Solitary fibrous tumor of the pleura. An immunohistochemical, electron microscopic and tissue culture study of a tumor producing insulin-like growth factor I in a patient with hypoglycemia

Our plain-English summary of Solitary fibrous tumor of the pleura. An immunohistochemical, electron microscopic and tissue culture study of a tumor producing insulin-like growth factor I in a patient with hypoglycemia, by E.H. Strøm, F. Skjørten, L.B. Aarseth, et al (Pathology, Research and Practice, 1991).

The study

• Authors: E.H. Strøm, F. Skjørten, L.B. Aarseth, E. Haug
• Journal: Pathology, Research and Practice
• Published: 1991;187(1):109-13; discussion 114-6
• Type of article: Case report
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a patient with recurrent hypoglycemia most likely caused by a solitary fibrous tumor of the pleura. After removal of the tumor, hypoglycemia resolved. The bland histologic picture of this tumor is emphasized. Electron microscopic and immunohistochemical observations support its non-mesothelial derivation. In vitro studies demonstrated that the tumor tissue produced insulin-like growth factor I (IGF-I), and its role as the cause of hypoglycemia is discussed.

In plain English

This article was a case report from Oslo, Norway, about one woman with a solitary fibrous tumor of the pleura (the lining around the lung) and repeated episodes of low blood sugar (hypoglycemia). The article does not mention asbestos or any other exposure. The woman, aged sixty-five, was admitted to hospital in 1984 after a cerebral insult (brain injury) caused by hypoglycemia, with a blood glucose of 1.1 mmol/l. A large left-sided chest tumor was found and completely removed. Hypoglycemia resolved after removal, and she was well without symptoms three years later. The tumor cells stained for vimentin but not for keratin, and electron microscopy found no microvilli. The authors took these findings to support a non-mesothelial origin and suggested the term "mesothelioma" should not be used for this tumor. Tumor tissue in culture released insulin-like growth factor I (IGF-I) at 1.3 to 2.8 nmol/l. However, her serum IGF-I was below the reference range and the tumor cells did not stain for IGF-I. The authors considered the tumor benign and speculated that IGF-I might contribute to the hypoglycemia.

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 of a single patient, with light microscopy, immunohistochemistry, electron microscopy and tissue culture of the removed tumor
• Who was studied: One woman aged sixty-five, admitted to hospital in 1984 because of hypoglycemia; treated at Ullevål Hospital, Oslo, Norway
• Main results:
  • The patient had a cerebral insult due to hypoglycemia, with a blood glucose level of 1.1 mmol/l, and recovered after glucose was given
  • In the patient's serum taken during hypoglycemia, the IGF-I level was 3 nmol/l, against a reference range of 11.6 to 48.4 nmol/l
  • The tumor was completely removed. It weighed 1980 g and was encapsulated
  • In this patient, hypoglycemia resolved after the tumor was removed, and she was well without symptoms three years later
  • Homogenized fresh tumor tissue contained sparse amounts of IGF-I. Culture medium with tumor cell suspension had IGF-I levels of 1.3 to 2.8 nmol/l
  • Tumor cells showed immunoreactivity for vimentin and focal reactivity for NSE, but no reactivity for keratin or protein S-100. A keratin-positive cell lining was seen at the tumor's periphery
  • None of the tumor cells showed immunoreactivity with antibodies to IGF-I
  • On electron microscopy, tumor cells were often joined by tight junctions and showed basal membrane-like material, but no microvilli were observed
  • Tumor cell nuclei showed no obvious atypia, and the mitotic count was up to 3 per 10 high-power fields in cell-rich areas
• The authors' conclusion: The authors considered the tumor benign and concluded that their findings support a non-mesothelial origin, suggesting the term "mesothelioma" should not be used for this tumor. They speculated that IGF-I made by the tumor might contribute to the patient's hypoglycemia, possibly through local effects without raised serum IGF-I.
• Limitations the authors state:
  • The authors acknowledged that the tumor cells did not stain for IGF-I, possibly because they contained only minimal amounts, consistent with the low levels found in culture medium
  • The authors noted that other researchers do not consider IGF-I a cause of tumor-related hypoglycemia because circulating levels are low in such patients

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor.

Related studies

• Immunohistochemical localization of transforming growth factor-beta and insulin-like growth factor-I in asbestosis in the sheep model — T.C. Lee, L.I. Gold, et al. (1997)
• Activated alveolar macrophages express the insulin-like growth factor-I receptor — W.N. Rom, P. Pääkkö (1991)
• Localized fibrous tumor of the serosal cavities. Immunohistochemical, electron-microscopic, and flow-cytometric DNA study — A.K. el-Naggar, J.Y. Ro, et al. (1989)
• Effect of insulin and epidermal growth factors on the synthesis of glycosaminoglycans/proteoglycans in cultured human malignant mesothelioma cells of different phenotypic morphology — G.N. Tzanakakis, N.K. Karamanos, et al. (1996)
• Hyaluronate activation of CD44 induces insulin-like growth factor-1 expression by a tumor necrosis factor-alpha-dependent mechanism in murine macrophages — P.W. Noble, F.R. Lake, et al. (1993)
• Expression of the Wilms' tumor gene WT1 in human malignant mesothelioma cell lines and relationship to platelet-derived growth factor A and insulin-like growth factor 2 expression — A.W. Langerak, K.A. Williamson, et al. (1995)

Browse more research in Pathology, Research and Practice, or return to medical research.