Giant Solitary Fibrous Tumor of the Pleura

Abstract

A 74-year-old male presented with dyspnea, cough, and chest pain. On physical examination, breath sounds were diminished over the posterior inferior part of the right hemithorax. A chest roentgenogram revealed elevation of the right hemidiaphragm (Fig. 1). Computed tomography (CT) of the chest revealed a homogeneous mass with welldefined borders filling a large part of the right hemithorax. The mass had scattered necrotic areas causing compression of adjacent vascular structures and bronchi (Fig. 2). Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) revealed a supradiaphragmatic mass with a standardized uptake value of 2.0 (Fig. 3). A transthoracic fineneedle aspiration biopsy was nondiagnostic. A right thoracotomy revealed a brown, lobulated, encapsulated mass that was pedunculated with increased vascularity. The mass occupied most of the right hemithorax and originated from diaphragmatic parietal pleura. The resected mass was 2,700 g and measured 25 9 15 9 11 cm. Histopathologic examination of the mass was consistent with a solitary fibrous tumor of the pleura. There were large necrotic areas within the tumor separated from each other by collagenous bands. In other locations there was a myxoid appearance. Spindle-shaped neoplastic cells that contained nuclear atypical and pleomorphism were noted. These cells were positive with CD34, vimentin, and BCL-2. The number of mytoses was 3 per 10 9 high-powered field (Fig. 4). The patient was discharged from the hospital 6 days after surgery. The patient received radiotherapy (10 9 300 cGy) 1 month following surgery. No recurrence was observed 1 year following discharge. Solitary fibrous tumor of the pleura is a relatively rare tumor originating from the mesenchymal cells of the submesothelial tissue of the pleura. It has unusual histologic and clinical features. The majority of these tumors are benign, but about 20% fulfill criteria for malignancy [1]. Individuals may present with symptoms of dyspnea, cough, chest pain, or hemoptysis. Postobstructive pneumonia may occur. The tumors can become locally aggressive and lifethreatening. The larger the tumor, the more likely that symptoms will be present. In giant solitary fibrous pleural tumors, pulmonary atelectasis or complete lung collapse and contralateral mediastinal shift may occur [2]. Radiologic imagining plays an important role in the diagnosis. However, in our individual, PET scanning was not very helpful other than to show no extrathoracic metastasis. Fine-needle aspiration biopsies rarely provide S. Karapolat (&) A. Onen A. Sanli M. Eyuboglu Department of Chest Surgery, Dokuz Eylul Medical School, Izmir, Turkey e-mail: samikarapolat@yahoo.com Fig. 1 Chest roentgenogram showing elevation of the right hemidiaphragm