Fibrous tumor of the lung: diagnostic and therapeutic considerations apropos of two cases.
Solitary fibrous tumor (SFT) of the pleura and the lung is an uncommon spindle cell neoplasm arising from the visceral pleura in the majority of the cases. Current diagnostic and therapeutic considerations are discussed apropos of 2 recent cases. 1st case: A 46-year-old male, heavy smoker, presented with nonspecific complaints and a mass in the left posterior mediastinum at the level of the 5th thoracic vertebra. Computed tomography (CT) and magnetic resonance imaging (MRI) of the chest confirmed the position of the mass in proximity to the thoracic wall at that level. Through a left posterolateral thoracotomy, a 4 x 5 x 2 cm mass, mushroom-shaped, stalky, completely covered by the lung parenchyma, was resected. Histopathological examination revealed a SFT of the lung. 2nd case: A 54-year-old woman presented with symptoms of respiratory distress and persistent hypoglycaemia. CT scan of the chest showed a huge mass within the right hemithorax, compressing the mediastinum and the contralateral lung. The mass was initially detected on chest radiography and CT scan 3 years before resection. Fine needle biopsy (FNB) results were inconclusive and resection of the mass through a right thoracotomy established the diagnosis of malignant SFT. Resection of the mass resulted in recovery of respiratory function and the paraneoplastic hypoglycaemia. Radiologic features and inconclusive fine needle aspiration (FNA)/FNB results make preoperative diagnosis of SFTs of the pleura and lung difficult. Diagnosis of SFT will be established with certainty after surgery. Resection with clear margins is the main important prognostic factor.
Foroulis
C N
CN
Department of Thoracic and Cardiovascular Surgery, Aristotle University of Thessaloniki, Medical School, AHEPA University Hospital, Thessaloniki, Greece. foroulis@med.auth.gr
Rammos
K S
KS
Tsomkopoulos
S
S
Sileli
M N
MN
Hatzibougias
I
I
Papakonstantinou
C
C
D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D054364:Solitary Fibrous Tumors / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed