Localized (solitary) fibrous tumors of the pleura: an analysis of 15 patients.
BACKGROUND
Localized fibrous tumors of the pleura (LFTPs) are rare neoplasms, which are considered to originate from submesothelial connective tissue. The aim of this article is to present 15 new cases because of their different clinical behaviors and to discuss the treatment of choice of such neoplasms.


METHODS
The records of 15 consecutive patients with LFTP operated at our Institution between 1995 and 2006 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all patients. Neoplasms were considered to be malignant if one or more of the following histologic features were present: increasing mitotic activity; high cellularity with crowding and overlapping of nuclei; necrosis; and pleomorphism.


RESULTS
No operative mortality was reported. The mean follow-up time was 76 months. Malignant transformation was seen in 1 patient 26 months after resection of a benign tumor. Six cases were pathologically considered to be malignant: 2 patients developed local recurrence. One of these underwent redo-surgery and required pneumonectomy; in the other one surgery is not indicated because at the time of diagnosis the patient was 85 years. Currently, all patients are alive and 13 disease-free.


CONCLUSIONS
For histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients. For malignant cases, complete surgical resection may be insufficient for the cure: further study should be performed to identify reliable prognostic factors to indicate and evaluate the effectiveness of systemic treatment.
Perna
Valerio
V
Hospital Universitario de Bellvitge, Thoracic Surgery Department, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain. v.perna@hotmail.com
Rivas
Francisco
F
Morera
Ricardo
R
Saumench
Josep
J
Ramos
Ricard
R
Macia
Ivan
I
Ureña
Anna
A
Escobar
Ignacio
I
Villalonga
Rosa
R
Moya
Juan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005350:Fibroma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology / Q000601:surgery; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome