Images in Cardiothoracic Medicine and Surgery
Huge solitary fibrous tumor of the pleura in a young man
Asian Cardiovascular & Thoracic Annals 21(5) 626–627 ß The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312462711 aan.sagepub.com
Salvatore Griffo1, Giuseppe De Luca2 and Francesco Petteruti2
Figure 1. (a) (b) Chest radiograph (posteroanterior and lateral projection) showing a large basal opacity with clear limits (arrows) in the right hemithorax; (c) Chest computed tomography showing a well-circumscribed and homogeneous mass of 18 10 cm. (d) Magnetic resonance imaging features of the mass (arrow). (e) The tumor in situ (arrow). (f) The resected mass.
A 35-year-old man was referred with progressive dyspnea and fatigue. Chest radiography revealed a large basal opacity on the right hemithorax (Figure 1(a), 1(b)). Chest computed tomography revealed a huge well-circumscribed round tumor with no substantial enhancement. It occupied the right thoracic cavity and measured 18 10 cm, causing compression atelectasis of the underlying lung (Figure 1(c)). Magnetic resonance imaging confirmed a huge mass adherent to the chest wall and diaphragm (Figure 1(d)). The patient underwent surgery by a right lateral muscle-sparing thoracotomy through the 5th intercostal space. The mass was attached to the mediastinal pleura by a pedunculated and vascularized stalk (Figure 1(e)). There was no invasion into mediastinal structures, thus the mass was resected en bloc with a partial pleurectomy. It appeared to be a solid tumor, well-circumscribed, encapsulated, and beefy red, weighing 1200 g (Figure 1(f)).
Histopathological examination showed bland-appearing spindle cells with bands of collagenized stroma. Immunohistochemistry was positive for vimentin, CD34, and BCL2, and negative for cytokeratin and calretinin, which was consistent with Solitary Fibrous Tumor of the pleura (SFTp). SFTp are rare neoplasms of mesenchymal origin. The incidence of SFTp is approximately 2, 8 cases per 100,000, accounting for fewer than 5% of all neoplasms involving the pleura. SFTp has been described in 1
Thoracic Surgery Unit, University Federico II, Naples, Italy Department of Cardiothoracic Surgery, Pineta Grande Hospital, Castel Volturno (CE), Italy 2
Corresponding author: Giuseppe De Luca, MD, Department of Cardiothoracic Surgery, Pineta Grande Hospital, Castel Volturno (CE), Via San Rocco 59/A, Marano di Napoli, 80016 Naples, Italy. Email: [email protected]
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Griffo et al.
627
all ages, but the peak of incidence is in the fifth and seventh decades of life, usually it is a benign nature, with the malignant form occuring in 12% of cases. Eighty percent of SFTp tumors are of visceral origin, the other 20% originate in the parietal pleura and are readily curable with careful, complete resections.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflicts of interest statement None declared.
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Huge solitary fibrous tumor of the pleura in a young man
Asian Cardiovascular & Thoracic Annals 21(5) 626–627 ß The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312462711 aan.sagepub.com
Salvatore Griffo1, Giuseppe De Luca2 and Francesco Petteruti2
Figure 1. (a) (b) Chest radiograph (posteroanterior and lateral projection) showing a large basal opacity with clear limits (arrows) in the right hemithorax; (c) Chest computed tomography showing a well-circumscribed and homogeneous mass of 18 10 cm. (d) Magnetic resonance imaging features of the mass (arrow). (e) The tumor in situ (arrow). (f) The resected mass.
A 35-year-old man was referred with progressive dyspnea and fatigue. Chest radiography revealed a large basal opacity on the right hemithorax (Figure 1(a), 1(b)). Chest computed tomography revealed a huge well-circumscribed round tumor with no substantial enhancement. It occupied the right thoracic cavity and measured 18 10 cm, causing compression atelectasis of the underlying lung (Figure 1(c)). Magnetic resonance imaging confirmed a huge mass adherent to the chest wall and diaphragm (Figure 1(d)). The patient underwent surgery by a right lateral muscle-sparing thoracotomy through the 5th intercostal space. The mass was attached to the mediastinal pleura by a pedunculated and vascularized stalk (Figure 1(e)). There was no invasion into mediastinal structures, thus the mass was resected en bloc with a partial pleurectomy. It appeared to be a solid tumor, well-circumscribed, encapsulated, and beefy red, weighing 1200 g (Figure 1(f)).
Histopathological examination showed bland-appearing spindle cells with bands of collagenized stroma. Immunohistochemistry was positive for vimentin, CD34, and BCL2, and negative for cytokeratin and calretinin, which was consistent with Solitary Fibrous Tumor of the pleura (SFTp). SFTp are rare neoplasms of mesenchymal origin. The incidence of SFTp is approximately 2, 8 cases per 100,000, accounting for fewer than 5% of all neoplasms involving the pleura. SFTp has been described in 1
Thoracic Surgery Unit, University Federico II, Naples, Italy Department of Cardiothoracic Surgery, Pineta Grande Hospital, Castel Volturno (CE), Italy 2
Corresponding author: Giuseppe De Luca, MD, Department of Cardiothoracic Surgery, Pineta Grande Hospital, Castel Volturno (CE), Via San Rocco 59/A, Marano di Napoli, 80016 Naples, Italy. Email: [email protected]
Downloaded from aan.sagepub.com by guest on March 26, 2015
Griffo et al.
627
all ages, but the peak of incidence is in the fifth and seventh decades of life, usually it is a benign nature, with the malignant form occuring in 12% of cases. Eighty percent of SFTp tumors are of visceral origin, the other 20% originate in the parietal pleura and are readily curable with careful, complete resections.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflicts of interest statement None declared.
Downloaded from aan.sagepub.com by guest on March 26, 2015
