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Weissferdt A. Spindle cell thymoma and its histological mimickers. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:25. [PMID: 37701646 PMCID: PMC10493621 DOI: 10.21037/med-22-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
Spindle cell thymomas are the most common spindle cell neoplasms of the anterior mediastinum. These tumors belong to the group of thymic epithelial neoplasms and are known for their wide histomorphologic spectrum. This histological heterogeneity is the reason why unequivocal diagnosis can be challenging, especially when dealing with small biopsy material. Conversely, less conventional patterns of the tumor may also pose significant diagnostic problems in resected material and the differential diagnosis often includes other spindle cell neoplasms that are known to arise in the mediastinal cavity. These can be of variable origin and may share overlapping pathological features with spindle cell thymoma. Since spindle cell thymomas are tumors that primarily affect the adult population and predominantly arise from the thymic gland in the anterior mediastinum, this review will focus on the differential diagnosis with other spindle cell neoplasms that share similar demographic characteristics and, for the most part, originate from the anterior mediastinal compartment. These include other epithelial spindle cell tumors of thymic origin (sarcomatoid thymic carcinoma and spindle cell carcinoid tumor), mesenchymal neoplasms [solitary fibrous tumor (SFT), synovial sarcoma, and dedifferentiated liposarcoma] and various other tumors with spindle cell morphology, that may occasionally involve the anterior mediastinum. The clinical, pathological, immunohistochemical and molecular hallmarks of these lesions will be discussed and useful tips for the differential diagnosis with spindle cell thymoma will be provided.
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Affiliation(s)
- Annikka Weissferdt
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Shi X, Liu X, Dong X, Wu H, Cai K. Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors. Front Oncol 2022; 12:820720. [PMID: 35186755 PMCID: PMC8854276 DOI: 10.3389/fonc.2022.820720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.
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Drobyazgin EA, Kutepov EV, Kutepov AV, Abdrakhmanov SV. [Treatment of a patient with giant solitary fibrous tumor of the left hip]. Khirurgiia (Mosk) 2021:93-99. [PMID: 34480461 DOI: 10.17116/hirurgia202109193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report surgical treatment of a 59-year-old female with a giant solitary-fibrous tumor of the left hip. Previous excision of hip hemangioma was performed in 2016. Recurrent tumor with fast growth has occurred since 2018. The neoplasm consisted of 2 tumors connected by vascular structures. CT revealed soft tissue neoplasms in the upper third of the left thigh (anterior, medial and dorsal regions). Large tumors with an isthmus along the inner surface had tuberous contours and internal septa. The last ones and walls accumulated contrast agent. No structural damage to femoral muscles was observed. The patient underwent resection of tumor and vascular ligation (great saphenous vein and its tributaries along the anterior surface, arteries from the deep femoral artery system along the posterior surface of tumor). There were no early postoperative complications. There are no complaints within 6 month after surgery. There is no lower limb dysfunction.
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Affiliation(s)
- E A Drobyazgin
- Novosibirsk State Medical University, Novosibirsk, Russia.,Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Meshalkin National Research Center, Novosibirsk, Russia
| | - E V Kutepov
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - A V Kutepov
- Novosibirsk State Medical University, Novosibirsk, Russia.,Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - S V Abdrakhmanov
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
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4
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Takahashi A, Nishimura H, Amano T, Deguchi M, Yoshino F, Kasei R, Kimura F, Moritani S, Murakami T. An abdominal-sacral approach with preoperative embolisation for vulvar solitary fibrous tumour: a case report. World J Surg Oncol 2021; 19:92. [PMID: 33781289 PMCID: PMC8008681 DOI: 10.1186/s12957-021-02206-5] [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: 07/09/2020] [Accepted: 03/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Solitary fibrous tumours (SFTs) in the female genital tract are uncommon. Resection of these tumours is controversial because it can cause life-threatening haemorrhage. We report a case of vulvar SFT that was excised in a combined abdominal-sacral approach after preoperative embolisation. Case presentation At another hospital, an inoperable intrapelvic tumour was diagnosed in a 34-year-old woman. Computed tomography and magnetic resonance imaging showed that the uterus, urinary bladder and rectum were compressed laterally by a pelvic tumour with a maximum diameter of 11 cm. This mass was hypervascular and had a well-defined border. Transperineal biopsy was performed, and immunostaining revealed that the mass was an SFT. The tumour was supplied by feeding vessels from the right iliac arteries. First, we embolised the feeding vessels. Second, we performed surgical resection in a combined abdominal-sacral approach; no blood transfusion was necessary, and no perioperative complications occurred. The final pathological diagnosis was SFT that was positive for CD34 and signal transducer and activator of transcription 6 according to immunohistochemical staining. Conclusion During a year of follow-up, the disease did not recur. Treatment of pelvic SFT should aim at complete resection through various approaches after careful measures are taken to prevent haemorrhage.
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Affiliation(s)
- Akimasa Takahashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroki Nishimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Mari Deguchi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Fumi Yoshino
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Ryo Kasei
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Fuminori Kimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Suzuko Moritani
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Kusatsu, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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5
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Unique Presentation and Management Approach of Pleural Solitary Fibrous Tumor. Case Rep Surg 2019; 2019:9706825. [PMID: 31886010 PMCID: PMC6915142 DOI: 10.1155/2019/9706825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/08/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022] Open
Abstract
Solitary fibrous tumor (SFT) of the pleura is an uncommon tumor that is often discovered incidentally on a routine chest X-ray. We report a case of a young female with a large, sessile, hypervascularized SFT of the pleura presenting with cardiopulmonary shock to a rural hospital with limited therapeutic interventions. We propose, in this case report, a unique multidisciplinary approach for the management of such a critical patient and the safe resection of the tumor.
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Madariaga ML, Borges LF, Rabinov JD, Chang DC, Lanuti M, Mathisen DJ, Gaissert HA. Angiography Before Posterior Mediastinal Tumor Resection: Selection Criteria and Patient Outcomes. Ann Thorac Surg 2018; 105:1000-1007. [PMID: 29373823 DOI: 10.1016/j.athoracsur.2017.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/07/2017] [Accepted: 12/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Resection of posterior mediastinal tumors may be complicated by bleeding or neurologic injury. Preoperative spinal angiography of mediastinal tumors has been underreported or not commonly practiced. This study evaluated the selection criteria and outcomes of patients with posterior mediastinal tumors who underwent preoperative angiography and embolization. METHODS This was a single-institution retrospective study of patients with posterior mediastinal tumors from 2002 to 2016. Multilevel spinal angiography was performed, with or without selective arterial embolization of vascular supply, in patients selected by thoracic or neurologic surgeons. RESULTS Ten of 87 patients (11%) with posterior mediastinal tumors underwent preoperative angiography. A mean of 11 arteries (range, 2 to 25) were studied. Embolization in 7 of 10 patients successfully occluded 1 to 3 arteries. There was no significant difference in age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, operative time, operative blood loss, complications, or death between patients with or without angiography. Patients who underwent angiography had larger tumors (1,490 vs 97 cm3, p < 0.0001), involvement of the neuroforamen (44% vs 10%, p < 0.05), and a longer hospital stay (9 vs 4.5 days, p < 0.05). Angiography was complicated in 1 patient by vocal cord ulceration after intubation of a tumor-compressed trachea. Shared blood supply between the tumor and the spinal cord precluded embolization and tumor resection in 1 patient. Use of angiography increased over time. CONCLUSIONS Selective preoperative angiography for evaluation of posterior mediastinal tumors identifies arterial variations, threatened spinal arteries, and targets for embolization. The specific role of angiography and embolization requires further investigation to standardize indications and protocols for the number of arteries examined.
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Affiliation(s)
- Maria Lucia Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts
| | - Lawrence F Borges
- Department of Neurosurgery, Massachusetts General Surgery, Boston, Massachusetts
| | - James D Rabinov
- Department of Radiology, Massachusetts General Surgery, Boston, Massachusetts
| | - David C Chang
- Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts.
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7
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Kallas E, Abrantes RD, Hueb AC. Tumor lamination in mediastinal giant tumors. ACTA ACUST UNITED AC 2017; 44:655-658. [PMID: 29267563 DOI: 10.1590/0100-69912017006007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 11/21/2022]
Abstract
Mediastinum tumors may grow slowly and reach giant proportions without symptoms, hindering surgical removal. Tumor big dimensions difficult surgical maneuvers, with risk of uncontrollable bleeding and prejudice to surrounding structures. It may be necessary the use of exceptional measures such as venous-venous circulatory deviation, pre-operatory embolization and total extracorporeal circulation. We describe the technique of tumor lamination that allows for complete or almost complete resection of such tumors that in many occasions are not resectable. The description is based on the results of four patients treated with mediastinum giant tumors.
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Affiliation(s)
- Elias Kallas
- - Hospital das Clínicas Samuel Libânio, Serviço de Cirurgia Cardiotorácica, Pouso Alegre, MG, Brasil
| | - Rafael Diniz Abrantes
- - Hospital das Clínicas Samuel Libânio, Serviço de Cirurgia Cardiotorácica, Pouso Alegre, MG, Brasil
| | - Alexandre Ciappina Hueb
- - Hospital das Clínicas Samuel Libânio, Serviço de Cirurgia Cardiotorácica, Pouso Alegre, MG, Brasil
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8
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You X, Sun X, Yang C, Fang Y. CT diagnosis and differentiation of benign and malignant varieties of solitary fibrous tumor of the pleura. Medicine (Baltimore) 2017; 96:e9058. [PMID: 29245313 PMCID: PMC5728928 DOI: 10.1097/md.0000000000009058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To investigate computed tomography (CT) characteristics of benign and malignant solitary fibrous tumors of the pleura (SFTPs).Preoperative CTs for 60 SFTP cases (49 benign and 11 malignant) with subsequently confirmed diagnoses were retrospectively analyzed.Tumor morphologies included mounded or mushroom umbrella-shape (19 cases, 31.7%), quasi-circular or oval-shape (30 cases, 50%), and growth resembling a casting mould (12 cases, 20%). Maximum tumor diameters were 1.1 to 18.9 cm (average: 6.4 ± 4.8 cm). Fifty-seven cases had clear boundaries, and 3 had partially coarse boundaries. Twenty-seven cases showed homogeneous density; 33, "geographic"-patterned inhomogeneous density; 6, calcifications; 12, intratumor blood vessels; and 3, thick nourishing peritumoral blood vessels. Pleural thickening (regular and irregular) was found adjacent to tumors in 4, compression of adjacent ribs with absorption and cortical sclerosis in 2, and location adjacent to ribs with bony destruction in 1. Four cases had a small amount of lung tissue enfolded along the boundary, 2 had multiple peritumoral pulmonary bullae, and 9 had small ipsilateral pleural effusions. Compared with benign and malignant SFTPs were larger (P < .001), had inhomogeneous density, and were more commonly associated with intratumor blood vessels and pleural effusions (P < .01).CT revealed characteristic patterns in SFTPs, including casting mould-like growth, rich blood supply, and "geographic"-patterned enhancement. In addition, larger tumor size, inhomogeneous intensities, abundant intratumor blood vessels, and pleural effusions were more common with malignancy. Lastly, multislice CT angiography can reveal feeding arteries and help guide surgical management.
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Affiliation(s)
- Xiaofang You
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Chunyan Yang
- Department of Radiology, The People's Hospital of Shihezi City, Shihezi, Xinjiang
| | - Yong Fang
- Tuberculosis Center for Diagnosis and Treatment, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Yangpu, Shanghai, China
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9
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Patel SR, Vachhani P, Moeslein F. Embolic Brain Infarcts: A Rare Fatal Complication of Preoperative Embolization of a Massive Solitary Fibrous Tumor of the Pleura. Cardiovasc Intervent Radiol 2016; 40:306-309. [PMID: 27837239 DOI: 10.1007/s00270-016-1501-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
Solitary fibrous tumor of the pleura (SFTP) is a rare intrathoracic neoplasm, often giant in size and highly vascular, which can make surgical resection very challenging. Preoperative percutaneous embolization before surgical removal can significantly reduce the risk of uncontrollable intraoperative hemorrhage. However, a rare potential life threatening complication could result from embolization of SFTP and must be taken into consideration. This report describes a 69-year-old female with a large right thoracic SFTP, who underwent preoperative angiography and embolization and developed diffuse embolic brain infarcts immediately after the administration of polyvinyl alcohol particles.
