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Bertoglio P, Querzoli G, Kestenholz P, Scarci M, La Porta M, Solli P, Minervini F. Surgery for Solitary Fibrous Tumors of the Pleura: A Review of the Available Evidence. Cancers (Basel) 2023; 15:4166. [PMID: 37627194 PMCID: PMC10453165 DOI: 10.3390/cancers15164166] [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: 07/31/2023] [Revised: 08/12/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Solitary fibrous tumors of the pleura (pSFT) are a relatively rare neoplasms that can arise from either visceral or parietal pleura and may have different aggressive biological behaviors. Surgery is well known to be the cornerstone of the treatment for pSFT. We reviewed the existing literature, focusing on the role of surgery in the management and treatment of pSFT. All English-written literature has been reviewed, focusing on those reporting on the perioperative management and postoperative outcomes. Surgery for pSFT is feasible and safe in all experiences reported in the literature, but surgical approaches and techniques may vary according to the tumor dimensions, localization, and surgeons' skills. Long-term outcomes are good, with a 10-year overall survival rate of more than 70% in most of the reported experiences; on the other hand, recurrence may happen in up to 17% of cases, which occurs mainly in the first two years after surgery, but case reports suggest the need for a longer follow-up to assess the risk of late recurrence. Malignant histology and dimensions are the most recognized risk factors for recurrence. Recurrence might be operated on in select patients. Surgery is the treatment of choice in pSFT, but a radical resection and a careful postoperative follow-up should be carried out.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
- Alma Mater Studiorum, University of Bologna, 40064 Bologna, Italy
| | - Giulia Querzoli
- Pathology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy;
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland; (P.K.); (F.M.)
| | - Marco Scarci
- Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London W2 1NY, UK;
| | - Marilina La Porta
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40100 Bologna, Italy; (M.L.P.); (P.S.)
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland; (P.K.); (F.M.)
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Ajouz H, Sohail AH, Hashmi H, Martinez Aguilar M, Daoui S, Tembelis M, Aziz M, Zohourian T, Brathwaite CEM, Cerfolio RJ. Surgical considerations in the resection of solitary fibrous tumors of the pleura. J Cardiothorac Surg 2023; 18:79. [PMID: 36823638 PMCID: PMC9951522 DOI: 10.1186/s13019-023-02168-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal pleural neoplasms with an overall good prognosis and low recurrence rate if completely resected and if degree of differentiation is favorable. Within the last decade, advances in research have led to more reliable methods of differentiating SFTs from other soft tissue tumors. Historically, several markers were used to distinguish SFTs from similar tumors, but these markers had poor specificity. Recent evidence showed NAB2-STAT6 fusion gene to be a distinct feature of SFTs with 100% specificity and sensitivity. Surgical resection, with an emphasis on obtaining negative margins, is the mainstay of treatment for SFTs. Preoperative planning with detailed imaging is imperative to delineate the extent of disease and vascular supply. One important radiologic distinction to aid delineation of a pleural-based tumor compared to a pulmonary parenchymal-based tumor is the angle that the tumor forms with the chest wall, which is obtuse for a pleural-based tumor, and acute for tumors of the lung parenchyma. Often, preoperative tissue diagnosis is not available, and surgery is both diagnostic and curative. Intraoperatively, emphasis should be on complete resection with negative margins. SFTs are resected via several approaches: thoracotomy, sternotomy with the option of hemi-clamshell extension, video-assisted thoracoscopic surgery, and robotic approach, which is increasingly being used and is our preference. We recommend a minimally invasive approach for most lesions, and have resected SFTs of the pleura that are up to 12 cm with the robotic approach. However, the current literature often cites 5 cm as the cut off for an open thoracotomy. Nevertheless, even with larger tumors, a minimally invasive robotic approach is our preference and practice. For giant SFTs (> 20 cm), an open approach may be preferable. Multiple thoracotomies and rib resection may be required to gain adequate exposure and ensure complete resection in these tumors. However, it is noteworthy that most of these tumors have a soft consistency and thus, once bagged, can easily be removed minimally invasively, and thus minimally invasive approach should not be completely ruled out. Recurrence in SFTs usually results from incomplete resection and redo surgery may portend a favorable prognosis.
