Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome

Our plain-English summary of Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome, by P. Magdeleinat, M. Alifano, A. Petino, et al (European Journal of Cardio-thoracic Surgery, 2002).

The study

• Authors: P. Magdeleinat, M. Alifano, A. Petino, J.P. Le Rochais, E. Dulmet, F. Galateau, P. Icard, J.F. Regnard
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2002;21(6):1087-93
• Cited by: 168 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aim of this paper is to study clinical characteristics, surgical treatment and outcome of patients with solitary fibrous tumor of the pleura operated in our institutions in a 20-year period.

Methods: Clinical records of all patients operated for solitary fibrous tumors of the pleura between 1981 and 2000 were reviewed retrospectively. Tumors were classified as malignant in the presence of at least one of the following criteria: (1) high mitotic activity; (2) high cellularity with crowding and overlapping of nuclei; (3) presence of necrosis; (4) pleomorphism; otherwise they were considered as benign.

Results: Sixty patients (mean age 55 years) were operated in this period. None had asbestos exposure. Symptoms were present in 31 cases. Surgical approaches included thoracotomy (n=53), video-assisted thoracoscopy (n=6), and median sternotomy (n=1). Tumors originated from visceral pleura in 48 cases, from parietal, mediastinal or diaphragmatic pleura in seven, two and three cases, respectively; their mean diameter was 8.5 cm. Tumors could be resected with their implantation basis in 49 patients. In the remaining 11, extended resections were performed, including lung parenchyma (lobectomy, n=4, pneumonectomy, n=2), osteomuscular chest wall structures (n=2), diaphragm (n=2), and pericardium (n=1). Two postoperative deaths (due to myocardial infarction and pulmonary embolism, respectively) occurred. Tumors were pathologically benign in 38 cases and malignant in 22 cases. Mean follow-up was 88 months. Resection was complete in all the patients with benign tumors and no recurrence occurred. Resection was considered as complete in 21/22 malignant tumors. Local recurrence was observed in two cases. Both could be successfully managed by iterative exeresis (no extended resection had been initially performed). Metastatic disease (responsible for patient's death) was observed following the only incomplete resection. Actuarial 5- and 10-year survival rates were 97% for benign tumors and 89% for malignant ones.

Conclusions: Surgical resection provided cure in all the patients with benign tumors. As insufficiency of exeresis is associated with all recurrences in malignant tumors, completeness of resection is in our experience the best prognostic factor in these forms.

In plain English

This was a retrospective review of the clinical records of 60 patients (25 men and 35 women, mean age 55) who had surgery for solitary fibrous tumors of the pleura between 1981 and 2000. Two surgical teams in France, in the Paris area and in Caen, did the operations. No patient had asbestos exposure. The tumor slides were re-examined, and a tumor was classed as malignant if at least one of four microscopic criteria was present. Thirty-one patients (52%) had symptoms. Tumors were benign in 38 patients (63%) and malignant in 22 (37%). Two patients died after surgery. Among the 58 who survived, mean follow-up was 88 months. No benign tumor came back. Actuarial 5- and 10-year survival was 97% for benign tumors and 89% for malignant ones. Among malignant tumors, two came back locally and were removed again. One patient whose tumor had been incompletely removed developed liver metastases and died 32 months later. The authors concluded that surgery cured all patients with benign tumors and that complete removal was, in their experience, the best prognostic factor.

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 review of a surgical case series from two surgical teams
• Who was studied: 60 patients (25 men, 35 women; mean age 55 years, range 30 to 87) operated on for solitary fibrous tumor of the pleura from 1981 to 2000. 45 were operated on by one team at the Marie Lannelongue Hospital and later the Hôtel-Dieu Hospital, Paris, and 15 at Caen University Hospital, France.
• Exposure: The study did not examine asbestos. The authors report that no patient had asbestos exposure. The subject was surgical treatment of the tumor.
• Main results:
  • Of the 60 tumors, 38 (63%) were benign and 22 (37%) were malignant.
  • 31 patients (52%) had symptoms related to the tumor.
  • Of four patients with postoperative complications, two died (one from myocardial infarction, one from pulmonary embolism).
  • Among the 58 patients who survived the postoperative period, mean follow-up was 88 months (range 3 to 252). No patient was lost to follow-up.
  • Among the 37 followed patients with benign tumors (mean follow-up 91 months), no recurrence occurred. One late death was from an unrelated cause.
  • Actuarial 5- and 10-year survival rates were 97% for patients with benign tumors and 89% for patients with malignant tumors.
  • Among the 21 followed patients with malignant tumors, two local recurrences were operated on again. A complete removal was achieved and both patients were alive and disease-free.
  • One patient with a malignant tumor that had been incompletely removed developed disseminated liver metastases and died 32 months after surgery.
  • 15 patients had a tumor that looked well-encapsulated to the surgeon but proved malignant at pathology.
  • Diagnostic accuracy of CT-guided aspiration biopsy before surgery was 45% in this series. A diagnosis was obtained in 5 of the 11 patients biopsied.
• The authors' conclusion: The authors concluded that, in their experience, surgical resection cured all patients with benign tumors and cure may be achieved in most malignant cases. They also concluded that completeness of resection is probably the best prognostic factor, so every such tumor should be considered possibly malignant.
• Limitations the authors state:
  • Only one patient received postoperative radiotherapy and one postoperative chemotherapy, chosen by referring physicians. No conclusion could be drawn about the effect of these added treatments.
  • The share of malignant tumors differs between published series. The authors say this may reflect differences in the patients studied or subjectivity in applying some pathology criteria, especially hypercellularity and pleomorphism.
  • Because large tumors vary from place to place, it may be difficult to establish that none of the four malignancy criteria is present anywhere in a very large tumor.

Topics

Medical terms in this study, explained in our Lexicon: Solitary Fibrous Tumor, Pleura, Necrosis, Asbestos Exposure, Thoracotomy, Thoracoscopy, Visceral Pleura, Parenchyma.

Related studies

• Malignant localized fibrous tumor of the pleura occurring in a person environmentally exposed to tremolite asbestos — M. Metintas, A.R. Gibbs, et al. (1997)
• Solitary fibrous tumor of the nasal cavity and orbit — M. Fukunaga, S. Ushigome, et al. (1995)
• Fine-needle aspiration cytology of localized fibrous tumor of pleura — D. Dusenbery, M.M. Grimes, et al. (1992)
• 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 — E.H. Strøm, F. Skjørten, et al. (1991)
• Solitary fibrous tumor of the pleura — A. Orki, A. Kosar, et al. (2008)
• Solitary benign fibrous tumors of the pleura — M.A. Regal, A.M. Al Rubaish, et al. (2008)

Browse more research in European Journal of Cardio-thoracic Surgery, or return to medical research.