Solitary fibrous tumour of the pleura: an incidental finding

We herein report a relatively rare case of a woman in her 30s with an incidental lung finding. She subsequently underwent resection for what was considered to be a solitary fibrous tumour of the pleura (SFTP). SFTPs are rare, slow-growing neoplasms from mesenchymal origin. These tumours are histologically characterised by proliferation of bland-looking spindled cells, arranged in a patternless pattern, with hypocellular and hypercellular areas set in a hyalinised stroma. Complete en bloc surgical excision (with margin negativity) is the treatment of choice for both benign and malignant SFTPs. Due to the possibility of local recurrence with benign and malignant SFTPs, clinical and radiological follow-up is recommended.

Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis

BACKGROUND

The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed.

METHODS

This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation).

RESULTS

Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04).

CONCLUSIONS

The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC.