Bilateral Orthotopic Lung Transplantation after Resection of Benign Solitary Fibrous Tumor in the Donor Lung

Abstract

IntroductionSolitary fibrous tumor (SFT) of the pleura is a rare soft tissue tumor of mesenchymal origin. Transplantation of donor lung with SFT has not been reported in the literature. We report the first case of a bilateral orthotopic lung transplantation utilizing donor lung which had SFT in the left lung.Case ReportThe donor was a brain dead 25 year old male who suffered from subarachnoid hemorrhage. He had no other comorbidities. The recipient is a 59 year old male with end stage fibrosing interstitial lung disease consistent with usual interstitial pneumonia (UIP) who was listed for bilateral orthotopic lung transplantation. His other comorbidities included triple vessel coronary artery disease, hypertension and type 2 diabetes mellitus. During the lung harvest, it was noted that the left lung had a circumferential 1 centimeter reddish appearing nodule in the left upper lobe. A stapled wedge resection of this nodule was performed during back table dissection. Pathology showed benign solitary fibrous tumor with 1 centimeter negative margins. The recipient underwent BOLT and 3 vessel coronary artery bypass grafting (CABG) on cardiopulmonary bypass via a thoracosternotomy (Clamshell). Post-operative course was uneventful and the patient was discharged home on post operative day 15. He continues to do well and symptom free at 1 year follow up. He underwent chest computed tomography (CT) scan 6 months and 1 year and there were no lung lesions identified.SummaryBilateral Orthotopic Lung Transplantation can be successfully be performed when utilizing donor lungs with benign tumors like solitary fibrous tumor. Regular follow up with CT scans is a necessary surveillance study to ensure there is no tumor recurrence. Solitary fibrous tumor (SFT) of the pleura is a rare soft tissue tumor of mesenchymal origin. Transplantation of donor lung with SFT has not been reported in the literature. We report the first case of a bilateral orthotopic lung transplantation utilizing donor lung which had SFT in the left lung. The donor was a brain dead 25 year old male who suffered from subarachnoid hemorrhage. He had no other comorbidities. The recipient is a 59 year old male with end stage fibrosing interstitial lung disease consistent with usual interstitial pneumonia (UIP) who was listed for bilateral orthotopic lung transplantation. His other comorbidities included triple vessel coronary artery disease, hypertension and type 2 diabetes mellitus. During the lung harvest, it was noted that the left lung had a circumferential 1 centimeter reddish appearing nodule in the left upper lobe. A stapled wedge resection of this nodule was performed during back table dissection. Pathology showed benign solitary fibrous tumor with 1 centimeter negative margins. The recipient underwent BOLT and 3 vessel coronary artery bypass grafting (CABG) on cardiopulmonary bypass via a thoracosternotomy (Clamshell). Post-operative course was uneventful and the patient was discharged home on post operative day 15. He continues to do well and symptom free at 1 year follow up. He underwent chest computed tomography (CT) scan 6 months and 1 year and there were no lung lesions identified. Bilateral Orthotopic Lung Transplantation can be successfully be performed when utilizing donor lungs with benign tumors like solitary fibrous tumor. Regular follow up with CT scans is a necessary surveillance study to ensure there is no tumor recurrence.