Localized fibrous tumor of the pleura

Resection of a giant thoracic solitary fibrous tumor treated with preoperative arterial coiling followed by a double-level thoracotomy

Solitary fibrous tumor (SFT) are rare pleura neoplasms often localized to middle or inferior hemithorax. A middle-aged woman presents to the emergency department following a motor vehicle accident, the computed tomography scan revealed a giant tumor occupying the entire left pleural cavity with a complete collapse of the left lung and substantial right deviation of heart and mediastinum. Using preoperative arterial coiling followed by a double-level thoracotomy we successfully resected the giant tumor. The SFT weighed ~10 lbs. At 2-month follow-up visit patient reports mild discomfort during strenuous movement/heavy lifting but denies any shortness of breath.

A Giant Solitary Fibrous Tumour of the Pleura

A solitary fibrous tumour of the pleura (SFTP) is a rare pathology, frequently benign in nature, and is usually diagnosed incidentally on imaging. We herein describe the case of a previously fit and well, 35-year-old Caucasian lady, who presented to us with a history of progressively worsening shortness of breath. Her chest X-ray showed a near-complete opacification of the right hemithorax, with displacement of the mediastinum towards the left. This study was supplemented by a computed tomography (CT), which demonstrated a well-circumscribed, non-homogenous mass, occupying the entirety of the right hemithorax. A large, smooth, encapsulated tumour was surgically resected via a posterolateral thoracotomy, measuring approximately 23.1 cm x 21.0 cm x 11.5 cm and weighing 3640 grams. Histopathology confirmed the diagnosis of a benign SFTP with an intermediate malignant potential. At six months, a follow-up CT scan demonstrated no evidence of disease recurrence.

Solitary fibrous tumor of the pleura mimicking a soft tissue sarcoma of the chest wall

Introduction and importance

Solitary fibrous tumors of the pleura (SFTPs) present a diagnostic challenge. We herein report a successful case mimicking a soft tissue sarcoma of the chest wall by a meticulous evaluation of the conventional images.

Case presentation

A 51-year-old woman presented with a left thoracic mass. The mass exhibited an extrapleural sign, which suggested a chest wall origin. However, the mass was found to be located more caudally by additional computed tomography. This positional change suggested that the mass was pedunculated from the visceral pleura, and an SFTP was suspected. The mass was found to originate from the visceral pleura of the left lower lobe and a pathological diagnosis of an SFTP was confirmed.

Clinical discussion

Although a positional shift with a postural change or the respiratory phase is a well-known characteristic radiological finding, such an intentional imaging study is available only for suspicious cases of SFTPs.

Conclusions

SFTPs pose a diagnostic challenge because of their rarity and the lack of specific radiological findings. Even conventional radiological images can be diagnostic by performing a meticulous evaluation regardless of any specific diagnosis being initially assumed.

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Solitary Fibrous Tumor of the Pleura (SFTP) poses a diagnostic challenge because of their rarity and the lack of specific radiological findings.

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The positional shift with a postural change or the respiratory phase is one of the most characteristic radiological findings, but would be feasible only in the suspicious cases of SFTP.

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Even conventional radiological images can be diagnostic by performing a meticulous evaluation regardless of any specific diagnosis being initially assumed.

Postoperative Radiotherapy for the Treatment of Solitary Fibrous Tumor With Malignant Transformation of the Pelvic: A Rare Case Report With Literature Review

Solitary fibrous tumor of the pelvic is an uncommon neoplasm with nonspecific symptoms. Reports of malignant transformation are especially rare. We report a case of solitary fibrous tumor in pelvic. A unique feature of our case compared with previously reported is that this patient relapsed with malignant transformation and had significant response to radiotherapy. The patient was initially treated with surgery, followed by postoperative dimensional conformal intensity modulated radiation therapy (dynamic MLC VRIAN 23EX Linac, inversely optimized by the Eclipse system) to provide a radical cure for residual tumor.In this case, there were no signs of recurrence after six and a half years of further follow-up, indicating that postoperation radiotherapy may be an effective treatment for SFT with malignant transformation in pelvic.

Pictorial essay of radiological features of benign intrathoracic masses

With increased exposure of patients to routine imaging, incidental benign intrathoracic masses are frequently recognized. Most have classical imaging features, which are pathognomonic for their benignity. The aim of this pictorial review is to educate the reader of radiological features of several types of intrathoracic masses. The masses are categorized based on their location/origin and are grouped into parenchymal, pleural, mediastinal, or bronchial. Thoracic wall masses that invade the thorax such as neurofibromas and lipomas are included as they may mimic intrathoracic masses. All examples are illustrated and include pulmonary hamartoma, pleural fibroma, sarcoidosis, bronchial carcinoid, and bronchoceles together with a variety of mediastinal cysts on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Sometimes a multimodality approach would be needed to confirm the diagnosis in atypical cases. The study would include the incorporation of radionuclide studies and relevant discussion in a multidisciplinary setting.

Solitary fibrous tumor originating in the pelvis: a case report

A 52 year old male presented with changes in bowel movements, and a mass was detected on digital rectal exam. Both CT and MRI revealed a large pelvic and gluteal mass filling the pelvic cavity displacing the adjacent pelvic structures. After surgical removal, pathology revealed solitary fibrous tumor; a rare neoplasm uncommonly discovered in the thorax, and even less commonly in extrapleural locations. We discuss in this article imaging findings and histological features of extrapleural solitary fibrous tumor.

Tumor fibroso localizado de la pleura: hallazgos radiológicos

Localized fibrous tumors of the pleura are rare tumors that represent less than 5% of the pleural tumors, although they have also been described in extrathoracic locations such as the abdomen, head and neck or central nervous system. A total of 80% begin in the visceral pleura and are not related with environmental risk factors. They generally occur in patients over 50 with a mild predominance in the woman. Up to 50% of the patients are asymptomatic, so that it appears as an incidental finding on the chest X-ray. These are slow growing tumors. They are seen on the X-ray as well-defined rounded lesions dependent on the pleura and 50% are pediculated. It is important to know its radiological characteristics for its diagnosis of suspicion and correct treatment since surgical resection is generally curative. Local recurrence after the surgery is very common if it is not completely excised.

From the archives of the AFIP: Localized fibrous tumor of the pleura

Eighty-two localized fibrous tumors of the pleura (LFTP) were reviewed retrospectively for the clinical, pathologic, and radiologic findings. Forty-four women and 38 men ranged in age from 17 to 78 years (mean, 54.7 years). Sixty-four benign LFTP ranged in size from 2 to 30 cm (mean, 13.2 cm), and 18 malignant tumors ranged from 3 to 23 cm (mean, 14.4 cm). Forty-eight patients (60%) presented with symptoms. Radiographs of 76 patients demonstrated solitary masses occupying or extending into the inferior hemithorax (79%). Computed tomography (CT) of 78 lesions demonstrated lobular masses (83%) that formed at least one acute angle (96%) or only acute angles (65%) with the adjacent pleura. Heterogeneous lesion attenuation was documented in 88% of enhanced and in 68% of unenhanced CT scans. Contrast enhancement was common (62% of cases). Magnetic resonance (MR) imaging of 18 lesions demonstrated heterogeneous signal intensity on both T1- and T2-weighted images (78% and 83%, respectively). Multiplanar MR imaging allowed visualization of the diaphragm and documentation of an intrathoracic mass in all cases. LFTP are solitary lobular heterogeneous masses that occur in symptomatic adults and often affect the inferior hemithorax. Malignant lesions are radiologically indistinguishable from those with benign histologic characteristics. Radiographic and CT features characteristic of pleural location are typically absent.