)
- Takuya Watanabe
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan.
| | - Eriko Suzuki
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Naoko Yoshii
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Takuya Kohama
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Kensuke Iguchi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Suiha Takeuchi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Minori Nakamura
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Takumi Endo
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
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8
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Szczyrek M, Bitkowska P, Jutrzenka M, Szudy-Szczyrek A, Drelich-Zbroja A, Milanowski J. Pleural Neoplasms-What Could MRI Change? Cancers (Basel) 2023; 15:3261. [PMID: 37370871 DOI: 10.3390/cancers15123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.
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Affiliation(s)
- Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paulina Bitkowska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marta Jutrzenka
- Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland
| | - Aneta Szudy-Szczyrek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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9
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Rimpa T, Athanassiadi K, Eleftheriou K, Vourlakou C, Chrysovergis I, Diakonikolaou Z, Katsaounou P, Kalomenidis I. A Giant solitary fibrous tumour resected through median sternotomy. Respirol Case Rep 2022; 10:e01031. [PMID: 36415784 PMCID: PMC9673596 DOI: 10.1002/rcr2.1031] [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: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 11/21/2022] Open
Abstract
Solitary fibrous tumour of the pleura (SFT) is rare neoplasms and consist less than 5% of the primary tumours of the pleura. In the English literature, very few cases of giant solitary fibrous tumours have been described. We report a clinical case of an intrathoracic giant SFT of the pleura in a 62‐year‐old female patient. Additionally, we reviewed the clinical, imaging and histopathological features, the therapeutic management and the clinical course of giant SFTs published in the English literature. For this, we conducted a comprehensive electronic search at the PubMed using the key words giant, huge, big and enormous.
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Affiliation(s)
- Theofani Rimpa
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital National and Kapodistrian University of Athens Athens Greece
| | | | - Kostantinos Eleftheriou
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital National and Kapodistrian University of Athens Athens Greece
| | | | | | - Zacharias Diakonikolaou
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital National and Kapodistrian University of Athens Athens Greece
| | - Paraskevi Katsaounou
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital National and Kapodistrian University of Athens Athens Greece
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital National and Kapodistrian University of Athens Athens Greece
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10
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Ghanim B, Baier D, Pirker C, Müllauer L, Sinn K, Lang G, Hoetzenecker K, Berger W. Trabectedin Is Active against Two Novel, Patient-Derived Solitary Fibrous Pleural Tumor Cell Lines and Synergizes with Ponatinib. Cancers (Basel) 2022; 14:cancers14225602. [PMID: 36428694 PMCID: PMC9688590 DOI: 10.3390/cancers14225602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumor of the pleura (SFT) is a rare disease. Besides surgery combined with radiotherapy in nondisseminated stages, curative options are currently absent. Out of fourteen primo-cell cultures, established from surgical SFT specimens, two showed stable in vitro growth. Both cell models harbored the characteristic NAB2-STAT6 fusion and were further investigated by different preclinical methods assessing cell viability, clone formation, and protein regulation upon single-drug treatment or in response to selected treatment combinations. Both fusion-positive cell models showed-in line with the clinical experience and the literature-a low to moderate response to most of the tested cytotoxic and targeted agents. However, the multi-tyrosine kinase inhibitors ponatinib and dasatinib, as well as the anti-sarcoma compound trabectedin, revealed promising activity against SFT growth. Furthermore, both cell models spontaneously presented strong FGFR downstream signaling targetable by ponatinib. Most interestingly, the combination of either ponatinib or dasatinib with trabectedin showed synergistic effects. In conclusion, this study identified novel trabectedin-based treatment combinations with clinically approved tyrosine kinase inhibitors, using two newly established NAB2-STAT6 fusion-positive cell models. These findings can be the basis for anti-SFT drug repurposing approaches in this rare and therapy-refractory disease.
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Affiliation(s)
- Bahil Ghanim
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Department of General and Thoracic Surgery, Karl Landsteiner University of Health Sciences, University Hospital Krems, 3500 Krems, Austria
| | - Dina Baier
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Inorganic Chemistry, University of Vienna, 1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, 1090 Vienna, Austria
- Correspondence:
| | - Christine Pirker
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Sinn
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gyoergy Lang
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Berger
- Center for Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Research Cluster “Translational Cancer Therapy Research”, 1090 Vienna, Austria
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11
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Khouzam MS, Khouzam N. Malignant solitary fibrous tumor of the pleura. J Cardiothorac Surg 2022; 17:92. [PMID: 35505352 PMCID: PMC9066725 DOI: 10.1186/s13019-022-01842-6] [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: 07/26/2021] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Solitary fibrous tumors of the pleura are rare diseases of the thoracic cavity. They frequently grow unnoticed until they exert compressive effects on adjacent organs. Treatment of solitary fibrous tumors of the pleura is surgical resection. Post-operative surveillance is recommended to identify early recurrent disease. Case presentation We present a rare case of a 76-year-old female patient with no previous pulmonary history who presented with progressive dyspnea, fatigue, and involuntary weight loss. On chest X-ray and computed chest tomography scan, she was found to have a 16.7 cm × 12.8 cm × 10.1 cm bulky mass occupying the left hemithorax with associated compressive atelectasis of the lung. She underwent a computed tomography guided biopsy that revealed the mass to be a solitary fibrous tumor. The patient underwent left muscle sparing lateral thoracotomy with complete resection of the tumor. Post procedure, the left lung fully expanded. 18 months post-resection, she developed a 3.3 cm × 1.7 cm tumor along the left internal thoracic artery lymph node chain which was histologically identical to the resected tumor. The patient is currently being treated with bevacizumab and temozolomide. Conclusion Solitary fibrous tumors are very rare pleural tumors. Surgical resection is the treatment of choice followed by close post-operative surveillance.
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Affiliation(s)
- Matthew S Khouzam
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, 60153, USA.
| | - Nayer Khouzam
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, FL, USA
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12
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Lei K, Rajagopal T. A Large Benign Solitary Fibrous Tumor in the Pelvis: A Unique Group. Cureus 2021; 13:e18164. [PMID: 34707948 PMCID: PMC8530770 DOI: 10.7759/cureus.18164] [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] [Accepted: 09/21/2021] [Indexed: 11/09/2022] Open
Abstract
Solitary fibrous tumors (SFTs) are a rare type of sarcoma and ubiquitous in nature, occurring anywhere in the body. Although only a few hundred cases have been described so far, certain histological features, such as hypercellularity and high mitotic index, have been associated with a more malignant course. Tumor sizes larger than 10 cm have also been associated with higher recurrence rates. There are clinical recommendations for two distinct patient groups, those with small and benign SFTs or those with large and malignant SFTs. There are few that acknowledge the unique group of those with large but benign tumors. A case involving a 62-year-old man who underwent surgical resection of a large but benign solitary fibrous tumor of the pelvis is described.
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Affiliation(s)
- Karen Lei
- General Surgery, California Northstate University, College of Medicine, Elk Grove, USA
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13
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Mejías-Lafontaine E, Galarza S, Gonzalez-Cancel I. Digital clubbing as first sign of giant solitary fibrous tumor. A case report. J Surg Case Rep 2021; 2021:rjab337. [PMID: 34377434 PMCID: PMC8341692 DOI: 10.1093/jscr/rjab337] [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: 07/03/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Solitary fibrous tumors are rare pleural tumors. Most of the time they are benign tumors and identified incidentally once they cause symptoms secondary to their mass effect. Here we present an interesting case of a 54-year-old female found with a giant solitary fibrous tumor with signs of hypertrophic pulmonary osteoarthropathy with associated digital clubbing 6 month before identifying the tumor. The initial percutaneous biopsy revealed pathologic findings consistent with benign solitary fibrous tumor, but after complete mass excision diagnosis was upgraded to a malignant solitary fibrous tumor. Percutaneous biopsy results should not guide therapy in these patients; this is why complete excision continues to be the treatment of choice.
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Affiliation(s)
| | - Sandra Galarza
- Department of Surgery, St Luke's Episcopal Medical Center, Ponce, Puerto Rico
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14
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Prisadov G, Hendrix H, Kamlak V, Welcker K. [Monstrous Solitary Fibrous Tumor of the Pleura - A Case Report and Review of the Literature]. Pneumologie 2021; 76:47-53. [PMID: 34331296 DOI: 10.1055/a-1542-7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Localized solitary fibrous tumors are a rare entity and are mostly found in the thorax, but can also occur in the liver, skin, meninges, peritoneum, and pericardium. Making the diagnosis is often difficult because of the various micromorphologic outlooks. The histopathological assessment with differentiated immunohistochemistry is decisive. Surgical resection of the localized solitary fibrous tumors is the therapy of choice. The recurrence and metastasis rates depend on the histological dignity and are in total very low. Therefore, continuous follow-up examinations are indicated. We report on a 76-year-old female patient with a monstrous solitary fibrous tumor of the pleura who complained of exertional dyspnea and sharp pain in the right thoracic region for several weeks. Computed tomography showed a massive, heterogeneous pulmonary mass 22 cm in diameter in the middle and lower field of the right lung with compression of the diaphragm and mediastinum. The tumor was completely resected through a double thoracotomy in the 5th and 8th ICR. Intraoperatively, the tumor was stalked to the middle lobe. In order to completely remove the tumor, a wedge resection was also performed from the middle lobe. The tumor weighed 2.4 kg. The diagnosis of a solitary fibrous tumor of the pleura was made histologically and immunohistochemically. Postoperatively, the lung has fully expanded. There was no evidence of a relapse at the 3-month follow-up examination. The clinical symptoms, diagnosis, treatment options, risk of recurrence and the prognosis of these tumors are shown and discussed in accordance with the literature.
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Affiliation(s)
- Georgi Prisadov
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf, Mönchengladbach
| | - Holger Hendrix
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf, Mönchengladbach
| | - Vladimir Kamlak
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf, Mönchengladbach
| | - Katrin Welcker
- Klinik für Thoraxchirurgie, Kliniken Maria Hilf, Mönchengladbach
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15
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Tumor and tumorlike conditions of the pleura and juxtapleural region: review of imaging findings. Insights Imaging 2021; 12:97. [PMID: 34236561 PMCID: PMC8266978 DOI: 10.1186/s13244-021-01038-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Pleural lesions form a diagnostic challenge for the radiologist. Whereas lesions can be initially detected on chest radiographs, CT and MRI imaging are the imaging modalities of choice for further characterization. In a number of cases, imaging findings can be relatively specific. In general unfortunately, imaging findings are rather aspecific. Evolution and extrathoracic imaging findings are important clues toward the diagnosis.
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16
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Fernández-Trujillo L, Bolaños JE, Álvarez C, Giraldo J, Velásquez M, Zúñiga-Restrepo V, Pérez B, Sua LF. Doege-Potter Syndrome and Hypoglycemia associated with Solitary Fibrous Tumor of the Pleura: Two Case Reports. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2020; 14:1179548420964759. [PMID: 33110350 PMCID: PMC7566176 DOI: 10.1177/1179548420964759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal neoplasms that
originate from mesenchymal growth in the pleura, tend to be single tumors,
usually have an indolent course and show nonspecific symptoms. SFTP can be often
diagnosed from an incidental finding of a single mass in the thorax and should
be confirmed by biopsy and immunohistochemistry. A minority of cases may present
Doege–Potter syndrome (DPS, episodes of refractory hypoglycemia) associated with
production of insulin-like growth factor 2 (IGF-2). Both SFTP and DPS are rare
occurrences with less than 2000 cases reported worldwide. The curative treatment
is tumor resection. Two cases of patients with DPS caused by SFTP are presented
below.
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Affiliation(s)
- Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Jhon E Bolaños
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | | | - Julián Giraldo
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Mauricio Velásquez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Cali, Colombia
| | | | - Bladimir Pérez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili. Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Pathology and Laboratory Medicine, Fundación Valle del Lili. Cali, Colombia
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17
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Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Chiba K, Tsuchida H, Yobita S, Uchiyama S, Iguchi K, Ogawa H, Niwa H. Solitary fibrous tumor of the pleura with marked cystic degeneration: a case report. Surg Case Rep 2020; 6:163. [PMID: 32638177 PMCID: PMC7340714 DOI: 10.1186/s40792-020-00931-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Solitary fibrous tumor of the pleura (SFTP) is a mesenchymal tumor, and computed tomography typically shows SFTPs as well-defined lobulated masses. We herein report a case of SFTP with cystic degeneration of the entire tumor. Case presentation The patient was a 67-year-old Japanese man who was referred to our hospital for an abnormal shadow on a chest X-ray. Computed tomography showed a 9-cm cystic tumor in the lower left lobe, with small nodules aggregated in the cyst. Pulmonary aspergillosis was suspected, and left basal segmentectomy was performed. A pedunculated cystic tumor was connected to the pleura with a stalk, and white polypoidal masses were found within the cystic tumor. Microscopy revealed uniform fibroblastic spindle cell proliferation and marked cystic degeneration, the cyst walls were formed of the same tumor cells. Immunohistochemical staining revealed that the tumor cells were positive for CD34, CD99, and BCL2. Based on these findings, the tumor was diagnosed as SFTP with cystic degeneration. Conclusion We experienced an extremely rare case of atypical SFTP with cystic degeneration.
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Affiliation(s)
- Takuya Watanabe
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan.
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Eriko Suzuki
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Naoko Yoshii
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Kensuke Chiba
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Hiroyuki Tsuchida
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Shogo Yobita
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Suiha Uchiyama
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Kensuke Iguchi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Hiroshi Ogawa
- Division of Pathology, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Hiroshi Niwa
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
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18
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Solsi A, Pho K, Shojaie S, Findakly D, Noori T. Doege-Potter Syndrome and Pierre-Marie-Bamberger Syndrome in a Patient With Pleural Solitary Fibrous Tumor: A Rare Case With Literature Review. Cureus 2020; 12:e7919. [PMID: 32494533 PMCID: PMC7263730 DOI: 10.7759/cureus.7919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Solitary fibrous tumors (SFT) represent a unique subset of mostly benign heterogeneous tumors with mesenchymal cell origins. These tumors have been reported in the past as being mostly indolent, with a slowly evolving clinical course and low potential for malignancy. Although found systemically, the incidence of SFT arising intrathoracically, from the pleura of the lung, is relatively poorly documented in the medical literature. SFT is a rare phenomenon, but in even rarer circumstances, these tumors are associated with distinctive paraneoplastic syndromes, such as Pierre-Marie-Bamberger syndrome (PMBS) and Doege-Potter syndrome (DPS). PMBS presents as digital clubbing and hypertrophic pulmonary osteoarthropathy. DPS has been characterized as a non-islet cell tumor hypoglycemia due to the ectopic secretion of insulin-like growth factor 2 (IGF-2), a pattern seen in fewer than 5% of cases of SFT. Treatment is typically through surgical resection. In our research of the medical literature, we found only very few cases in which the association with SFT and both paraneoplastic syndromes were described. Here, we report an uncommon case of a 68-year-old male patient found to have an incidental right hemithoracic tumor with digital clubbing and intermittent severe episodes of fasting hypoglycemia after initially presenting with a syncopal episode.
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Affiliation(s)
- Anup Solsi
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Karen Pho
- Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
| | - Shiva Shojaie
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Tarreq Noori
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
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19
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Pleural Solitary Fibrous Tumors-A Retrospective Study on 45 Patients. ACTA ACUST UNITED AC 2020; 56:medicina56040185. [PMID: 32316178 PMCID: PMC7230748 DOI: 10.3390/medicina56040185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
Abstract
Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.
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20
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Lv G, Wang K, Li M, Li Z, Zheng A, Pang Q. Recurrence of multiple metastases after surgical removal of a primary malignant solitary fibrous tumor from the main bronchus: A case report. Medicine (Baltimore) 2018; 97:e13560. [PMID: 30558017 PMCID: PMC6320158 DOI: 10.1097/md.0000000000013560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/14/2018] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Limited knowledge is available regarding solitary fibrous tumors (SFTs), about 15% of which are malignant. In particular, the long-term survival of patients with malignant SFTs (mSFTs), the disease course, and the potential for recurrence of second primary tumors or distant metastases are largely undetermined. PATIENT CONCERNS We report a rare case in which an mSFT was found at the main bronchus of the right lung of a 37-year-old man. DIAGNOSIS The tumor cells of mSFT were spindle-shaped and expressed antigen Ki-67, B-cell lymphoma 2, cluster of differentiation 31, and vimentin. INTERVENTIONS A total pneumonectomy was performed. OUTCOMES The patient developed fibrosarcoma of the small intestine at 6 months, as well as extensive pleural and peritoneal metastases at 1 year, after removal of the primary mSFT from the right main bronchus. LESSONS From these findings, we expect that patients with primary mSFT, especially of the lung, have a high potential to develop second tumors or distant metastases. Close monitoring after surgery is necessary to improve the outcomes of these patients.
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Affiliation(s)
| | | | - Miao Li
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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21
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Ershadi R, Rahim M, Abbasi M, Erfanian R. Giant solitary fibrous tumor of the pleura. J Surg Case Rep 2018; 2018:rjy270. [PMID: 30397437 PMCID: PMC6210664 DOI: 10.1093/jscr/rjy270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction: Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors representing <5% of all tumors of the pleura. Literature reveals only two case series and a few solitary reports. Case report: A 68-year-old male presented to our hospital after experiencing exertional dyspnea. A chest CT revealed a giant heterogeneous mass. CT-guided transthoracic core needle biopsy demonstrated SFTP. The well-circumscribed, encapsulated resected mass was measured to be 30 cm × 21 cm × 15 cm and weighed 6900 g. Discussion: SFTP are a rare pathology of the pleural cavity, which most of the time develop from submesothelial fibroblasts of the visceral pleura. Due to their non-characteristic clinical picture, SFTP are usually diagnosed in the later stages of the development. A significant issue in the management of giant SFTP is radical resection of the tumor to relieve compression of the lung parenchyma and other mediastinal structures. Conclusion: SFTP are rare neoplasms that fortunately are benign 80% of the time. Only a few cases of giant SFTP that cover almost the entire pleural space are described in the literature. This report represents one of the largest resected SFTP reports in the literature.
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Affiliation(s)
- Reza Ershadi
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohamadbagher Rahim
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Abbasi
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Reza Erfanian
- Department of Thoracic Surgery, Valiasr Hospital, Tehran University of Medical Science, Tehran, Iran
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22
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Gorospe L, Mota-Goitia I, Almeida-Aróstegui NA, Muñoz-Molina GM, Cabañero-Sánchez A, Saldaña-Garrido D, Moreno-Mata N. Adolescent With Chest Pain and Dyspnea. Ann Emerg Med 2018; 72:351-400. [PMID: 30236324 DOI: 10.1016/j.annemergmed.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Luis Gorospe
- Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | - Gemma M Muñoz-Molina
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | - Nicolás Moreno-Mata
- Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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23
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Song Z, Yang F, Zhang Y, Fan P, Liu G, Li C, Ding W, Zhang Y, Xu X, Ye Y. Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura. Onco Targets Ther 2018; 11:5227-5238. [PMID: 30214228 PMCID: PMC6118252 DOI: 10.2147/ott.s168045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Solitary fibrous tumor of the pleura (SFTP) is a rare pleural neoplasm arising from mesenchymal cells, accounting for <5% of pleural neoplasms. Approximately 10% of cases of SFTP demonstrate malignant potential, leading to local recurrence after radical surgery and subsequent metastasis. Methods A large malignant-like mass was found in the left thoracic cavity of a 61-year-old woman. Following radical resection of the mass, the patient was diagnosed with malignant SFTP by histologic and immunohistochemical analyses. In addition, a next-generation sequencing-based mutation test was used to reveal the mutational profile of the tumor. The genetic alteration panel was analyzed with reference to public data on the ClinVar and COSMIC databases, after which the public SFTP data were analyzed for frequency of altered genes. Finally, through overlay of the abovementioned two sets, the genetic alteration accounting for SFTP initiation was anticipated to be identified. Results In the mutation panel of our malignant SFTP group, kinase insert domain receptor (KDR) and fms-related tyrosine kinase 1 (FLT1) scored high in pathogenesis but had only a medium frequency; the NAB2–STAT6 fusion appeared to be the dominant genetic alteration in public SFTP samples. Conclusion The high frequency of NAB2–STAT6 fusion indicates its prominent role in SFTP, while somatic mutations such as FLT1-R593W and KDR-V297I may also contribute to the malignant angiogenic phenotype. The present study affirmed the heterogeneity of SFTP, and more sophisticated classification methods will be needed to explore its underlying mechanisms. Summary We believe that improvement in the prognosis of SFTP relies on early diagnosis, margin-free resection, and long-term follow-up. Through genetic analysis, it appears that both NAB2–STAT6 fusion and somatic mutations such as FLT1-R593W and KDR-V297I contribute to SFTP development.
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Affiliation(s)
- Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fan Yang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yingguo Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Ping Fan
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Guowei Liu
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Chao Li
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Wansheng Ding
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Yulong Zhang
- Wuwei Tumour Hospital, Gansu Province 733000, China,
| | - Xiaohong Xu
- College of Nursing, Tianjin Medical University, Tianjin 300070, China,
| | - Yancheng Ye
- Wuwei Tumour Hospital, Gansu Province 733000, China,
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24
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You YH, Liu RT, Zhang Y. A large solitary fibrous tumour of the pleura: a case report and review of the literature. J Int Med Res 2018; 46:1672-1677. [PMID: 29376453 PMCID: PMC6091813 DOI: 10.1177/0300060517750534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report a clinical case of a solitary fibrous tumour of the pleura (SFTP) in a 67-year-old female patient complaining of chest pain for 2 months. A localized large mass was found in the left inferior hemithorax by computed tomography scan. The patient underwent a thoracotomy at the left side with endotracheal anaesthesia. During surgical resection, the tumour was located in the left inferior hemithorax and was attached to the inferior lobe of the left lung and diaphragmatic pleura by a fibrous pedicle. A wedge resection of the left lower lobe was undertaken to completely remove the tumour. Diagnosis of the SFTP was confirmed by the surgical findings and subsequent histological and immunohistochemical examinations. At the 6-month follow-up, no signs of local tumour recurrence or metastasis were documented. After a 3-year follow-up, this patient remains in good health.
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Affiliation(s)
- Yong-Hao You
- 1 Department of Surgery, Clinical Medical College of Yangtze University, Jingzhou, Hubei Province, China.,2 Department of Cardiothoracic Surgery, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, China
| | - Rong-Ting Liu
- 2 Department of Cardiothoracic Surgery, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei Province, China
| | - Yi Zhang
- 3 Department of Thoracic Surgery, Huangpi District Hospital, Wuhan, Hubei Province, China
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25
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Solitary fibrous tumor of the abdominal wall re-surfacing as unilateral pleural effusion and mass: A case report and review of the literature. Respir Med Case Rep 2017; 23:4-7. [PMID: 29159031 PMCID: PMC5683803 DOI: 10.1016/j.rmcr.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
Background Solitary fibrous tumors (SFTs) are rare fibroblastic mesenchymal neoplasms that were initially described in the pleura, but have been increasingly recognized to occur in other parts of the body. They have been traditionally regarded as indolent tumors that are rare to metastasize after surgical resection. Here, we describe a case of a Filipino female who initially presented with unilateral pleural effusion and mass, and was ultimately diagnosed with recurrent solitary fibrous tumor that originated from the abdominal wall. Then, we reviewed existing literature on intra- and extrathoracic SFTs with focus on pathological characteristics, recommendations for treatment as well as post-treatment surveillance. Case presentation A 79-year-old Filipino female with a history of solitary fibrous tumor of the abdominal wall status post complete surgical resection 3 years ago presented with unilateral pleural effusion and mass, and was diagnosed with recurrent solitary fibrous tumor that metastasized to the lung. She was not a candidate for systemic chemotherapy and ultimately died 1 year later from progressive respiratory failure. Conclusions Solitary fibrous tumor are rare mesenchymal tumors that were initially described in the pleura, but have now been reported in many other sites. Complete surgical resection is the mainstay therapy for all cases; however, long-term monitoring and surveillance several years after initial presentation is crucial to prevent disease recurrence, and adjuvant treatment may be necessary for patients with high-risk features. Additional studies are needed to demonstrate the clinical utility of risk stratification models and to develop post-treatment surveillance guidelines for extrathoracic SFTs.
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Intrathoracic solitary fibrous tumor - an international multicenter study on clinical outcome and novel circulating biomarkers. Sci Rep 2017; 7:12557. [PMID: 28970578 PMCID: PMC5624895 DOI: 10.1038/s41598-017-12914-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023] Open
Abstract
Intrathoracic solitary fibrous tumor (SFT) is a rare disease. Radical resection is the standard of care. However, estimating prognosis and planning follow-up and treatment strategies remains challenging. Data were retrospectively collected by five international centers to explore outcome and biomarkers for predicting event-free-survival (EFS). 125 histological proven SFT patients (74 female; 59.2%; 104 benign; 83.2%) were analyzed. The one-, three-, five- and ten-year EFS after curative-intent surgery was 98%, 90%, 77% and 67%, respectively. Patients age (≥59 vs. <59 years hazard ratio (HR) 4.23, 95 confidence interval (CI) 1.56–11.47, p = 0.005), tumor-dignity (malignant vs. benign HR 6.98, CI 3.01–16.20, p <0.001), tumor-size (>10 cm vs. ≤10 cm HR 2.53, CI 1.10–5.83, p = 0.030), de Perrot staging (late vs. early HR 3.85, CI 1.65–8.98, p = 0.002) and resection margins (positive vs. negative HR 4.17, CI 1.15–15.17, p = 0,030) were associated with EFS. Furthermore, fibrinogen (elevated vs. normal HR 4.00, CI 1.49–10.72, p = 0.006) and the neutrophil–to-lymphocyte-ratio (NLR > 5 vs. < 5 HR 3.91, CI 1.40–10.89, p = 0.009) were prognostic after univariate analyses. After multivariate analyses tumor-dignity and fibrinogen remained as independent prognosticators. Besides validating the role of age, tumor-dignity, tumor-size, stage and resection margins, we identified for the first time inflammatory markers as prognosticators in SFT.
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27
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Gupta A, Souza C, Sekhon H, Gomes M, Hare S, Agarwal P, Kanne J, Seely J. Solitary fibrous tumour of pleura: CT differentiation of benign and malignant types. Clin Radiol 2017; 72:796.e9-796.e17. [DOI: 10.1016/j.crad.2017.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/09/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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28
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Dimofte G, Makkai – Popa ST, Porumb V, Nicolescu S, Lunca S. Long-term survival differences in gastric cancer after D2 lymphadenectomy and an improved assessment of resectability. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2017. [DOI: 10.25083/2559.5555.21.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. The purpose of this work is to compare the long-term survival between a control group with mostly D1 lymphadenectomy and a study group with mostly D2 lymphadenectomy. Materials and Methods. We analyzed consecutive cases operated by a single surgeon performing mostly D2 lymphadenectomy and a control group of consecutive gastric cancer patients operated by a group of surgeons, performing mostly D1 lymphadenectomy, in a period when D2 lymphadenectomy was not the standard and was introduced as a new technique in our center. Results. We found 30,56% D2 lymphadenectomy in the control groups and 85,1% in the study group. At a five years interval from surgery the control group had no survivors, while the study group had 8 (20%) survivors. Conclusions. The spleen and pancreas preserving D2 lymphadenectomy done by experienced surgeons, according to the current guidelines in order to select operable patients improves the overall survival of such gastric cancer patients.
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Coebergh Van Den Braak RR, Hartholt KA, Pannekoek BJ, Smedts F, Van Der Elst M. Solitary Fibrous Tumors of the Pleura: Current Diagnostic Tools. Am Surg 2017. [DOI: 10.1177/000313481708300309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Ben J. Pannekoek
- Department of Surgery Reinier de Graaf Group Delft, The Netherlands
| | - Frank Smedts
- Department of Surgery Reinier de Graaf Group Delft, The Netherlands
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Vejvodova S, Spidlen V, Mukensnabl P, Krakorova G, Molacek J, Vodicka J. Solitary Fibrous Tumor - Less Common Neoplasms of the Pleural Cavity. Ann Thorac Cardiovasc Surg 2016; 23:12-18. [PMID: 28049955 DOI: 10.5761/atcs.oa.16-00108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE solitary fibrous tumors (SFT) represent a heterogeneous group of primary pleural neoplasms with a low incidence rate and of which the biological origin, which consists of mesenchymal cells, is uncertain. METHODS The authors present herewith a retrospective analysis of 22 patients with SFTs who were diagnosed and surgically treated between the years 2000-2015. The preoperative tumors were successfully verified morphologically by transthoracic core needle biopsy under CT control in 27.3% of patients. Surgical approaches were either posterolateral thoracotomy or videothoracoscopy. The follow-up median was 45 months (range 1-188 months). RESULTS Twenty tumors were surgically removed radically, two tumors were found to be unresectable due to the considerable tumor size. From histological point of view 81.8% of tumors were SFT with low malignant potential, 18.2% of tumors with high malignant potential. Despite the radical extirpation of the SFT, it relapsed in two patients. CONCLUSION The gold standard of SFT treatment is radical surgical removal; however, patients at risk of recurrence require additional follow-ups. The results of adjuvant therapy in recurrent and malignant forms of SFTs are the subject of discussion and further study.
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Affiliation(s)
- Sarka Vejvodova
- Clinic of Surgery, Faculty of Medicine in Pilsen, Charles University in Prague, University Hospital Pilsen, Pilsen, Czech Republic
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Guerrini S, Ricci A, Osman GA, Mariotta S. Different clinical and radiological features of solitary fibrous tumor of the pleura: Report of two cases. Lung India 2016; 33:72-4. [PMID: 26933312 PMCID: PMC4748670 DOI: 10.4103/0970-2113.173065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two cases of solitary fibrous tumor of the pleura (SFTP). The first appeared in a young, new mother as a large mass in the upper lobe of the left lung that caused compression of lung parenchyma without significant respiratory symptoms but with polyarticular paraneoplastic syndrome; the other was documented by an occasional chest x-ray in a man affected by chronic obstructive pulmonary disease (COPD) as a small peripheral mass 4 years before and no longer controlled. Both patients underwent surgical resection with quick and full recovery. SFTP is a benign, slow growing neoplasm that is mostly localized. It appears in adult or elderly patients often with few symptoms. The computed tomography (CT) of the chest with contrast medium is important in order to see the shape of the mass and relationships with adjacent structures but only histology can provide the diagnosis. Surgery is the best treatment.
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Affiliation(s)
- Simone Guerrini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgia Amira Osman
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Mariotta
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Abstract
Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum. Materials and Methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011. Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year. Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.
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Affiliation(s)
- Fatima Shamsuddin
- Department of Pathology, Malabar Medical College and Research Center, Kozhikode, Kerala, India
| | - Urmila N Khadilkar
- Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Debarshi Saha
- Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
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Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. Most commonly they affect the pleura but they been described in other viscera. SFT of the pancreas is extremely rare, and only eight cases have been reported to date. We perform a literature review and report a ninth case. The patient is a 54-year-old African-American female who presented with several months of abdominal pain. Abdominal radiography demonstrated a lesion in the head of the pancreas, and she underwent a Whipple operation. Pathology demonstrated SFT of the pancreas. She is alive and well 1 year post-operatively. SFT of the pancreas predominately affects middle-aged women. These tumors are difficult to distinguish radiologically from neuroendocrine tumors. While SFT of the pancreas tend to have an indolent course, there is the potential for malignancy. We recommend complete surgical excision.
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Affiliation(s)
- Andrew R Baxter
- Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Elliot Newman
- Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Cristina H Hajdu
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
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Giant solitary fibrous tumour of the pleura. Case report and review of the literature. Radiol Oncol 2015; 49:395-401. [PMID: 26834527 PMCID: PMC4722931 DOI: 10.2478/raon-2014-0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background Solitary fibrous tumours of the pleura (SFTP) are rare tumours. They are mostly benign. Only around 12% of them are malign ant. In the initial stage they are mostly asymptomatic and by growing they cause chest pain, irritating cough and dyspnoea on account of the pressure created on the surrounding structures. Rare giant tumours have compression symptoms on the mediastinal structures. The condition requires tiered diagnostic radiology. Preoperative biopsy is not successful in most cases. The therapy of choice is radical surgical tumour removal. Malignant or non-radically removed benign solitary fibrous tumours of the pleura additionally require neoadjuvant therapy. Case report A 68-year old patient was hospitalized for giant solitary fibrous tumour of the pleura in the right pleural cavity. With its expansive growth the tumour caused the shift of the mediastinum by compressing the lower vena cava, right cardiac auricle as well as the intermediate and lower lobe bronchus. Due to cardiac inflow obstruction and right lung collapse, the patient’s life was endangered with signs of cardio-respiratory failure. After preoperative diagnostic radiology, the tumour was surgically removed. Postoperatively, the patient’s condition improved. No disease recurrence was diagnosed after a year. Conclusions Giant solitary fibrous tumour of the pleura may cause serious and life-threatening conditions by causing compression of the pleural cavity with its expansive growth. Early diagnosis of the condition enables less aggressive as well as video-assisted thoracic surgery in patients with significantly better state of health. Large tumour surgeries in cardio-respiratory affected patients are highly risk-associated procedures.
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Solitary fibrous tumor of the pleura - analysis of 18 cases. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:208-15. [PMID: 26702276 PMCID: PMC4631912 DOI: 10.5114/kitp.2015.54456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022]
Abstract
Introduction Solitary fibrous tumors of the pleura (SFTP) are primary tumors arising from mesenchymal cells. Immunohistochemical studies have demonstrated that the origin of these tumors is mesenchymal rather than mesothelial. The aim of this study is to present our experience with diagnosing and treating patients with SFTP. Material and methods We analyzed 18 patients treated at the Department of Thoracic Surgery of the Medical University of Lodz. The patients’ medical histories and the results of postoperative histopathological investigation of the tumors were analyzed. Postoperative histopathological samples were evaluated with regard to the current criteria of malignancy. Results In 17 patients, the tumors were surgically removed. Benign and small lesions (less than 3 cm in size) were removed by video-assisted thoracoscopic surgery (VATS). In 5 cases, malignant tumors were found in the postoperative material. Conclusions Solitary fibrous tumors of the pleura is a tumor with frequently asymptomatic clinical course. Treatment consists in resection which includes the adjacent structures, especially if the tumor is malignant.
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Tapias LF, Lanuti M. Solitary fibrous tumors of the pleura: review of literature with up-to-date observations. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors with unpredictable biologic characteristics. Attempts have been made to standardize prognostic criteria without improvement in predicting prognosis or recurrence. The infrequent nature of this tumor contributes to the paucity of data that are used to make useful observations. Here, we present a comprehensive review of contemporary literature to summarize important clinical management aspects of patients with SFTP, focusing on surgical treatment, the role for adjuvant therapies, the potential impact of new prognostic models and the management of recurrences. SFTP remains poorly understood; therefore, new information such as a detailed molecular characterization may improve current prognostic models and lead to new treatment strategies.
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Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Schmid S, Csanadi A, Kaifi JT, Kübler M, Haager B, Kayser G, Passlick B, Wiesemann S. Prognostic factors in solitary fibrous tumors of the pleura. J Surg Res 2015; 195:580-7. [DOI: 10.1016/j.jss.2015.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
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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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Jadczak P, Guz W, Kaznowska E, Ramotowski R, Szalacha-Tarała E, Górecki A, Samojedny A. Solitary fibrous tumour of the pleura - cases analysis. Pol J Radiol 2014; 79:368-73. [PMID: 25352940 PMCID: PMC4210359 DOI: 10.12659/pjr.890525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 12/04/2022] Open
Abstract
Background Isolated fibrous tumor of the pleura (SFTP – Solitary fibrous tumour of the pleura/localized fibrous tumour of the pleura) is a rare primary tumour of the pleura of mesenchymal origin. In most cases, it is a benign lesion. It is composed of spindle cells similar to fibroblasts and derives probably from submesothelial mesenchyme. The aim of the study was to analyze clinical symptoms, incidence, possibility of suggesting the diagnosis on the basis of imaging tests, and confirmation of the diagnosis in pathological tests with regard to studies of histochemistry examination. Material/Methods Clinical and morphological material obtained from 14 patients from Department of Thoracic Surgery of Subcarpathian Chest Disease Center treated between year 2004 and 2010 was analysed. In the first stage, selected cases of patients with isolated fibrous tumour of the pleura were chosen from the archives and the analysis of their medical history was carried out. Basic information about age, gender, medical history, smoking habit, physical examination and results of imaging, endoscopic and morphological examinations were noted. The second parallel component of the study was pathomorphological examinations of the surgical material obtained from the patients, including the assessment of morphology and immunohistochemistry. Results Of the 14 examined patients, fibrous tumour occurred in 8 men and 6 women. The age range of the patients was 37–73 years, with a peak attributable to the 6th decade of life. In 8 patients the tumour was detected incidentally during routine examinations. In 7 patients there were no clinical signs of respiratory disease, and if present, then the most common complaint was shortness of breath. Regarding symptoms not connected with the respiratory system, anemia occurred most frequently. Fibrous tumour of the pleura was more often associated with the visceral pleura than with the parietal pleura. The largest lesion was approximately 20 cm in size. Conclusions Fibrous tumour of the pleura is a pleura-based neoplasm which is usually detected incidentally, and is often asymptomatic or poorly symptomatic. Computed tomography imaging allows to suggest a correct diagnosis. Histopathological diagnosis is based on immunohistochemical examinations.
