Giant solitary fibrous tumour of pleura -an uncommon intrathoracic entity- a case report and review of the literature

A Recurrent Solitary Fibrous Tumor With an Exceptional Response to Low-Dose Radiotherapy: A Case Report and Literature Review

Solitary fibrous tumor (SFT) is a soft tissue tumor derived from mesenchymal cells. We report a case of a giant SFT with insulin-like growth factor 2 (IGF-2) production in the pelvis of an 85-year-old male. SFT was diagnosed in surgery for a complaint of left lower abdominal distension. Subsequent tumor recurrence and progression caused rectal passage obstruction and hypoglycemia. Low-dose radiotherapy of 15 Gy in five fractions was started five years and four months after surgery, initially for a huge tumor around the rectum to improve rectal passage obstruction. The tumor volume shrank from 1054 cc before irradiation to 449 cc at one month and 396 cc at 10 months after irradiation. He had reached 90 years old at that time. Two months after the initial irradiation, similar radiotherapy of 15 Gy in five fractions was performed for a huge tumor in the right abdominal cavity. This tumor decreased from 1874 cc before irradiation to 615 cc at two months and 556 cc at seven months after irradiation. Dexamethasone (2.5 mg) was used for paraneoplastic syndrome at the time of initial radiation but was then reduced and became unnecessary two months after the second irradiation. Acute and late adverse events were mild. The patient is alive 60 months after the first irradiation. This case suggests that low-dose radiotherapy is beneficial as palliative therapy for symptom relief in patients with SFT.

Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors

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.

The Diagnosis of Pleural Tumors Other Than Mesothelioma

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

CONCLUSIONS

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

Giant solitary fibrous tumour of the pleura an unpredictable entity: case series and literature review

A small proportion of tumours can undergo malignant transformation. We report a case series of five patients diagnosed with giant solitary fibrous tumours of the pleura. These cases highlight the unpredictable nature of this disease process, with significant variability in clinical course observed, from indolence to aggressive progression. Three patients were found to have malignant disease on explant, with two of these having preoperative imaging and histology suggesting benign pathology. This finding emphasises that accurately differentiating between benign and malignant disease on imaging and/or biopsy has low specificity and sensitivity and cannot be relied upon in guiding the management of these tumours. Patients with solitary fibrous tumours of the pleura should be managed cautiously, owing to the unpredictable and potentially aggressive clinical course. We would advocate the position that all patients with solitary fibrous tumours of the pleura should be managed as if they have malignant disease. Prolonged follow-up is required due to the risk of disease recurrence, even in patients with benign disease.

Solitary fibrous tumour: a rare tumour of the pleural cavity

Solitary fibrous tumours are a rare group of tumours that originate from connective tissues such as the pleura and mediastinum. When growing within the thoracic cavity these tumours exert pressure on vital organs and large vessels. We have successfully operated on two patients with large solitary fibrous tumours and managed the pathophysiological changes manifested as superior vena cava syndrome resulting from these tumours.

Solitary Fibrous Tumor - Less Common Neoplasms of the Pleural Cavity

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.

Malignant pleural mesothelioma signs and symptoms

Malignant pleural mesothelioma (MPM) is developed from mesothelial cells and its behavior depends on the degree of pleural invasion and adjacent organs. This extension around the pleural cavity or more unlikely located on a limited area leads to clinical signs as dyspnea, shortness of breath, cough or chest pain. The relationship between asbestos exposure and MPM has been well established. The symptoms of MPM usually appear 30–40 years after exposure to asbestos. Consequently, patients are unaware that the clinical presentation is related to their clinical exposure which happened much earlier in their lives. Clinical manifestations of MPM are usually nonspecific and should not be used alone as diagnostic criteria, even in case of previous asbestos exposure as recommended by the ERS guidelines.

Giant solitary fibrous tumor of the pleura: A case report

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.

Renal malignant solitary fibrous tumor with single lymph node involvement: report of unusual metastasis and review of the literature

Solitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway.

Primary pleural squamous cell carcinoma misdiagnosed as localized mesothelioma: a case report and review of the literature

Primary pleural squamous cell carcinoma is very rare, and there is a lack of experience in the diagnosis and treatment of this condition. An asymptomatic 75-year-old man was referred to us after a right pleural nodule was found on computed tomography during a routine health examination. He underwent surgery for his pleural tumor twice over the following 2 years. Histopathological examination eventually led to a diagnosis of primary pleural squamous cell carcinoma.

An elusive chest coin in an African child: a pleural fibroma's long, tortuous path to freedom

Fibrous tumour of the pleural is rare and controversial tumor. Most of the reported cases is adults and the elderly. This case presentation is a solitary fibrous tumour in a fifteen year old girl, which to the best of our knowledge is the youngest report, who was sent for a psychiatric evaluation due to persistent complaint of “movement” in her chest, later referred to a tuberculosis clinic because of a chest radiograph report of loculated pleural effusion likely secondary to tuberculosis. She eventually had a chest computerized tomography and subsequent resection of the lesion. Histology confirmed the computerized tomography diagnosis of solitary fibrous tumour and there was no recurrence five years after excision. This report highlights the difficulty often encountered in developing countries where clinicians solely rely on clinical acumen for diagnosis and treatment due to poor patients’ financial status and scarcely available diagnostic resources.