Benign localized fibrous tumor of the pleura: report of 25 new cases

Our plain-English summary of Benign localized fibrous tumor of the pleura: report of 25 new cases, by S. Enon, D. Kilic, C. Yuksel, et al (The Thoracic and Cardiovascular Surgeon, 2012).

The study

• Authors: S. Enon, D. Kilic, C. Yuksel, A. Kayi Cangir, S. Percinel, S.D. Sak, A. Gungor, S. Kavukcu, I. Okten
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 2012;60(7):468-73
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Benign localized fibrous tumors (BLFT) of the pleura are very rare slow-growing neoplasms that generally have a favorable prognosis. The aim of this manuscript is to evaluate the predictors of outcome with the review of the literature in a series of 25 patients with BLFT.

Methods: Between January 1985 and November 2009, 25 patients underwent an operation due to BLFT. Of these patients, 14 (56%) were male; mean age was 41.1 (25 to 64) years. All patients underwent thoracotomy. Left thoracotomy approach was used in 16 patients. The mass lesions were totally excised. The histopathological examinations were performed with hematoxylin-eosin and immunohistochemical staining methods.

Results: Of the patients, 18 (72%) were symptomatic. Symptoms were cough in 36%, shortness of breath in 32%, and chest pain in 20% of the patients. One patient (4%) appeared to have some symptoms (pain and swelling of the joints) associated with pulmonary osteoarthropathy. Seven patients (28%) underwent an operation due to mass lesion detected at routine control visits. None of the patients had a history of exposure to asbestos. Radiological investigations revealed 16 (64%) mass lesions in the left. Of the lesions found on exploration, 5 (20%) were intrapulmonary localized lesion without pedicle and 20 were pedicled. Of the pedicled masses, 5 were connected to parietal pleura and 15 to visceral pleura and all were intrathoracic extrapulmonary localized lesions. Eight (32%) lesions connected to left lower lobe. Additionally, three pedicled lesions were located in the lung fissure. Pedicled lesions were totally excised together with their pedicles. Intraparenchymal mass lesions were resected using wedge resection. The diameter of the resected masses was ranging between 3 and 22 cm (mean: 8.7). Macroscopically, all were encapsulated with a homogeneous cut surface. Intraoperative mortality and morbidity was not observed. The average hospitalization duration for all patients was 8.6 days (5 to 12). The mean follow-up was 33.6 (9 to 142) months with no recurrence.

Conclusions: Benign localized fibrous tumors are uncommon and treated by surgical means. According to our data obtained from literature review, clinicians should be aware of recurrence possibility even after complete resection of benign localized fibrous tumor and the risk of malign transformation.

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In plain English

This article reported on 25 patients who had surgery for a benign localized fibrous tumor of the pleura, a rare tumor of the lining of the chest. They were treated at the authors' clinic in Ankara, Turkey, between January 1985 and November 2009, and the authors also reviewed the medical literature. Of the patients, 14 were male and 11 female. None had a history of exposure to asbestos. Eighteen patients (72%) had symptoms, most often cough (36%), shortness of breath (32%) and chest pain (20%). Seven (28%) had a mass found at routine check-ups. All tumors were removed through open chest surgery (thoracotomy). They measured 3 to 22 cm across (mean 8.7 cm). Twenty were attached by a stalk (pedicle) and 5 lay within the lung. Tissue staining in 22 patients was consistent with the benign diagnosis. There were no postoperative complications, no deaths during the operations, and no recurrence over a mean follow-up of 33.6 months. The authors said this follow-up was relatively short. Based on their literature review, they concluded that clinicians should be aware these tumors can recur after complete removal and can become malignant.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of patients operated on at one clinic, combined with a review of the literature
• Who was studied: 25 patients operated on with a diagnosis of benign localized fibrous tumor of the pleura at the authors' clinic (Ankara, Turkey), January 1985 to November 2009; 14 (56%) male and 11 (44%) female; mean age reported as 41.08 (25 to 64) years in the methods
• Exposure: Asbestos was not an exposure in this series: none of the 25 patients had a history of asbestos exposure. The study concerned surgical treatment of the tumor.
• Main results:
  • Of the 25 patients, 18 (72%) had symptoms: cough in 36%, shortness of breath in 32%, chest pain in 20%
  • Seven patients (28%) were operated on because of a mass found at routine control visits
  • All operations were performed by thoracotomy (open chest surgery)
  • 16 (64%) masses were in the left side of the chest and 9 (36%) in the right
  • 5 tumors were inside the lung without a pedicle and 20 were pedicled (5 attached to parietal pleura, 15 to visceral pleura)
  • Resected tumors measured 3 to 22 cm in diameter (mean 8.7 cm)
  • Immunohistochemical staining was done in 22 patients (tissue blocks unavailable for 3). It was positive for CD34 and Vimentin and negative for Desmin, SMA and S-100, which the authors said was consistent with the diagnosis.
  • No patient had postoperative complications and there was no intraoperative mortality
  • Mean postoperative follow-up was 33.6 (9 to 142) months, with no recurrence observed
• The authors' conclusion: The authors concluded that, based on their literature review, clinicians should be aware that these tumors can recur even after complete resection and carry a risk of malignant transformation. They also stated that pedicle presence and large tumor size were not prognostic factors in their series.
• Limitations the authors state:
  • The authors attributed the absence of recurrence possibly to the relatively short mean follow-up, compared with series in which recurrence or malignant transformation was seen

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Pleura, Neoplasm, Prognosis, Thoracotomy, Immunohistochemistry, Parietal Pleura, Visceral Pleura.

Related studies

• Solitary benign fibrous tumors of the pleura — M.A. Regal, A.M. Al Rubaish, et al. (2008)
• Localized malignant pleural mesothelioma — T. Nakano, R. Hamanaka, et al. (2012)
• Huge malignant solitary fibrous tumor of the pleura — W.A. Arab, D. Lamoth, et al. (2012)
• Solitary fibrous tumor of the pleura — A. Orki, A. Kosar, et al. (2008)
• Solitary fibrous tumors of the pleura: a case report and review of the literature — P. Mordenti, R. Di Cicilia, et al. (2013)
• Solitary fibrous tumor of the pleura: 3 case reports — E. Amorim (2015)

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