Solitary fibrous tumor of the mediastinum. A report of 14 cases

Fourteen cases of a mediastinal neoplasm identical to solitary fibrous tumor (so-called fibrous mesothelioma) of the pleura were observed. The lesions presented with cough, chest pain, dyspnea, or as asymptomatic masses detected radiographically. Two patients had associated hypoglycemia. Eleven of the tumors were in the antero-superior mediastinum. One arose on a pedicle from the thymus, and another had entrapped thymic elements. Tumor cells were variably immunoreactive for vimentin and actin, but not for keratin, and lacked ultrastructural evidence of mesothelial or epithelial differentiation. Eight cases had highly cellular mitotically active regions of which six of seven with follow-up behaved aggressively; the exception was the pedunculated tumor. A 13-cm, histologically bland tumor has recurred twice. Aggressive behavior was more common than reported for solitary fibrous tumor of the pleura, but the same criteria (size, cellularity, mitotic activity, presence of pedicle) were of prognostic significance. The occurrence of solitary fibrous tumor in the mediastinum with the suggestion of thymic origin for some cases, combined with the immunohistochemical and ultrastructural findings, support a mesenchymal origin for this tumor. The differential diagnosis includes spindle cell thymoma, hemangiopericytoma, and peripheral nerve tumors.