Contralateral recurrence of a malignant solitary fibrous tumor of the pleura

We present an unusual case of a contralateral recurrence of malignant solitary fibrous tumor of the pleura (SFTP) nine years after a complete resection. Recurrence of malignant SFTP has already been described, but is usually localized. In our case the patient underwent surgical resection for a malignant SFTP of the left upper lobe in 2000. Nine years later computed tomography (CT)-scans showed lesions that were suspicious of tumor recurrence in the right lung. Thoracoscopy, wedge-resections and pathological findings revealed four nodules of a malignant SFTP of the right middle and lower lobe, histopathologically identical to the tumor, which had been resected nine years ago. A coincidental mucinous bronchioloalveolar carcinoma of the left lower lobe was resected by thoracotomy. To our knowledge this is the first report of contralateral recurrence of a malignant SFTP years after complete resection in the literature. The possibility of a new primary tumor on the right with local metastasis could not be excluded in the clinical and histopathological examinations. Therefore, contralateral recurrence of malignant SFTP should be considered in the postoperative follow-up even years after complete resection.     

Resection of a giant, invasive malignant solitary fibrous tumor of pleura

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13?cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle ??-actin. SFTPs have malignant potential, as 20?C30?% of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.     

电视胸腔镜手术治疗胸膜孤立性纤维瘤的临床分析

目的探讨电视胸腔镜手术（VATS）治疗胸膜孤立性纤维瘤（SFTP）的价值,总结微刨治疗经验。方法1999年2月至2010年10月VATS治疗SFFP患者19例,其中全胸腔镜手术14例,胸腔镜辅助小切口（6～8cm）手术3例,胸腔镜联合后外侧大切口（15cm）手术2例。结果全组均完整切除肿瘤,手术顺利,无并发症及围手术期死亡。术中证实13例肿瘤起源于脏层胸膜有蒂,5例起源于壁层胸膜无蒂宽基底,1例起源于纵隔胸膜有蒂。主要诊断依据免疫组化分析,19例患者的Vimentin和CD34均阳性表达;病理诊断良性17例,恶性2例。平均住院时间6d（4-11d）。术后平均随访51个月,无复发和转移。结论VATS创伤小,可作为治疗SFTP的首选方法,值得推荐。     

Solitary fibrous tumor of the pleura with a minute malignant component and diaphragmatic vascular supply: Report of a case

We resected a fist-sized, solitary fibrous tumor of the pleura (SFTP) with a minute malignant component, following percutaneous embolization of its feeding artery. The tumor had macroscopic characteristics of a benign SFTP, and most parts of it were microscopically benign. However, further careful pathological examination revealed a minute malignant component in its periphery. We report this case to show that large and mostly benign SFTPs may contain malignant components, which can be overlooked. Thus, large SFTPs should be resected in consideration of this possibility.     

Solitary fibrous tumor of the pleura with hemothorax at the thoracic apex

A 31-year-old man was referred to our hospital with a diagnosis of a left lung mass and substantial pleural effusion. 1,300mL of blood was drained. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a hypervascular, round shaped mass, 9cm in diameter occupying the left thoracic apex. The mass was broad-based, arising from the area of antero-lateral parietal pleura at the level of the thoracic apex and the first rib. The tumor was successfully resected via median sternotomy and left first intercostal thoracotomy without either claviculectomy or claviculotomy. For the complex surgical access and the tumor's hypervascularity, a careful operative procedure was needed to avoid massive bleeding. The tumor was diagnosed microscopically and immunohistochemically as a solitary fibrous tumor of the pleura and did not meet the criteria for malignancy.     

Malignant solitary fibrous tumor in the pleura.

We present a case of malignant solitary fibrous tumor of the pleura in an asymptomatic 75-year-old man. A needle biopsy specimen revealed a solitary fibrous tumor of the pleura with suspected. The tumor was resected and the final diagnosis was a malignant solitary fibrous tumor. At one-and-a-half years later, the patient has no clinical or radiological evidence of recurrence. The propriety of a needle biopsy for preoperative diagnosis is discussed.     

Giant solitary fibrous tumor of the pleura

Primitive neoplasms of the pleura are uncommon. Solitary fibrous tumor of the pleura (SFTP) is a benign variety of primitive pleural tumor, which is usually asymptomatic and discovered as an incidental finding. However, these tumors can sometimes become locally aggressive and can even be life-threatening. The treatment of choice is surgical resection. We report a case of SFTP in a 78-year-old woman with no relevant history, who presented with marked respiratory insufficiency and who required extended posterolateral thoracotomy to achieve complete resection of an SFTP weighing 2 kg.     

Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura.

OBJECTIVE: Solitary fibrous tumours of the pleura (SFTP) are rare and can histologically be differentiated into benign and malignant forms. The aim of this study is to present new cases, and discuss up-to-date preoperative examinations, the role of video-assisted thoracic surgery and long-term outcome. METHODS: Between 1993 and 2006, 27 SFTPs were diagnosed (14 females, mean age+/-SD, 62.3+/-9.6 years) at our institution. Medical records were reviewed, and follow-up was obtained by repeated examinations or contact with general practitioners. RESULTS: SFTPs were associated with symptoms in 63% of all cases. In the six patients in which positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) was performed preoperatively, malignant lesions were all found to be positive. Complete resection was achieved by video-assisted thoracic surgery in 15 and anterolateral thoracotomy in 12 patients. Mean hospital stay was shorter for patients operated by video-assisted thoracic surgery compared to thoracotomy, 4.5 (range 3-6) versus 7.5 (range 4-25) days, respectively (p<0.01). Histology revealed 17 benign and 10 malignant SFTP. Mean+/-SD tumour diameter of malignant SFTPs was larger than in benign forms, 11.9+/-7.1 versus 6.1+/-3.5 cm, respectively (p<0.01). Tumour recurrence was recognised in four patients with malignant SFTPs at a median time interval after surgery of 38 (range 6-122) months, two late deaths occurred resulting from tumour recurrences. CONCLUSIONS: SFTPs can be treated minimally invasively by video-assisted thoracic surgery with short hospital stay. Large SFTPs with increased FDG-uptake have a high likelihood for malignancy. Long-term follow-up is mandatory in malignant SFTPs because of late recurrences associated with death.     

Outcome of surgical intervention for isolated intrathoracic lymph node metastasis from infradiaphragmatic malignancy: report of two cases.

We report 2 cases with isolated intrathoracic lymph node involvement. This is an unusual manifestation of metastatic spread from an extrathoracic malignancy. Case 1 was a 47-year-old female with a history of radical hysterectomy for cervical cancer of the uterus. Left intrathoracic lymphadenopathy was detected during follow-up. These lesions were surgically removed and diagnosed as multiple lymph node metastases. Two years later, right intrathoracic lymphadenopathy was evident and excised again. Eight months after the re-thoracotomy, retroperitoneal recurrence appeared and she died of the disease. Case 2 was a 41-year-old female with a history of resection of sigmoid colon cancer with liver metastases. A solitary nodule in the left upper lobe was shown by a chest computed tomography (CT). Left upper lobectomy was performed and the lesion was diagnosed as a solitary lymph node metastasis. She has had no recurrence for 3 years since thoracotomy.     

胸膜孤立性纤维瘤的诊治

目的 探讨胸膜孤立性纤维瘤的诊断和治疗方法.方法 回顾性分析2002年至2007年10例胸膜孤立性纤维瘤病人的临床和病理资料.10例中男3例,女7例.术前行超声引导下粗针穿刺活检明确诊断2例.全组均行手术治疗,其中3例行胸腔镜手术切除.结果 组织病理学报告,良性和恶性肿瘤各5例;恶性肿瘤CD34表达阳性率较低(3/5例),其中CD34阴性者nestin表达均阳性.失访1例,其余9例随访6～35个月,平均17.3个月,复发1例,死于脑转移1例.结论 超声引导下粗针穿刺结合免疫组化检查是术前明确诊断的一种较好方法.对于较小带蒂的肿瘤,胸腔镜手术是最佳手术方法.CD34阴性,同时nestin表达阳性可能是胸膜孤立性纤维瘤的一个恶性指标.     

Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.     

Giant pleural fibroma with an abdominal vascular supply mimicking a pulmonary sequestration

A 37 -year-old woman was found to have a giant mass in her right chest with an abnormal abdominal vascular supply at preoperative workup. Suspecting a pulmonary sequestration, the lesion was embolized and then removed through a standard thoracotomy. A broad-based, vascularized pedicle connected the mass to the diaphragm. Final pathology demonstrated a solitary fibrous tumor of the pleura with no malignant features. We believe this is the first case of solitary fibrous tumor of the pleura with a direct vascular supply from the abdominal aorta at the level of the renal arteries reported in the literature.     

Metastatic renal clear cell carcinoma mimicking stage IV lung cancer

We present a 63-year-old man who wasinvestigated for a lesion in the apex of theleft lung and a coexisting osteolytic lesion inthe right major trochanter. FNA of the thoracicmass was suggestive for malignancy yet notdiagnostic regarding the tumor type and thesite of the primary tumor. A diagnosis of astage IV lung cancer was favored and heunderwent a left exploratory thoracotomy inview to resect the primary tumor. Anextrapulmonary mass localized to the pleura notinvolving the ipsilateral lung was disclosed.Multiple biopsies revealed metastatic clearcell RCC. A 5×7 cm left renal tumor wasrevealed in a postoperative abdominal CT scan.He was treated with combination of interferon Aand vinblastin followed by radical nephrectomy.Twenty-four months after the diagnosis he is alivewithout evidence of local or distant recurrence.Pleural metastases from RCC are mainlypresented as malignant pleural effusions.Thoracic metastatic lesions localized to thepleura, forming solitary or multiple mass(es)have been rarely reported. We review theliterature regarding this rare clinicalmanifestation of the disease and we discussdiagnostic and therapeutic options.     

Solitary Fibrous Tumor of the Pleura: An Analysis of 13 Cases

BACKGROUND: Solitary fibrous tumor of the pleura is a rare soft-tissue tumor. In search of appropriate diagnosis and treatment methods, we present our experience with 13 patients. METHODS: The medical charts of 13 patients treated during the last 5 years were reviewed, as well as pathological records, including immunohistochemical stains. Follow-up data were obtained. In addition, a literature review with regard to treatment and clinical outcome was performed. RESULTS: Our series consisted of four men and nine women with a mean age of 47 years. Two were diagnosed before operation with ultrasonography-guided core needle biopsy. All patients underwent primary surgical treatment, and four of them were resected by video-assisted thoracic surgery. Seven tumors were malignant and the other six were benign. Immunohistochemical staining showed nestin was positive in three malignant solitary fibrous tumors of pleura (3/7), which were negative for CD34. Except for one, all patients were followed-up for 3 to 35 (mean, 14.5) months. Among them, one patient experienced a recurrence and one patient died of brain metastasis. CONCLUSION: Ultrasonography-guided core needle biopsy combined with immunohistochemical analysis might be a safe and rapid method to provide a confirmatory diagnosis before resection. For smaller, pedunculated tumors, video-assisted thoracic surgery could be a powerful and useful approach. We speculate that CD34-negative and nestin-positive might be a malignant marker for solitary fibrous tumor of pleura.     

