Dyspnea with slow-growing mass of the left hemithorax

Our plain-English summary of Dyspnea with slow-growing mass of the left hemithorax, by N. Patel, A. Bishay, M. Bakry, et al (Chest, 2007).

The study

• Authors: N. Patel, A. Bishay, M. Bakry, L. George, A. Saleh
• Journal: Chest
• Published: 2007;131(3):904-908
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of a 65-year-old male patient who presented with gradually worsening dyspnea over 2 years. History was significant for smoking and the absence of any hazardous occupational exposure. The clinical findings at presentation included absent breath sounds and stony dullness on the left side, with tracheal deviation contralaterally and clubbing. A chest roentgenogram showed a left-sided opacity occupying almost the entire left hemithorax. A subsequent CT scan of the chest revealed an intrathoracic, extrapulmonary lesion producing a mediastinal shift. Surgical resection of the mass was performed, and pathology, along with immunohistochemical studies positive for CD34 and negative for epithelial markers, confirmed the diagnosis of solitary fibrous tumor of the pleura (SFTP). SFTP is a rare neoplasm, and diagnosis is often difficult. Suspicion of SFTP should arise in the setting of a patient presenting with a paucity of symptoms (except in the case of an accompanying paraneoplastic syndrome), the absence of exposure to asbestos, and a large mass with sharp margins and encapsulation seen on a chest radiograph.

In plain English

This case report described a 65-year-old man whose shortness of breath had gradually worsened over 2 years. He had quit smoking 25 years earlier and reportedly had no hazardous occupational exposure. On examination, left-side breath sounds were absent and his windpipe was pushed to the right. A chest X-ray showed an opacity filling almost three quarters of the left chest. A CT scan showed a large, solid mass arising from the pleura (the lining around the lung) that pushed central chest structures aside. The mass did not invade the ribs or lung and was surgically removed. Staining positive for CD34 and negative for cytokeratin confirmed a solitary fibrous tumor of the pleura. The authors judged that microscope findings strongly indicated the tumor was becoming malignant. Recovery required prolonged mechanical ventilation, and his breathlessness was notably improved a few months later. The authors concluded that this diagnosis should be considered when a patient has few symptoms (exceptions being a paraneoplastic syndrome or a tumor large enough to compress nearby structures), no asbestos exposure, and a large, sharply bordered, encapsulated mass on imaging.

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 report (single patient), followed by a discussion of published literature
• Who was studied: One 65-year-old man with shortness of breath (dyspnea) that had worsened over 2 years. The article does not state where or when he was treated. The authors were from New York Methodist Hospital, Brooklyn, NY, and St. John's Clinic, Springfield, MO.
• Exposure: No asbestos or other hazardous occupational exposure was reported for this patient. He was a former smoker who had quit 25 years before.
• Main results:
  • On examination the patient had absent breath sounds and stony dullness on the left side, tracheal deviation to the right, and clubbing.
  • The chest X-ray showed a large opacity occupying almost three quarters of the left hemithorax, with the trachea shifted to the right.
  • The CT scan showed a large, solid, pleural-based mass that pushed the mediastinum to the opposite side.
  • On CT there was no invasion of the ribs or lung tissue, and no calcification or pleural effusion.
  • After surgical removal, immunohistochemical staining was positive for CD34 and negative for cytokeratin, which confirmed solitary fibrous tumor of the pleura (SFTP).
  • The authors judged that high mitotic activity, cellular pleomorphism, necrosis and hemorrhage strongly indicated that the tumor, which may have been benign at first, was undergoing malignant transformation.
  • The patient had a difficult recovery and needed prolonged mechanical ventilation after surgery.
  • His dyspnea was notably improved at a follow-up visit a few months later.
• The authors' conclusion: The authors concluded that SFTP should be considered when three things are present. The first is a patient with few symptoms, with stated exceptions for a paraneoplastic syndrome or a tumor large enough to cause compression. The second is no exposure to asbestos. The third is a large, sharply demarcated, encapsulated mass on chest X-ray or CT. They added that tissue pathology with CD34 confirmation is necessary.
• Limitations the authors state:
  • No contrast CT image was available, so the authors could not determine how vascular the tumor was.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Dyspnea, Hemithorax, Occupational Exposure, Clubbing, CT Scan, Intrathoracic, Surgical Resection, Pathology.

Related studies

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• Radiographic abnormalities in asbestos insulators: effects of duration from onset of exposure and smoking. Relationships of dyspnea with parenchymal and pleural fibrosis — R. Lilis, A. Miller, et al. (1991)
• Longitudinal analysis of respiratory symptoms in population studies with a focus on dyspnea in marine transportation workers — V.H. Arrandale, M. Koehoorn, et al. (2009)
• Abnormal wasted ventilation fraction and normal pulmonary hemodynamics during exercise in patients with exertional dyspnea — Z. Mohsenifar, H.V. Brown, et al. (1982)
• A left pleural effusion with a calcified tumoral mass and left hemithoracic uptake on bone scan — E. Quoix, M.P. Chenard, et al. (2001)
• Persistent Dyspnea in a 74-Year-Old Man With Normal Spirometry and Lung Volumes — W.H. Chong, B. Saha, et al. (2021)

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