Localized fibrous tumours of the pleura: 15 new cases and review of the literature

Our plain-English summary of Localized fibrous tumours of the pleura: 15 new cases and review of the literature, by M. Suter, S. Gebhard, M. Boumghar, et al (European Journal of Cardio-thoracic Surgery, 1998).

The study

• Authors: M. Suter, S. Gebhard, M. Boumghar, N. Peloponisios, C.Y. Genton
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 1998;14(5):453-9
• Type of article: Review
• Cited by: 82 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To present a series of localized fibrous tumours of the pleura (LFTP), to define the clinical and histopathological diagnostic criteria of this tumour, and to determine the optimal treatment and follow-up.

Methods: Review of the charts of the patients with the diagnosis of LFTP (formerly called benign fibrous mesothelioma), as well as of all the histological sections, including immunohistochemical stains. Review of the literature with special emphasis on the clinical and histological criteria of malignancy.

Results: During the last 30 years, we found 15 patients with a complete clinical chart and histological material, particularly paraffin blocks of the tumour. The mean age was 57 years (range 27-79). Eight patients were asymptomatic, and the remaining seven presented with non-specific symptoms. All but one had complete resection of the tumour, including partial lung resection in two and partial chest wall resection in three. The diagnosis was confirmed by histological review in 15 cases. Immunohistochemical stainings showed positivity for vimentin in all cases, for CD 34 in 80%, but were consistently negative for cytokeratins. Nine tumours were histologically classified as malignant. Among them, five recurred, two of which were responsible for death. One benign tumour recurred after 1 year, and was treated successfully by repeat resection and radiotherapy. Overall, 13 patients (86%) were alive with no evidence of disease between 10 months and 27 years after the first resection.

Conclusions: LFTP is a rare tumour which has a benign clinical course in over 80% of the cases, and is asymptomatic in half the patients. The diagnosis is difficult to establish before operation. Treatment consists of complete resection including adjacent structures if necessary. The clinical behaviour of LFTP cannot be predicted on the basis of histological aspects only. If histologically malignant tumours are more prone to recurrence and poor outcome, broad-based and locally invasive tumours bear a higher risk of recurrence. Long term follow-up is therefore mandatory in all cases in order to perform early re-resection when recurrence occurs.

In plain English

This article from Lausanne, Switzerland, described 15 patients with localized fibrous tumour of the pleura (LFTP), a tumour formerly called benign fibrous mesothelioma, and reviewed published literature on it. The authors searched 30 years of hospital and pathology records, found 18 patients and excluded three whose tumour samples were missing. The 15 included six men and nine women with a mean age of 57; eight had no symptoms. No patient gave a history of asbestos exposure. All underwent thoracotomy (open chest surgery). When the authors re-examined the tissue using published criteria from an earlier study (England's criteria), nine tumours were classed as malignant, compared with one at the original diagnosis. Five of the malignant tumours recurred, two of them causing death from respiratory failure 5 and 10 months after surgery, and one benign tumour also recurred. Overall, 13 patients (86%) were alive with no evidence of disease between 10 months and 27 years after the first operation. The authors concluded that long-term follow-up is mandatory in all cases.

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: Retrospective case series (review of hospital charts and re-examination of tumour tissue) combined with a review of the literature
• Who was studied: 15 patients (six men, nine women; mean age 57, range 27 to 79) diagnosed with LFTP or benign fibrous mesothelioma over the previous 30 years at the University Hospital (Centre Hospitalier Universitaire Vaudois) and its Institute of Pathology in Lausanne, Switzerland. Of 18 patients found, three were excluded because tumour tissue was missing.
• Exposure: Asbestos exposure was not studied. The article reports that no patient in the series gave a history of asbestos exposure. The study concerned the tumour's features, treatment and outcome.
• Main results:
  • Eight of the 15 patients had no symptoms.
  • All 15 patients underwent thoracotomy.
  • On review using England's criteria, nine tumours were classified as malignant (only one had been at the initial diagnosis) and six were confirmed benign.
  • Eight tumours had been wrongly interpreted as benign at the initial examination of the tissue.
  • All tumours showed vimentin on staining, and CD34 was reported in 11 (80%). Staining for cytokeratins was negative in all cases.
  • Among the nine malignant tumours, five recurred, and two of these recurrences caused death.
  • Two patients died from respiratory failure due to massive local recurrence, 5 and 10 months after resection.
  • One benign tumour recurred and was treated by repeat resection and radiotherapy.
  • Overall, 13 of the 15 patients (86%) were alive with no evidence of disease, between 10 months and 27 years after the first resection.
• The authors' conclusion: The authors concluded that long-term follow-up is mandatory in all cases, because recurrence can occur even after removal of tumours that look clearly benign.
• Limitations the authors state:
  • The authors had no explanation for why 60% of their tumours were histologically malignant by England's criteria, which they called an unusually high rate.
  • The authors' view that thoracoscopy could be used for diagnosis or for removing small tumours rests on experience with a single case.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleura, Mesothelioma, Paraffin Block, Immunohistochemistry.

Related studies

• Localized fibrous tumour of the pleura: two case reviews — F. Pond, A. Wilson, et al. (1997)
• Solitary fibrous tumour of the pleura: an ultrastructural and immunohistochemical study — S. Keating, G.T. Simon, et al. (1987)
• Malignant localized fibrous tumor of the pleura occurring in a person environmentally exposed to tremolite asbestos — M. Metintas, A.R. Gibbs, et al. (1997)
• A case of giant benign localized fibrous tumor of the pleura — M. Biçer, S. Yaldiz, et al. (1998)
• Localized fibrous tumors (LFTs) of the pleura: clinical data, asbestos burden, and syntactic structure analysis applied to newly defined angiogenic/growth-regulatory effectors — K. Kayser, J. Trott, et al. (2005)
• Benign localized fibrous tumor of the pleura: report of 25 new cases — S. Enon, D. Kilic, et al. (2012)

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