A giant solitary fibrous tumor of the pleura: diagnostic implications in an unusual case with literature review.
A solitary fibrous tumor of the pleura (SFTP) is an uncommon tumor, in contrast to a relatively common mesothelioma in pleura. Its average size varies from 6 to 8 cm. We report herein a case of a giant SFTP in a 53-year-old man who presented with cough since five years along with chest pain on the left side and progressive dyspnea since two months. Radiological findings revealed a large pleural mass measuring 25 cm in its largest dimension, filling the pleural cavity with effusion. Biopsy showed a spindle cell tumor with areas of dense sclerosis. Subsequent excision unraveled a large multinodular, grey-white tumor, histologically, composed of spindle cells in a 'patternless' arrangement in dense collagenous stroma with areas of hyalinization. Focal areas showed hypercellularity with atypia and mitoses, but less than 4/10 High-Power Field, unassociated with necrosis. On immunohistochemistry, tumor cells showed diffuse positivity with vimentin, CD34 and BCL2 along with cytoplasmic positivity for MIC2 (CD99), whereas cytokeratin, EMA, calretinin and HBME-1 were negative. Diagnosis of an SFTP was substantiated over a close differential of a desmoplastic mesothelioma. In view of atypical features, a close follow-up of the case was recommended.
Mune
Swati
S
Department of Pathology, Tata Memorial Hospital, Mumbai, India.
Rekhi
Bharat
B
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Nutan
N
Jambhekar
Nirmala A
NA
D018952:Antigens, CD34 / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D064032:Calbindin 2; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D006651:Histocytochemistry; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D013902:Radiography, Thoracic; D064030:S100 Calcium Binding Protein G / Q000032:analysis; D054363:Solitary Fibrous Tumor, Pleural / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014746:Vimentin / Q000032:analysis; D000951:Antigens, Neoplasm
D018952:Antigens, CD34; D014408:Biomarkers, Tumor; D064032:Calbindin 2; D019253:Proto-Oncogene Proteins c-bcl-2; D064030:S100 Calcium Binding Protein G; D014746:Vimentin; C576764:CALB2 protein, human; C432845:HBME-1 antigen; D000951:Antigens, Neoplasm