A case of localized fibrous tumor of the pleura after four years follow up and evaluate the doubling time with computed tomography]

Thirty-five-year female had taken video assisted thoraco-surgery (VATS) and resected her localized fibrous tumor of parietal pleura. She suspected chest tumor with annual X-ray survey for lung disease four years ago. She complained of left side back pain recently. Her chest CT revealed that the tumor enlarged than before. She was performed video assisted thoraco-surgery. The tumor was solid hard and connected to the parietal pleura with pedicle, which was resected easily from her pleural cavity. Histrogical examination detected that her tumor was localized fibrous tumor of parietal pleura. CD 34 and Vimentin were positive and cytokeratin was negative in this case. Four year and two examinations of the chest CT later, we could determine the doubling time (800.7 days) of localized fibrous tumor in this case.     

Huge localized mesothelioma of the diaphragm in a 17-year-old Female — a case report with calculated tumor volume doubling time —

An operative case of localized mesothelioma of the pleura developed in a 17-year-old female was reported. She was admitted to our hospital complaining of right chest pain. A chest X-ray film showed a huge mass in the right lower field of the lung. After the embolization of the right inferior phrenic artery, which was the main feeder to the tumor, it was then successfully resected combined with the right diaphragm and the right lower lobe of the lung. Histologicaly, the tumor was diagnosed as benign localized mesothelioma (solitary fibrous tumor of the pleura). Further histological and immunohistochemical study revealed that it had developed from the connective tissue under the parietal mesothelium of the diaphragm. As chest roentgenograms had been undertaken during past two years, the tumor volume doubling time was calculated at 153 days. Despite the short tumor volume doubling time as like primary lung cancer, she is alive without recurrence 5 years after the operation.     

Solitary fibrous tumor of the pleura with associated Doege–Potter syndrome

Doege–Potter syndrome is a paraneoplastic syndrome characterized by tumor-associated hypoglycemia secondary to a solitary fibrous tumor of the pleura. We present a case of an 84-year-old man, who presented with acute mental confusion and therapy-resistant hypoglycemia. Diagnostic imaging revealed a large sharply defined pleural tumor based on the left diaphragm, after surgical resection the diagnosis was made of a malignant solitary fibrous tumor of the pleura and restoration of the glucose homeostasis was observed.     

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

A 43-year-old woman presented to us with progressive breathlessness, dry cough and weight loss. A chest radiograph showed homogeneous opacification of the entire left hemithorax. A contrast enhanced computed tomography (CECT) scan of the thorax showed a large intrathoracic mass occupying almost the entire left hemithorax and appeared grossly inoperable. A transcutaneous CT guided tru-cut biopsy revealed a solitary fibrous tumour. We reviewed the CT scans based on the biopsy report, and, in retrospect, the mediastinal vessels seemed more stretched and pushed by the tumor rather than directly infiltrated by it. We performed an exploratory thoracotomy and to our surprise, were able to dissect the mass quite easily off the mediastinum. She had an uneventful postoperative recovery, and the final histopathology confirmed a solitary fibrous tumor. We report this case to emphasize that a cursory clinico-radiological interpretation can dissuade surgical intervention in these patients.     

Solitary fibrous tumor of the liver with presenting symptoms of hypoglycemic coma

We report a patient with solitary fibrous tumor of the liver, a rare fibrous neoplasm which to our knowledge has been reported in only 21 patients in the English literature. Most frequently, solitary fibrous tumors arise in the thoracic cavity, particularly in the pleura. Hypoglycemia has rarely been associated with these mesenchymal tumors. The presentation of this patient with hypoglycemic coma without preceding symptomatology, to our knowledge, has never been reported.     

肾孤立性纤维瘤1例报告并文献复习

目的:探讨肾孤立性纤维瘤(SFT)的临床病理学特征。方法:对我院收治的1例肾SFT患者的临床资料进行分析,并复习相关文献。结果:本例患者因左侧腰痛1个月入院,术前诊断为左肾肿瘤,行根治性左肾切除术,术后病理诊断为肾SFT,术后随访1年,未见肿瘤复发转移。结论:肾SFT临床罕见,治疗方法以手术治疗为主,最终依靠病理学检查结合免疫组化染色确诊,大部分为良性肿瘤,但也有少部分肾SFT为恶性,术后需长期随访。