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Affiliation(s)
- Shreyas R Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Prasann Vachhani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Fred Moeslein
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD, 21201, USA
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10
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Zhang L, Liu X, Li X, Tang Z, Shi C, Wang G. Diagnosis and surgical treatment of mediastinal solitary fibrous tumor. Asia Pac J Clin Oncol 2016; 13:e473-e480. [PMID: 27640885 DOI: 10.1111/ajco.12594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/15/2016] [Accepted: 07/24/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Lei Zhang
- Department of Cardiothoracic Surgery; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
- School of Medicine; Shandong University; Jinan Shandong China
| | - Xuegang Liu
- Department of Cardiothoracic Surgery; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
- School of Medicine; Shandong University; Jinan Shandong China
| | - Xiaojun Li
- Department of Cardiothoracic Surgery; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
| | - Zhen Tang
- Department of Cardiothoracic Surgery; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
| | - Chao Shi
- Department of Cardiothoracic Surgery; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
| | - Gengming Wang
- Department of Radiotherapy; the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui; China
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11
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Perrotta F, Cerqua FS, Cammarata A, Izzo A, Bergaminelli C, Curcio C, Guarino C, Grella E, Forzano I, Cennamo A, Tafuri D, Rocca A, Bianco A, Mazzarella G. Integrated therapeutic approach to giant solitary fibrous tumor of the pleura: report of a case and review of the literature. Open Med (Wars) 2016; 11:220-225. [PMID: 28352798 PMCID: PMC5329829 DOI: 10.1515/med-2016-0042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/07/2015] [Indexed: 11/23/2022] Open
Abstract
The fibrous tumors of the pleura are rare primary tumors, accounting for 5% of malignant pleural neoplasms, which generally originate from sub-mesothelial mesenchymal tissue of the visceral pleura. These tumours generally exhibit clinical benign behavior although 12% of solitary fibrous tumors can be malignant and have worse outcomes. These tumors are considered “giant” when the lesion > 15 cm. Surgical treatment is the best choice for both benign and malignant neoplasms. We retrospectively analyzed the main case series of giant fibrous tumors of the pleura. In addition we report our experience of a 76-year-old woman treated by pre-surgical embolization involving implantation of vascular plugs. Surgery was successfully carried out without complications; imaging and functional assessment 6 months post intervention demonstrated both the absence of recurrence and improvement of lung function parameters.
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Affiliation(s)
- Fabio Perrotta
- Department of Cardiotho-racic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Francesco Saverio Cerqua
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Antonino Cammarata
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Alessandro Izzo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | | | - Carlo Curcio
- A.O. dei Colli - Hosp. Monaldi - Thoracic Surgery Unit, Naples, Italy
| | - Carmine Guarino
- A.O. dei Colli - Hosp. Monaldi - Bronchology Unit, Naples, Italy
| | - Edoardo Grella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Imma Forzano
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Antonio Cennamo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Naples, Italy
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12
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Yokoyama Y, Hata K, Kanazawa T, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Watanabe T. Giant solitary fibrous tumor of the pelvis successfully treated with preoperative embolization and surgical resection: a case report. World J Surg Oncol 2015; 13:164. [PMID: 25924672 PMCID: PMC4417519 DOI: 10.1186/s12957-015-0578-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/06/2015] [Indexed: 01/14/2023] Open
Abstract
Solitary fibrous tumors (SFTs) rarely develop in the pelvis. When they do arise, they are usually treated using surgery, although SFTs are often very large by the time of diagnosis, which makes surgical excision difficult. We report a case of a 63-year-old man who was referred to our hospital for the treatment of a giant tumor of the pelvis. Computed tomography (CT) revealed a 30 × 25 × 19 cm sized hypervascular tumor that almost completely filled the pelvic cavity. The diagnosis of SFT was made by CT-assisted needle biopsy. The feeding arteries of the tumor were embolized twice. The first embolization aimed to reduce the tumor volume, while the second one was planned a day prior to the surgery to obtain hematostasis during the operation. Tumor resection was then performed. The blood loss during the operation was 440 ml, and there was no uncontrollable bleeding. The postoperative course was uneventful. No recurrence of SFT was observed during a 2-year follow-up.