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Affiliation(s)
- Przemysław Jadczak
- Clinical Department of Radiology, Provincial Hospital No. 2, Rzeszów, Poland
| | - Wiesław Guz
- Clinical Department of Radiology, Provincial Hospital No. 2, Rzeszów, Poland ; Institute of Physiotherapy, University of Rzeszów, Rzeszów, Poland
| | - Ewa Kaznowska
- Department of Pathomorphology, Subcarpathian Chest Disease Center, Rzeszów, Poland
| | - Radosław Ramotowski
- Clinical Department of Radiology, Provincial Hospital No. 2, Rzeszów, Poland
| | - Ewa Szalacha-Tarała
- Clinical Department of Radiology, Provincial Hospital No. 2, Rzeszów, Poland
| | - Andrzej Górecki
- Computed Tomography Laboratory, Public Healthcare Institution No. 2, Rzeszów, Poland
| | - Antoni Samojedny
- Clinical Department of Radiology, Provincial Hospital No. 2, Rzeszów, Poland
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Takahashi H, Ohkawara H, Ikeda K, Harada-Shirado K, Furukawa M, Sukegawa M, Shichishima-Nakamura A, Noji H, Wakamatsu S, Tasaki K, Suzuki H, Ogawa K, Takeishi Y. Pleural solitary fibrous tumor complicated with autoimmune hemolytic anemia. Intern Med 2014; 53:1549-52. [PMID: 25030571 DOI: 10.2169/internalmedicine.53.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 74-year-old woman who presented with autoimmune hemolytic anemia (AIHA) associated with pleural solitary fibrous tumor (SFT). Her AIHA was initially treated with 1 mg/kg daily of oral prednisolone (PSL) for 2 months, which had a limited effect. However, after surgical tumor resection, the patient showed remarkable improvement of AIHA with normalizations of serum lactate dehydrogenase and bilirubin levels, and we were able to rapidly reduce the PSL dosage. This is the first description of a case of AIHA caused by SFT.
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MESH Headings
- Administration, Oral
- Aged
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Diagnosis, Differential
- Dose-Response Relationship, Drug
- Female
- Glucocorticoids/administration & dosage
- Humans
- Prednisolone/administration & dosage
- Radiography, Thoracic
- Solitary Fibrous Tumor, Pleural/complications
- Solitary Fibrous Tumor, Pleural/diagnosis
- Solitary Fibrous Tumor, Pleural/surgery
- Thoracic Surgical Procedures/methods
- Tomography, X-Ray Computed
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Affiliation(s)
- Hiroshi Takahashi
- Department of Cardiology and Hematology, Fukushima Medical University, Japan
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Fritzsche C, Reisinger EC, Oerter R. Hypoglycemia and finger clubbing-consider Doege-Potter. Am J Med 2013; 126:e35-6. [PMID: 24262742 DOI: 10.1016/j.amjmed.2013.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos Fritzsche
- Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, University of Rostock, Rostock, Germany
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42
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Fan F, Zhou H, Zeng Q, Liu Y. Computed tomography manifestations of a malignant solitary fibrous tumour of the pleura with distinct blood supply from celiac trunk. Eur J Cardiothorac Surg 2013; 45:1108-10. [PMID: 24078101 DOI: 10.1093/ejcts/ezt481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Solitary fibrous tumours of the pleura (SFTPs) are rare and roughly 80% of them have a benign course. Malignant SFTPs are seldom reported, as are their computed tomography (CT) manifestations. We report the case of a 45-year old male patient who presented with coughing for over 2 months. A large lesion in his right hemithorax was found by chest X-ray. CT scan showed patchy areas and a sharp time-attenuation curve. CT angiography reconstruction revealed a distinct feeding vessel from celiac trunk. After surgery, the tumour was confirmed to be a malignant SFTP by immunochemistry.
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Affiliation(s)
- Fan Fan
- Department of Neurosurgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hui Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, PR China
| | - Qinghai Zeng
- Department of Dermatovenereology, Third Xiang Ya Hospital, Central South University, Hunan, PR China
| | - Yupeng Liu
- Department of Orthopaedics, Xiang Ya Hospital, Central South University, Hunan, PR China
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43
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Solitary fibrous tumours of the pleura: report of two cases and literature review. Ir J Med Sci 2013; 182:729-33. [PMID: 23609596 DOI: 10.1007/s11845-013-0952-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
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.
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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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45
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Novoa N. Re: 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 2013; 44:118. [PMID: 23462819 DOI: 10.1093/ejcts/ezt120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nuria Novoa
- Department of Thoracic Surgery, University Hospital of Salamanca, Salamanca, Spain.
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46
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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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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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