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Affiliation(s)
- Hana Ajouz
- grid.418456.a0000 0004 0414 313XDepartment of Surgery, University of Miami Health System, Miami, FL USA
| | - Amir Humza Sohail
- grid.137628.90000 0004 1936 8753Department of Surgery, New York University Langone Health, New York, USA
| | - Hassan Hashmi
- grid.415875.a0000 0004 0368 6175Department of Surgery, LeHigh Valley Health Network, Allentown, PA USA
| | | | - Sabrina Daoui
- New York University Long Island School of Medicine, Mineola, NY, USA.
| | - Miltiadis Tembelis
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health, New York, USA
| | - Muhammad Aziz
- grid.411726.70000 0004 0628 5895Department of Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Tirajeh Zohourian
- grid.137628.90000 0004 1936 8753Department of Surgery, New York University Langone Health, New York, USA
| | - Collin E. M. Brathwaite
- grid.137628.90000 0004 1936 8753Department of Surgery, New York University Langone Health, New York, USA
| | - Robert J. Cerfolio
- grid.137628.90000 0004 1936 8753Department of Surgery, New York University Langone Health, New York, USA
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Zuo Z, Zhou H, Sun Y, Mao Q, Zhang Y, Gao X. Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:890. [PMID: 32793734 DOI: 10.21037/atm-20-4974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A solitary fibrous tumor (SFT) is a rare spindle cell tumor-derived from mesenchymal cells. It may be linked to the fusion of the NAB2-STAT6 gene caused by 12q chromosome rearrangement. It can occur in the connective tissue of any part of the body; however, it is most common in the pleura. Solitary fibrous tumors of the pleura (SFTP) are a persistent painless mass with slow growth. With the increase of the tumor, there will be corresponding compression symptoms. Pleural effusion is rare, and the cytology of pleural effusion is mostly negative. Occasionally, SFTP can induce paraneoplastic syndrome, distant metastasis, and malignant transformation. Lung function may have mild to moderate restrictive ventilation dysfunction. CT is a crucial method for the clinical diagnosis of SFTP. The histopathological features of SFTP are the coexistence of sparse and dense areas. CD34, CD99, Bcl-2, and vimentin are the most valuable immunohistochemical markers.The positive expression rate of STAT6 in benign SFT was even 100%. Adhesion or unclear boundary with surrounding tissues, pleural effusion or calcification, tumors with a maximum diameter greater than 10 cm, invasive growth, uneven density, metastasis or recurrence, paraneoplastic syndrome, moderate to severe cell heterogeneity, high Ki67 proliferation index, and low STAT6 expression suggest SFTP may be a malignant tumor. Gene analysis on next generation sequencing may help reveal the mutation characteristics of SFTP. Complete tumor resection is the gold standard of SFTP. Resectability is the most important prognostic factor. Age, size, mitosis, and necrosis are considered risk stratification factors for prognosis. Fortunately, 80% of SFTP are benign and have anexcellentprognosis but need long-term follow-up.We report a case of rapidly growing tumor with pleural effusion within 9 months, who was surgically treated and is currently under follow-up. And the literature is reviewed.
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Affiliation(s)
- Zhitong Zuo
- Department of Respiratory Disease, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Haiyue Zhou
- Department of Respiratory Disease, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Yan Sun
- Department of Respiratory Disease, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Qing Mao
- Department of Pathology, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Yong Zhang
- Department of Cardio-Thoracic Surgery, The Hospital Affiliated to Jiangnan University, Wuxi, China
| | - Xiaowei Gao
- Department of Respiratory Disease, The Hospital Affiliated to Jiangnan University, Wuxi, China
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Amore D, Cicalese M, Scaramuzzi R, Di Natale D, Casazza D, Curcio C. Hybrid robotic thoracic surgery for excision of large mediastinal masses. J Vis Surg 2018; 4:105. [PMID: 29963394 DOI: 10.21037/jovs.2018.05.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/06/2022]
Abstract
Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.
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Affiliation(s)
- Dario Amore
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | | | | | - Dino Casazza
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
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