Solitary fibrous tumors of the pleura: a case report and review of the literature

Our plain-English summary of Solitary fibrous tumors of the pleura: a case report and review of the literature, by P. Mordenti, R. Di Cicilia, R. Delfanti, et al (Tumori, 2013).

The study

• Authors: P. Mordenti, R. Di Cicilia, R. Delfanti, P. Capelli, C. Paties, L. Cavanna
• Journal: Tumori
• Published: 2013;99(4):e177-83
• Type of article: Case report, Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Solitary fibrous tumors of the pleura are rare and slow-growing neoplasms originating from the mesenchymal tissue underlying the mesothelial layer of the pleura. These tumors may have an unpredictable clinical course. Most cases occur in the sixth or seventh decades of life with no gender predilection, and more than 80% of cases are benign. The predominant clinical symptoms and signs are dyspnea, cough, chest pain, finger clubbing and hypoglycemia. However, because many patients are asymptomatic, the incidence rates are affected by the likelihood of its incidental detection, often through medical imaging of the chest. Surgical resection is the treatment of choice and is usually curative, even though local recurrence can occur many years after an adequate resection.

Methods: We reviewed the literature by performing a computerized search of MEDLINE, CANCERLIT and Embase with the terms fibrous tumor, pleura, surgery, immunohistochemical analysis. Articles and s were also identified by back-referencing from other relevant papers.

Results: The clinical, radiological and pathological features of a 48-year-old woman with a primary solitary fibrous tumor of the pleura are reviewed and a literature search for other reported cases has been performed.

Conclusions: Although localized fibrous tumors of the pleura are considered histologically benign, there is a risk of recurrence and malignant transformation. Complete surgical resection is mandatory and long-term clinical and radiological follow-up is indicated in all patients. For malignant cases complete surgical resection may not be adequate and studies are needed to define the role of preoperative and postoperative systemic treatment. Diagnosis is very difficult in limited samples such as fine-needle aspiration or needle-core tissue biopsy, and immunohistochemical analysis may be useful to differentiate solitary fibrous tumor of the pleura from mesothelioma and other similar tumors.

In plain English

This article combined a report of one patient with a review of published literature on solitary fibrous tumors of the pleura, a rare tumor of the lining around the lungs. The patient was a 48-year-old woman referred in February 2010 for persistent left chest pain. A CT scan showed an 8.2 by 5.4 cm mass in the lower back part of the left chest cavity. Needle and bronchoscopy biopsies did not give a diagnosis, so surgeons removed the mass through an open chest operation. Laboratory tests confirmed a solitary fibrous tumor and found no tumor at the cut edge. She was followed with regular chest CT scans, and the article did not report how she fared. For the review, the authors examined about 400 English-language papers. They stated that more than 800 cases had been reported and that no relationship to asbestos exposure was evident. The article did not say whether this patient had been exposed to asbestos. The authors concluded that diagnosis before surgery is usually difficult and that surgery remains the main means of diagnosis and 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 (one patient) combined with a narrative review of the literature
• Who was studied: One 48-year-old woman referred for persistent left chest pain in February 2010 (authors based at Ospedale Guglielmo da Saliceto, Piacenza, Italy); the review covered about 400 English-language papers with no time limit
• Exposure: No asbestos exposure history is reported for the patient. The literature review section states that no relationship between these tumors and asbestos exposure was evident.
• Main results:
  • In the patient, CT showed a lesion measuring 8.2 by 5.4 cm in the posterior-inferior left pleural cavity
  • In the patient, bronchoscopy with biopsy, fine-needle aspiration and core biopsies were negative, so the mass was removed by exploratory thoracotomy
  • In the patient, the tumor stained positive for CD34, CD99 and Bcl-2 and negative for cytokeratin, the cut margin was free of tumor, and the final diagnosis was solitary fibrous tumor of the pleura
  • The patient was followed with chest CT twice a year for the first 2 years and yearly after that; the outcome of follow-up was not reported
  • From the literature: more than 800 cases had been reported
  • From the literature: the reported proportion of malignant tumors varied from 7% to 60%
  • From the literature: no data supported radiotherapy or chemotherapy after removal of malignant tumors
• The authors' conclusion: The authors concluded that diagnosis before surgery is usually difficult, though newer immunohistochemical analysis may be very useful, and that surgery remains the main way to reach the final diagnosis and the treatment of choice.

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Pleura, Neoplasm, Dyspnea, Clubbing, Incidence, Surgical Resection, Malignant Transformation.

Related studies

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

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