Successful resection of a hypervascular paravertebral solitary fibrous tumor of pleura preserving the artery of Adamkiewicz, which was detected on preoperative angiography

Abstract

BackgroundSolitary fibrous tumor of the pleura is rarely observed, accounting for 1% of all mediastinum tumors. There have been only a few reports of preoperative embolization for hypervascular tumors around the artery of Adamkiewicz (AKA). We report a rare case of solitary fibrous tumor for which transcatheter embolization was successfully performed before surgical resection.Case presentationA 66-year-old woman with sudden-onset back pain was referred to our hospital for the evaluation of a left intrathoracic abnormal shadow on chest X-ray. Preoperative computed tomography (CT) showed a large, posterior mediastinal, paravertebral, and well-demarcated mass with high contrast enhancement and significant vascularization fed by the intercostal artery (ICA), measuring 8.1 × 7.6 × 6.4 cm. Therefore, solitary fibrous tumor, unicentric Castleman disease, or paraganglioma was included in the differential diagnosis. The patient underwent preoperative transcatheter arterial embolization followed by surgical extirpation. Thanks to the appropriate assessment of the anatomy, we could resect the tumor safely. The pathological diagnosis was solitary fibrous tumor of pleura.ConclusionsWe recommend preoperative transcatheter arterial embolization (TAE) for hypervascular tumors close to the AKA that may require surgical removal; to reduce intraoperative hemorrhage, the AKA should be accurately detected during surgery.