Rare pleural tumors

Our plain-English summary of Rare pleural tumors, by C.T. Erb, K.M. Johnson, A.W. Kim (Clinics in Chest Medicine, 2013).

The study

• Authors: C.T. Erb, K.M. Johnson, A.W. Kim
• Journal: Clinics in Chest Medicine
• Published: 2013;34(1):113-36
• Type of article: Review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary pleural tumors other than mesothelioma account for fewer than 1% of all lung cancers, and consequently they pose diagnostic and management challenges. Their treatment must be targeted toward the specific tumor type and is often quite different from the treatment for mesothelioma or metastases. Despite the best efforts at diagnosing and treating these tumors, the prognosis associated with some of the benign and many of the malignant variants of these tumors remains poor. In this review, we describe the radiologic and pathologic features of the less common primary pleural tumors and propose a diagnostic approach to their evaluation.

Copyright © 2013 Elsevier Inc. All rights reserved.

In plain English

This article was a narrative review by authors at Yale School of Medicine. It covered primary pleural tumors other than mesothelioma, meaning tumors that start in the lining of the lung and chest wall, which the authors noted are known mainly from case reports and small case series. It described how these tumors look on imaging and under the microscope, and it proposed a diagnostic approach. The authors stated that about 5% of primary pleural tumors are solitary fibrous tumors of the pleura and another 5% are other rare types. In ten published series they tabulated, 274 of 945 solitary fibrous tumors (29%) were malignant. On asbestos, the review stated that asbestos exposure has not been found to be associated with solitary fibrous tumors or calcifying fibrous tumors. It listed asbestos exposure among risk factors for certain pleural sarcomas, citing other reports. It also noted that asbestos-related pleural plaques, rounded atelectasis and inflammatory asbestos reactions can look like tumors on scans. The authors concluded that diagnosis rests on imaging, tissue samples and laboratory testing of the tissue.

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: Narrative review of published literature on rare (nonmesothelioma) primary pleural tumors, with a proposed diagnostic approach
• Who was studied: Published cases and series of nonmesothelioma primary pleural tumors, chiefly solitary fibrous tumor of the pleura, plus adenomatoid tumor, calcifying fibrous tumor, lipoma, sclerosing hemangioma, lymphoma, thymoma, primitive neuroectodermal tumor, squamous cell carcinoma, melanoma, sarcomas and others
• Exposure: Not a study of one exposure. The review discussed risk factors including radiation, prior pleural procedures, chronic infection and genetic factors. It mentioned asbestos only in passing: as not associated with solitary fibrous tumors, and as a reported risk factor for certain pleural sarcomas.
• Main results:
  • Of primary pleural tumors other than malignant mesothelioma (the remaining 10%), about 5% were described as solitary fibrous tumors of the pleura and the other 5% as a variety of less common tumors
  • Across ten published series of solitary fibrous tumor of the pleura with more than 30 patients, compiled by the authors, 671 of 945 tumors (71%) were benign and 274 (29%) were malignant
  • In a cited series of solitary fibrous tumors of the pleura, 5-year survival was 96% for benign tumors and 68% for malignant tumors
  • For calcifying fibrous tumor of the pleura, the review stated that no association has been found with smoking or asbestos exposure
  • The review listed asbestos exposure, along with chest wall irradiation, chronic tuberculous pyothorax and smoking, as risk factors for certain pleural sarcomas, citing other reports
  • Asbestos-related conditions were listed among things that can mimic primary pleural tumors on imaging: pleural plaques (asbestos exposure; holly leaf shape on x-ray) and rounded atelectasis (a mass in a patient with exposure to asbestos)
  • On FDG PET-CT scans, inflammatory asbestos reactions were among the processes listed that can mimic malignant primary pleural tumors
• The authors' conclusion: The authors concluded that primary pleural tumors are uncommon, and that diagnosis is established with proper imaging, tissue specimens and histopathology, aided by immunohistochemical staining and cytogenetics
• Limitations the authors state:
  • The authors noted that the literature on these tumors consists mainly of case reports or small case series
  • The authors stated that risk factors for nonmesothelioma primary pleural tumors are not well established

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Prognosis.

Related studies

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• The IASLC Mesothelioma Staging Project: Improving Staging of a Rare Disease Through International Participation — H. Pass, D. Giroux, et al. (2016)
• Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease — D.M.M. Freitas, R.L. Ramos, et al. (2017)
• The Challenge of Defining Treatment Standards for a Rare Disease: Malignant Peritoneal Mesothelioma — H.L. Kindler (2016)
• Multicystic peritoneal mesothelioma: A short review — C.H. Zhang, J.W. Yu, et al. (2017)
• Malignant pleural mesothelioma with heterologous osteoblastic elements: computed tomography, magnetic resonance, and positron emission tomography imaging characteristics of a rare tumor — R.A. Salgado, R. Corthouts, et al. (2005)

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