Huge malignant solitary fibrous tumor of the pleura

Our plain-English summary of Huge malignant solitary fibrous tumor of the pleura, by W.A. Arab, D. Lamoth, V. Echavé, et al (General Thoracic and Cardiovascular Surgery, 2012).

The study

• Authors: W.A. Arab, D. Lamoth, V. Echavé, E. Rizcallah, M. Sirois
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2012;60(6):397-400
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Introduction: Solitary fibrous pleural tumors are rare mesenchymal tumors that can be mistaken for mesothelioma. A positive staining of vimentin, negative staining of cytoplasmic keratin, and expression of the CD34 antigen can confirm their diagnosis. These tumors should be surgically excised although they are benign because they have malignant potential and tendency for recurrence.

Patients And Methods: We present here a 63-year-old patient who had an inconclusive biopsy of a huge right intrathoracic lesion. Further testing after radical surgical resection revealed a malignant solitary fibrous pleural tumor. Surgery was complicated with injury of the thoracic duct. Patient was re-operated upon for ligation of the thoracic duct. He is doing well with no recurrence after 18 months of follow-up.

Conclusion: In conclusion, definitive treatment for solitary fibrous tumor is radical surgical resection with close follow-up for the recurrences. Follow-up of this tumor is essential especially when it showed malignant features on pathological examination.

In plain English

This was a case report about one man treated by thoracic surgeons at the Université de Sherbrooke in Canada. He had a rare tumor, a solitary fibrous tumor of the pleura, which the authors note can be mistaken for mesothelioma. He came to the clinic with right-sided chest pain that had built up over a year. He had smoked for five years and denied exposure to asbestos or other hazardous materials. Scans showed a huge mass in the lower right chest. After two inconclusive needle biopsies, surgeons removed the whole mass, which measured about 18 by 15 by 10 cm and weighed 1.316 kg. Under the microscope, the tumor showed features the authors judged to favor a low-grade malignancy. Staining was positive for CD34 and bcl2 and negative for cytoplasmic keratin, which supported the diagnosis. On the second day after surgery, lymph fluid (chyle) leaked into the chest, and a second operation tied off the thoracic duct. He received no adjuvant therapy after surgery and had no recurrence after 18 months. The authors concluded that surgical removal followed by close follow-up is the best treatment.

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 (a single patient)
• Who was studied: One 62-year-old man (63 in the abstract) seen at the authors' out-patient clinic. The authors are from the thoracic surgery service of the Université de Sherbrooke, Quebec, Canada. Dates of treatment are not given.
• Exposure: No asbestos exposure was reported: the patient denied exposure to asbestos or other hazardous materials. He had a 5-year history of smoking a quarter pack of cigarettes per day.
• Main results:
  • Before surgery, CT-guided needle biopsy was done twice in this patient and was inconclusive both times.
  • The surgically removed mass measured approximately 18 by 15 by 10 cm and weighed 1.316 kg. It was attached by a stalk (pedicle) to the pleural surface at the base of the right lung.
  • Microscopy showed mild nuclear atypia, 5 mitoses per 10 light microscopic fields, and areas of tumor necrosis. The authors judged these findings to favor a low-grade malignancy.
  • Tumor cells were multifocally positive for CD34, diffusely positive for bcl2, and negative for cytoplasmic keratin. This led to the diagnosis of solitary fibrous tumor.
  • On the second day after surgery, the patient developed chylothorax. The authors attributed it to thoracic duct injury during extensive dissection of adhesions. A second thoracotomy was done to ligate the thoracic duct.
  • The patient received no post-operative adjuvant therapy and had no recurrence after 18 months of follow-up.
• The authors' conclusion: The authors concluded that surgical excision is the best treatment, followed by close follow-up to detect early recurrences. They also wrote that fine needle biopsy is not always helpful and can be avoided because it does not change the management plan.

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Mesenchymal Tumor, Mesothelioma, CD34, Biopsy, Intrathoracic, Surgical Resection.

Related studies

• Solitary fibrous tumor of the pleura — A. Orki, A. Kosar, et al. (2008)
• Solitary benign fibrous tumors of the pleura — M.A. Regal, A.M. Al Rubaish, et al. (2008)
• Benign localized fibrous tumor of the pleura: report of 25 new cases — S. Enon, D. Kilic, et al. (2012)
• 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)
• Solitary fibrous tumors of the pleura: an estimation of population incidence — T. Thorgeirsson, H.J. Isaksson, et al. (2010)

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