|Year : 2023 | Volume
| Issue : 1 | Page : 19-21
An incidental finding ‒ Solitary fibrous tumor of the pleura
Sivanthi Sapna Rajendran, Gayathri Anur Ramakrishnan
Department of Respiratory Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
|Date of Submission||23-Dec-2022|
|Date of Acceptance||18-Feb-2023|
|Date of Web Publication||29-Apr-2023|
Dr. Sivanthi Sapna Rajendran
No. 8, 4A, J D Jayithri Flats, P T Rajan Salai, KK Nagar, Chennai - 600 078, Tamil Nadu
Source of Support: None, Conflict of Interest: None
A 46-year-old female, with no previous history of respiratory complaints, was found to have a lesion in the left lower zone on chest X-ray during preoperative evaluation for undergoing hysterectomy in view of vaginal prolapse. Computed tomography (CT) of the chest showed a well-defined lobulated pleural-based lesion with smooth margins in the left lower lobe measuring 9.3 cm × 5.3 cm. She underwent CT-guided lung biopsy which showed a mesenchymal neoplasm. Hence, uniportal Video assisted thoracoscopic surgery (VATS) was done and a biopsy Histo-pathological examination (HPE) sent showed pleomorphic spindle cells with little cytoplasm and immunohistochemistry showed vimentin, CD34, STAT 6 positivity, and pan-cytokeratin negativity, consistent with solitary fibrous tumor of the pleura.
Keywords: CD34, solitary fibrous tumor of the pleura, uniportal VATS
|How to cite this article:|
Rajendran SS, Ramakrishnan GA. An incidental finding ‒ Solitary fibrous tumor of the pleura. J Assoc Pulmonologist Tamilnadu 2023;6:19-21
|How to cite this URL:|
Rajendran SS, Ramakrishnan GA. An incidental finding ‒ Solitary fibrous tumor of the pleura. J Assoc Pulmonologist Tamilnadu [serial online] 2023 [cited 2023 May 29];6:19-21. Available from: https://www.japt.in//text.asp?2023/6/1/19/375461
| Introduction|| |
The solitary fibrous tumor of the pleura (SFTP) is a rare primary tumor of the pleura, arising from mesenchymal cells in tissue subjacent to mesothelial-lined pleura (80% of solitary fibrous tumors of the pleura originate in the visceral pleura and 20% in the parietal pleura). It represents <5% of all pleural tumors, with a predilection toward mid and lower chest zones.
A 46-year-old female was evaluated preoperatively for hysterectomy (Indication: vaginal prolapse). She had no respiratory complaints of cough, breathlessness, or chest pain. She had no past history of tuberculosis/asthma/chronic obstructive pulmonary disease/COVID-19 pneumonia/obstructive sleep apnea/interstitial lung disease. Chest skiagram showed left lower zone pleural-based homogenous opacity sparing left costophrenic angle [Figure 1].
|Figure 1: Chest X Ray (CXR) showing left lower zone pleural-based homogenous opacity sparing left costophrenic angle|
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Computed tomography (CT) of the chest showed a well-defined lobulated pleural-based lesion with smooth margins in the left lower lobe measuring 9.3 cm × 5.3 cm [Figure 2]. The lesion is isodense to the muscle and homogenous on moderate contrast enhancement [Figure 3] with no adjacent rib destruction in contrast-enhanced CT chest.
|Figure 2: CT chest lung window showing a well-defined lobulated pleural-based lesion with smooth margins in the left lower lobe measuring 9.3 cm × 5.3 cm. CT = Computed tomography|
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|Figure 3: CECT chest showing a lesion in left lower lobe that is isodense to the muscle and homogenous on moderate contrast enhancement with no adjacent rib destruction. CECT = Contrast-enhanced computed tomography|
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CT-guided lung biopsy was suggestive of a mesenchymal neoplasm. Uniportal VATS intraoperatively revealed a pedunculated mass arising from both parietal and visceral pleura, and HPE sent showed pleomorphic spindle cells with little cytoplasm and immunohistochemistry showed vimentin, CD34, STAT 6 positivity [Figure 4], and pan-cytokeratin negativity, consistent with a solitary fibrous tumor of the pleura.
| Discussion|| |
The solitary fibrous tumor of the pleura occurs in all age groups from 5 to 87 years, but they peak in the sixth and seventh decades of life with an even distribution between men and women. They are mostly benign (80%), remain asymptomatic, usually discovered incidentally, or continue to grow in malignant cases causing obstructive/compressive symptoms such as dyspnea, chest pain, and cough.
Most of the benign SFTP are small pedunculated tumors, whereas the malignant variants are often larger than 10 cm and grow beneath the parietal pleura of the chest wall, diaphragm, or mediastinum. Macroscopically, benign and malignant tumors appear as firm, smoothly lobulated masses. Most of them are encapsulated by a thin, translucent membrane, containing a reticulated vascular network.
Histologically, they are characterized by a typical morphologic appearance of alternating hypo-and hypercellular areas of spindle-shaped cells, dense bands of collagen, and a hemangiopericytomatous vascular pattern. Histologic characteristics distinguishing benign from malignant variants are crucial in estimating the risk of recurrence and planning adjuvant therapies.
Some are malignant (12%) by histology. A high mitotic rate, necrosis, and pleomorphism have been used as determinants of malignancy. Most SFTPs stain positive for CD34 which was originally described as a hematopoietic stem cell marker. CD34 immunoreactivity appears useful as a positive marker for distinguishing SFTP from other tumors.
The main differential diagnoses of malignant SFTP include pleural mesothelioma, neurogenic sarcoma, synovial sarcoma, hemangiopericytoma, fibrosarcoma, and malignant fibrous histiocytoma. Complete en-bloc surgical resection is the mainstay of therapy for all benign and malignant SFTP. Whereas pedunculated tumors can be safely resected with a wedge resection of the lung, large sessile tumors often require a lobectomy or a pneumonectomy to achieve complete resection.
It has a good prognosis though long-term follow-up is essential due to the risk of local recurrence (8% of benign and 63% of malignant cases). The 1-year follow-up in our case showed no recurrence [Figure 5].
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]