Primary Pleural Tumors Research Articles

Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma

BackgroundPleural neoplasms are rare and can be subdivided into pleural metastasis and primary pleural neoplasms. Non-mesothelioma primary pleural neoplasms are a diverse group of extremely rare pathologies.Case presentationIn this case series, we describe the presentation and management of two rare primary pleural neoplasms. A first case describes a primary pleural yolk sac tumor treated with neoadjuvant chemotherapy, extended pleurectomy decortication, and hyperthermic intrathoracic chemotherapy. In a second case we describe the management of a primary pleural synovial sarcoma by neoadjuvant chemotherapy and extrapleural pneumonectomy. A complete resection was obtained in both cases and the post-operative course was uncomplicated. No signs of tumor recurrence were noted during follow-up in the first patient. In the second patient a local recurrence was diagnosed 6 months after surgery.ConclusionNeo-adjuvant chemotherapy followed by extensive thoracic surgery, including hyperthermic intrathoracic chemotherapy, is a feasible treatment strategy for non-mesothelioma primary pleural neoplasms, but careful follow-up is required.

Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade.

Malignant Pleural Mesothelioma (MPM) is a primary pleural tumor with scarce prognostic data estimates given its rarity. This study aims to explore the epidemiologic and survival predictors amongst patients with MPM, extending from the largest and most recent study conducted between 1973 and 2009. 3384 patients diagnosed with MPM between 2010 and 2017 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors. Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. Nonmalignant pleural effusion, based on histology, was associated with higher CSM (HR = 1.22, 95% CI 1.05-1.4, p < 0.05). Fibrous mesothelioma, older age, and distant disease were associated with increased mortality. All intervention strategies were associated with improved survival outcomes. Earlier diagnosis may improve outcomes, as available interventions are associated with lower mortality when feasible at diagnosis. The study paves the way for further prospective and retrospective studies to focus on the identification of patient subsets that may benefit from early mesothelioma screening.

Solitary fibrous tumor of pleura presenting as respiratory failure: unusual presentation of a rare tumor

Solitary fibrous tumors of the pleura (SFTPs) are rare primary pleural tumors derived from sub-mesothelial mesenchymal tissue that are mostly incidentally diagnosed in asymptomatic subjects. Symptomatic SFTPs usually present with dry cough and chest pain. We report the case of a 55-year-old lady with a 9-month history of shortness of breath, right-sided chest pain, and heaviness, who presented to our institute with hypercapnic respiratory failure and later required invasive mechanical ventilation. Subsequent radiological and histopathological investigations led to the diagnosis of a benign SFTP occupying almost the entire right hemithorax. She was treated with complete surgical resection by thoracotomy resulting in immediate resumption of adequate ventilation in the postoperative period. We emphasize the importance of large pleural tumors as a rare but reversible cause of hypercapnic respiratory failure.

Pleural Neoplasms—What Could MRI Change?

The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies’ detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.

A Pleuropulmonary Blastoma: A Rare Malignant Lung Disease in Children

Pleuropulmonary blastoma (PPB) is Avery uncommon, mesenchymal malignant tumor in chest cavity that occurs mostly in children before preschool age (less than 6year old) . while it is the most popular primary pleural and lung tumor in children and adolescent malignancy. PPB has three macroscopically subtypes on a tumor have poor progression pathway start from cystic PPB (type I) to mixed cystic and solid (type II) and pure solid (type III). In the majority of PPB cases A gremlin mutation `need multimodal aggressive therapies including surgery and chemotherapy and/or radiotherapy. the study perform in Basra oncology center during eight years between 2012 -2019 have six cases of PPB male to female 1:1 most of cases less five years of old. most of cases were poor prognosis type II / III (mixed / pure solid) three cases type II and other three cases are type III and inspite of forceful treated by multimodal of treatment involved surgical ,chemotherapy and radiotherapy have poor destiny and the death rate 33.3%.

Correlation between CT , MRI of the chest and medical thoracoscopic findings in primary pleural tumors

Correlation between CT , MRI of the chest and medical thoracoscopic findings in primary pleural tumors

A Case of Primary Epithelioid Sarcoma of the Pleura.

BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.

Squamous cell carcinoma as a primary pleural tumor – case report

The differential diagnosis of primary pleural tumors is a very difficult challenge. The clinical symptoms are insufficient to make a clear and definitive diagnosis. This report presents the case of a 63-year-old male patient who was admitted to Department of Pulmonology due to evidence of increasing respiratory failure due to COVID-19 infection. The X-ray showed massive infiltrate on the left pleural cavity. A bronchofiberoscopy was performed with material removal for histopathological examination. No tumor cells were found in the first pathomorphology report. A videothoracoscopy was performed, in which excerpts from the wall and pleura of the lungs were taken. Pathomorphologic findings excluded mesotheliomas and adenocarcinomas, and after additional reactions a low-differentiated squamous cell carcinoma with adenomatoid differentiation features. The final diagnosis was squamous cell carcinoma. This case highlights that the diagnosis of tumors of the pleura requires cooperation between pathomorphologists and clinicians. Further studies are needed to associate COVID-19 infection with the occurrence of rare pleural tumours.

Diagnosis and Management of Malignant Pleural Effusion: A Narrative Literature Review

Malignant pleural effusion (MPE) is defined as an effusion that occurs in association with malignancy, as evidenced by the finding of malignant cells on pleural fluid cytology or pleural biopsy. The pathophysiology of MPE is not yet clear, but several hypotheses have been developed to explain the mechanism of MPE. Accumulation of effusion in the pleural cavity occurs due to increased vascular permeability due to the inflammatory reaction caused by the infiltration of cancer cells in the parietal and/or visceral pleura. Other possible mechanisms are the direct invasion of the tumor adjacent to the pleura, obstruction of the lymph nodes, hematogenous spread, and primary pleural tumor. Pleural fluid from a malignant process is usually an exudate. To distinguish between exudate and transudate is to assess the protein and LDH levels of the pleural fluid. Hemorrhagic pleural fluid with a red blood cell count &gt;100,000/mm3 suggests an MPE. Pleural fluid glucose levels at low &lt; 60 mg/dl at about 15-20% MPE. The definitive diagnosis of MPE is by finding malignant cells in the pleural fluid (cytology) or pleural tissue (pathological histology). Management of malignant pleural effusions is principally palliative. Management that is often done in cases of MPE is therapeutic thoracentesis, pleurodesis, drainage with long-term indwelling catheter, manufacture of the pleuroperitoneal shunt, intrapleural therapy, and radiotherapy.

Giant Solitary Fibrous Tumour of the Pleura

Solitary fibrous tumour of the pleura is a rare primary pleural neoplasm. These tumours are usually asymptomatic and are incidentally detected. Majority of these neoplasms are benign and surgical excision provides excellent results. With the widespread use of imaging and better diagnostic criteria, this tumour is likely to be detected more frequently. We encountered a patient with a giant solitary fibrous tumour of the pleura. In this report, we describe the case of a patient with a giant solitary fibrous tumour of the pleura, review the literature and present the details of management of this patient.

REPERFUSION PULMONARY EDEMA AFTER RESECTION OF A MALIGNANT SOLITARY FIBROUS TUMOR OF THE PLEURA MANAGED WITH VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Solitary fibrous tumors of the pleura (SFTP) are rare tumors that account for 5% of all primary pleural tumors. SFTP originate from the submesothelial mesenchymal layer of the pleura from primitive fibroblast or mesenchymal cells. Although most are benign and can be cured by complete resection, malignant forms of SFTP are known to recur more frequently. CASE PRESENTATION: A 66-year-old female with history of hypertension and prior resection of an SFTP via median sternotomy in 2004 (pathology unknown) presented with increasing dyspnea on exertion over the previous four weeks, greatly decreasing her functional status. Imaging revealed a large soft tissue mass occupying most of the right hemithorax and displacing the mediastinum to the left (Figure 1). Patient underwent resection of the large right SFTP via a right thoracotomy with lung isolation via a double lumen ET tube. Upon re-expansion of the right lung at the end of the case, patient became acutely hypoxic and hypotensive, with massive bilateral pulmonary edema on bronchoscopy. Condition persisted despite aggressive suctioning and increased ventilatory and vasopressor support, and patient was emergently placed on venovenous (VV) ECMO in the OR via a 21F right femoral vein cannula and a 17F right internal jugular vein cannula. The patient's hypoxia resolved and blood pressure stabilized on vasoactive drips, while massive pulmonary edema resolved gradually through discharge on POD15. Post-op course complicated by tamponade physiology that required emergent pericardiocentesis, AKI requiring hemodialysis (with full recovery), and atrial fibrillation requiring cardioversion, with resultant stabilization in hemodynamics. ECMO support was discontinued on POD3. Final pathology revealed a 22 x 18 x 10.5cm malignant SFTP with 5 mitotic figures per 10 high power fields. DISCUSSION: RPE is characterized by pulmonary edema plus or minus clinical symptoms, sometimes including hemodynamic instability, after rapid re-inflation of a previously collapsed lung. Although almost exclusively described after drainage of pneumo- or hemothorax in the literature [1], this rare phenomenon is the most likely cause of the massive pulmonary edema seen in our patient with long-term lung compression by SFTP. The pathophysiology of RPE likely includes tissue reperfusion, hypoxia, and free radial damage, among other processes, as the mechanism for lung damage and pulmonary edema. Treatment is generally supportive based on the clinical manifestations of RPE, including ECMO in our case and only two other cases reported in the literature [2, 3]. CONCLUSIONS: VV ECMO allows for complete lung rest while providing adequate oxygenation for end organ perfusion, although not without possible complications, most concerning of which are hemorrhagic. This case is the first to demonstrate the successful use of VV ECMO in a very rare case of RPE after resection of a malignant SFTP. REFERENCE #1: Meeker JW, Jaeger AL, Tillis WP. An uncommon complication of a common clinical scenario: exploring reexpansion pulmonary edema with a case report and literature review. J Community Hosp Intern Med Perspect. 2016; 6:32257. REFERENCE #2: Tung YW, Lin F, Yang MS et al. Bilateral developing reexpansion pulmonary edema treated with extracorporeal membrane oxygenation. Ann Thorac Surg 2010; 89:1268-1271. REFERENCE #3: Shires AL, Green TM, Owen HL et al. Case 4--2009. Severe reexpansion pulmonary edema after minimally invasive aortic valve replacement: management using extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2009; 23:549-554. DISCLOSURES: No relevant relationships by Ann Defnet, source=Web Response No relevant relationships by Harvey Pass, source=Web Response No relevant relationships by Deane Smith, source=Web Response No relevant relationships by Gerardo Velez, source=Web Response

Narrative review of theoretical considerations regarding HITHOC between past and future.

Hyppocrates constructed the medicines-surgery-energy triangle which includes all therapeutical modalities. Hyperthermic intraoperative chemotherapy (HITHOC) is a synergy-based single stage multimodality treatment encompassing the locoregional manifestation of the systemic malignant process. Pleural space, thermal effect, lavage/irrigation and chemotherapy represent the basic science ports of the network hub: HITHOC. The malignant transformation and process of the pleural surface (and underlying lung) challenges space management and tissue control. Thermotherapy without local chemotherapy is insufficient, similar to the normothermic local irrigation aligned with anticancer agents. The local administration of combined heat-transfer fluid and chemotherapy with or without subsequent surgical removal offers reasonable outcome in extensive primary pleural neoplasms (malignant mesothelioma), advanced (> Stage IIIA) NSCLC, functionally inoperable lung cancer and pleural carcinosis from extrathoracic malignancies. Measured by symptom-free survival and the quality of life, HITHOC in its present form, offers a modest yet fully substantiated solution. HITHOC in combination with the local application of targeted therapy and/or immunotherapy administered in the pleural space are currently under investigation. Additional development including new acting substances, their solvents and the means regarding surgical delivery and anesthesiology techniques are sign posts up ahead. Level 2 evidence are required in order to stepping up the recommendation levels, rewriting protocols and guidelines, in which HITHOC earns its revered position in the decision making process it deserves.

Imaging Features of Various Benign and Malignant Tumors and Tumorlike Conditions of the Pleura: A Pictorial Review.

Pleural masses may be caused by various conditions, including benign and malignant neoplasms and non-neoplastic tumorlike conditions. Primary pleural neoplasms include solitary fibrous tumor, malignant mesothelioma, and primary pleural non-Hodgkin's lymphoma. Metastatic disease is the most common neoplasm of the pleura and may uncommonly occur in patients with hematologic malignancy, including lymphoma, leukemia, and multiple myeloma. Pleural effusion is usually associated with pleural malignancy. Rarely, pleural malignancy may arise from chronic empyema, and the most common cell type is non-Hodgkin's lymphoma (pyothorax-associated lymphoma). Non-neoplastic pleural masses may be observed in several benign conditions, including tuberculosis, pleural plaques caused by asbestos exposure, and pleural loose body. Herein, we present a review of benign and malignant pleural neoplasms and tumorlike conditions with illustrations of their computed tomographic images.

A descriptive analysis of lung and pleural tumours in a premier referral centre in Sri Lanka

Introduction: This study describes pathological findings of lung and pleural neoplasms among a cohort of Sri Lankan patients. Methods A descriptive cross-sectional study was conducted among patients with lung and pleural tumours referred to National Hospital for Respiratory Diseases in 2017. Patients who underwent biopsy under direct vision or radiological guidance were included. Contrast Enhanced Computerized Tomography (CECT) findings were correlated with the histological diagnosis. Results The population was aged 8-93[mean (SD) =58.4(13.3)] years. Of 396 patients, 252(63.6%) were males. Majority (n=324, 81.4%) had lung tumours while 72(18.2%) had pleural tumours. Malignant neoplasms were found in 373(n=94.2). Of them, majority (n=180, 45.5%) were core biopsies, followed by lobectomies (n=77, 19.4%). Commonest benign lung tumour was hamartoma (n=13, 3.3%). Schwannoma was the commonest benign pleural tumour (n=3, 0.8%). Among the primary malignant lung tumours, adenocarcinoma was the commonest (n=124, 31.3%). Six (1.5%) primary malignant pleural neoplasms (mesotheliomas) were found. Among the metastatic deposits in the lung, the majority was colorectal adenocarcinomas (n=9, 2.3%). The sensitivity, specificity, positive and negative predictive values of CECT in discriminating malignant lung and pleural tumours were 94.6%, 90.9%, 99.3%, and 54.1% respectively. A one-way ANOVA showed significant differences in the distribution of age among different types of masses [F (5,396) =2.759, p=.018]. The age of patients with benign lung neoplasms (mean=51.3±17.4 years), was less compared to the malignant pleural tumours and primary malignant lung tumours. Primary malignant lung tumours predominated among males [χ2 (5,396) =27.463, p=.000]. Conclusions Adenocarcinoma was the commonest primary lung tumour (Male: Female=1.6:1). There was a male predominance in primary malignant lung tumours. CECT has a poor negative predictive value in discriminating malignant neoplasms of lung and pleura.

The Diagnosis of Pleural Tumors Other Than Mesothelioma.

- Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention. - To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis. - Review of relevant literature published via PubMed and other search engines. - A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.

Histomorphological and Immunohistochemical Analysis of Pleural Neoplasms

Primary pleural neoplasms are rare entities compared with the pleural involvement by metastatic carcinoma.The current study aimed at investigating the complete spectrum of pleural neoplasms and differentiating between them with the aid of immunohistochemistry (IHC). Consecutive pleural biopsy specimens positive for a neoplasm, both primary and metastatic, were included in the study. Diagnosis or a differential diagnosis was suggested on histopathology confirmed by a panel of IHC markers such ascytokeratin(AE1/AE3), epithelial membrane antigen (EMA),vimentin, calretinin, CD34, CD99, SMA,bcl2, S100, CK7,CK20,TTF1,GCDFP, HMB45, LCA, synapto-physin, chromogranin, and naspsin. A total of 35 cases of pleural neoplasms included 15 (42.9%) primary pleural neoplasms and 20 (57.1%) metastatic carcinoma. Synovial sarcoma, malignant mesothelioma (MM), and solitary fibrous tumor (SFT) accounted for 14.2%,11.4%, and 8.5% of metastatic cases, respectively. Epithelioid sarcoma(ES), neuroendocrine carcinoma, and inflammatory myofibroblastic tumor were less common, each contributing to 2.9% of pleural neoplasms. Among the 20 cases of metastatic carcinoma, 13 were from the lung and 7 from the breast. Lung neoplasms metastasizing to the pleura were adenocarcinoma (n=12) and atypical carcinoid (n=1). Analysis of histopathological pattern along with a panel of appropriate IHC markers distinguished the rare entities of pleural neoplasms essential to determine the prognosis and treatment modality.

MR Imaging of Pleural Neoplasms.

The pleura may be affected by primary tumors or metastatic spread of intrathoracic or extrathoracic neoplasms. Primary pleural neoplasms represent ∼10% of all pleural tumors, and malignant lesions are more common than benign lesions. The most common primary tumors include malignant pleural mesothelioma and solitary fibrous tumor. Although pleural neoplasms may initially be evaluated with computed tomography (CT) and/or fluorodeoxyglucose positron emission tomography (PET)/CT, magnetic resonance (MR) imaging is complementary to these other imaging modalities for disease staging and evaluation of patients. In this article, we discuss the etiology, clinical presentation, and imaging of pleural neoplasms, with specific attention given to the role of MR imaging.

Solitary Fibrous Tumor – Less Common Neoplasms of the Pleural Cavity

solitary fibrous tumors (SFT) represent a heterogeneous group of primary pleural neoplasms with a low incidence rate and of which the biological origin, which consists of mesenchymal cells, is uncertain. The authors present herewith a retrospective analysis of 22 patients with SFTs who were diagnosed and surgically treated between the years 2000-2015. The preoperative tumors were successfully verified morphologically by transthoracic core needle biopsy under CT control in 27.3% of patients. Surgical approaches were either posterolateral thoracotomy or videothoracoscopy. The follow-up median was 45 months (range 1-188 months). Twenty tumors were surgically removed radically, two tumors were found to be unresectable due to the considerable tumor size. From histological point of view 81.8% of tumors were SFT with low malignant potential, 18.2% of tumors with high malignant potential. Despite the radical extirpation of the SFT, it relapsed in two patients. The gold standard of SFT treatment is radical surgical removal; however, patients at risk of recurrence require additional follow-ups. The results of adjuvant therapy in recurrent and malignant forms of SFTs are the subject of discussion and further study.

Malignant Giant Solitary Fibrous Tumor of the Pleura Metastatic to the Thyroid Gland

Solitary fibrous tumor (SFT) of the pleura is a rare mesenchymal neoplasm arising from mesenchymal cells in the areolar tissue subjacent to the mesothelial-lined pleura and accounting for less than 5% of primary pleural tumors. SFTs are generally benign and asymptomatic, with 10-year survival rates of up to 98%. Unfortunately, approximately 10% have malignant potential, leading to local recurrence after radical surgery and/or metastatic spread. Of note, giant pleural SFT, which consists of a tumor occupying at least 40% of the affected hemithorax, is even less common with only anecdotal cases reported in the medical literature. We describe a unique case of giant SFT of the pleura that metastasized to the thyroid gland 1 year after complete resection, focusing on its clinical and pathological features of presentation. En bloc resection remains the mainstay of therapy with curative intent. Patients with large tumors may undergo preoperative angiography with percutaneous embolization of the tumor, which allows to reduce perioperative bleeding. In case of local recurrence, surgery still remains the best treatment option. However, surgery can also be considered in patients with isolated metastatic spread. Every suspected and proven SFT of the pleura should undergo surgical resection, as clinical and radiological criteria cannot accurately distinguish benign from malignant forms. Moreover, the peculiar histological features of SFT should not be neglected when planning clinicoradiological follow-up. Additionally, suspicious clinical findings during follow-up should always be thoroughly investigated in order to exclude or confirm the diagnosis of recurrent disease.

Pedunculated solitary fibrous tumours arising from the pleura

Solitary fibrous tumour (SFT) is one of the rare tumours which arise from visceral pleura. Klemperer and Rabin first described SFT as a distinct clinical entity among primary pleural tumoUrs in 1931. Approximately 820 cases have been reported in literature to date. The management of patients with SFT is complete resection of the tumour and follow up of the patient to detect any possible late recurrence. In the present paper, we report two cases of pedunculated solitary fibrous tumours of the pleura that appeared as a wandering chest nodule to which surgical resection undertaken at our hospital. The aim is to summarise our experience in the management of solitary fibrous tumour.