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Affiliation(s)
- Yuichiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keisuke Hata
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takamitsu Kanazawa
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hironori Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Soichiro Ishihara
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Eiji Sunami
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Joji Kitayama
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toshiaki Watanabe
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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13
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Liu B, Liu L, Li Y. Giant solitary fibrous tumor of the pleura: A case report. Thorac Cancer 2015; 6:368-71. [PMID: 26273386 PMCID: PMC4448389 DOI: 10.1111/1759-7714.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/07/2014] [Indexed: 11/26/2022] Open
Abstract
A 62-year-old male farmer weighing 79 kg was taken to a hospital after experiencing exertional dyspnea and shortness of breath for a month. A chest roentgenogram and computed tomography showed a giant mass in his right thorax. A CT-guided biopsy demonstrated a solitary fibrous tumor of the pleura (SFTP). Because of the large size of the tumor and the substantial pleural effusion in the right hemithorax, the patient was referred to our institution for radiofrequency ablation. After one month, we performed an exploratory thoracotomy to dissect the giant mass with the right, middle, and lower lobes. The measurement of the tumor was 20 cm × 18 cm × 13 cm and it weighed 3250 g. The histopathology of the resected specimen confirmed SFTP. The patient had no postoperative complications; six months after surgery, no recurrence occurred.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University Beijing, China
| | - Yuanbo Li
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University Beijing, China
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14
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Kamata T, Sakurai H, Nakagawa K, Watanabe SI, Tsuta K, Asamura H. Solitary fibrous tumor of the pleura: morphogenesis and progression. A report of 36 cases. Surg Today 2015; 46:335-40. [PMID: 25893773 DOI: 10.1007/s00595-015-1176-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/19/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE We attempted to identify the exact point of tumor eruption of a solitary fibrous tumor of the pleura (SFTP). METHODS We morphologically classified 36 SFTPs into 5 categories. Type A showed a connection that included a bloodstream with the pleura on both sides. Type B only showed a connection that included a bloodstream with the visceral pleura, and had a non-bloodstream connection with the parietal pleura. Type C only showed a connection that included a bloodstream with the visceral pleura, and had no connection with the parietal pleura. Type D showed a non-bloodstream connection with the visceral pleura, and only showed a connection that included a bloodstream with the parietal pleura. Finally, type E had no connection with the visceral pleura, and only showed a connection that included a bloodstream with the parietal pleura. The clinicopathological profiles of the tumors were investigated according to their type. RESULTS The distribution of the 36 SFTPs was as follows: A (19 %), B (6 %), C (67 %), D (0 %) and E (8 %). The tumors categorized as type A tended to be large in size. CONCLUSIONS SFTPs commonly arise from the visceral pleura and in accordance with tumor progression they will form a non-bloodstream connection with the parietal pleura. Finally, a vascular pedicle will arise with the parietal pleura.
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Affiliation(s)
- Tsugumasa Kamata
- Division of Thoracic Surgery, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-Ku, Tokyo, 104-0045, Japan.,Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Hiroyuki Sakurai
- Division of Thoracic Surgery, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Kazuo Nakagawa
- Division of Thoracic Surgery, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shun-ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, 1-1 Tsukiji 5-chome, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Koji Tsuta
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Hisao Asamura
- Department of Surgery, Division of General Thoracic Surgery, School of Medicine, Keio University, Shinjuku-Ku, Tokyo, Japan
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