Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome.
OBJECTIVE
The aim of this paper is to study clinical characteristics, surgical treatment and outcome of patients with solitary fibrous tumor of the pleura operated in our institutions in a 20-year period.


METHODS
Clinical records of all patients operated for solitary fibrous tumors of the pleura between 1981 and 2000 were reviewed retrospectively. Tumors were classified as malignant in the presence of at least one of the following criteria: (1) high mitotic activity; (2) high cellularity with crowding and overlapping of nuclei; (3) presence of necrosis; (4) pleomorphism; otherwise they were considered as benign.


RESULTS
Sixty patients (mean age 55 years) were operated in this period. None had asbestos exposure. Symptoms were present in 31 cases. Surgical approaches included thoracotomy (n=53), video-assisted thoracoscopy (n=6), and median sternotomy (n=1). Tumors originated from visceral pleura in 48 cases, from parietal, mediastinal or diaphragmatic pleura in seven, two and three cases, respectively; their mean diameter was 8.5 cm. Tumors could be resected with their implantation basis in 49 patients. In the remaining 11, extended resections were performed, including lung parenchyma (lobectomy, n=4, pneumonectomy, n=2), osteomuscular chest wall structures (n=2), diaphragm (n=2), and pericardium (n=1). Two postoperative deaths (due to myocardial infarction and pulmonary embolism, respectively) occurred. Tumors were pathologically benign in 38 cases and malignant in 22 cases. Mean follow-up was 88 months. Resection was complete in all the patients with benign tumors and no recurrence occurred. Resection was considered as complete in 21/22 malignant tumors. Local recurrence was observed in two cases. Both could be successfully managed by iterative exeresis (no extended resection had been initially performed). Metastatic disease (responsible for patient's death) was observed following the only incomplete resection. Actuarial 5- and 10-year survival rates were 97% for benign tumors and 89% for malignant ones.


CONCLUSIONS
Surgical resection provided cure in all the patients with benign tumors. As insufficiency of exeresis is associated with all recurrences in malignant tumors, completeness of resection is in our experience the best prognostic factor in these forms.
Magdeleinat
Pierre
P
Service de Chirurgie Thoracique, Hôtel-Dieu, 1, Place du Parvis Notre Dame, 75181 Paris Cedex 04, France. pierre.magdeleinat@htd.ap-hop-paris.fr
Alifano
Marco
M
Petino
Antonio
A
Le Rochais
Jean Philippe
JP
Dulmet
Elisabeth
E
Galateau
Françoise
F
Icard
Philippe
P
Regnard
Jean François
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005350:Fibroma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed