Resection of a giant, invasive malignant solitary fibrous tumor of pleura

Our plain-English summary of Resection of a giant, invasive malignant solitary fibrous tumor of pleura, by K. Imai, K. Hirayama, I. Matsuzaki, et al (General Thoracic and Cardiovascular Surgery, 2012).

The study

• Authors: K. Imai, K. Hirayama, I. Matsuzaki, Y. Minamiya, H. Saito, M. Mitsui, Y. Hosono, J. Ogawa
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2012;60(12):859-62
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.

In plain English

This case report described one patient, a 61-year-old woman with a large malignant solitary fibrous tumor of the pleura (SFTP). In 2006 she had a mastectomy for a breast lump that turned out to be benign. Three years later she developed fever and left flank pain. A CT scan showed a tumor about 13 cm in size in the left chest, invading the left lower lobe of the lung and the diaphragm. In January 2010 surgeons removed the tumor together with the left lower lobe of the lung. The tumor arose from the visceral pleura. Laboratory staining of the tumor cells was positive for CD34 and vimentin and negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle actin. More than 45% of the cells strongly expressed Ki-67, and the diagnosis was malignant SFTP. She received no follow-up chemotherapy and was alive without recurrence one year after surgery. The article did not give the patient's asbestos-exposure history. Citing earlier work, the authors described these tumors as unrelated to malignant mesothelioma. The authors concluded that all SFTPs need careful long-term follow-up.

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)
• Who was studied: One 61-year-old woman who had previously had a left mastectomy in 2006 for a benign breast granuloma. The authors are from Akita University and Hachinohe City Hospital, Japan.
• Exposure: The article does not give the patient's asbestos or other exposure history. Citing earlier literature, the authors state that solitary pleural tumors are not asbestos-related.
• Main results:
  • CT showed a tumor about 13 cm in size in the left chest cavity, invading the left lower lobe of the lung and the diaphragm.
  • In January 2010 the tumor was removed through a posterolateral thoracotomy, with left lower lobectomy and large tumor-free margins.
  • The tumor originated from the visceral pleura of the left lower lobe of the lung.
  • Tumor cells stained positive for CD34 and vimentin, and negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle actin.
  • More than 45% of the tumor cells strongly expressed Ki-67, which the authors took as indicating malignant potential. The final diagnosis was malignant SFTP.
  • The patient was discharged on post-operative day 14, received no adjuvant chemotherapy, and was alive without recurrence 1 year after surgery.
• The authors' conclusion: The authors concluded that radical resection with wide tumor-free margins gives the best chance of cure, and that careful long-term clinical follow-up is required in all cases of SFTP.

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Pleura, Neoplasm, Fibroblast, Mesothelioma, Spindle Cell, Collagen, CD34.

Related studies

• Solitary fibrous tumors of the pleura: an estimation of population incidence — T. Thorgeirsson, H.J. Isaksson, et al. (2010)
• 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 benign fibrous tumors of the pleura — M.A. Regal, A.M. Al Rubaish, et al. (2008)
• Solitary fibrous tumor of the pleura: 3 case reports — E. Amorim (2015)
• Huge malignant solitary fibrous tumor of the pleura — W.A. Arab, D. Lamoth, et al. (2012)

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