Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome

Abstract

The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing.

Figure 1

1A: Chest radiograph showing a lobulated mass in the right chest suggestive of a benign pleural tumour. 1B: CT-scan showing a lobulated mass in the right chest suggestive of a benign pleural tumour. 1C: Tumour at macroscopy, well-circumscribed and encapsulated. 1D: Cut surface of the tumour tan-coloured and whorled appearance. 1E: Photomicrograph showing bland spindle cell proliferation with a patternless architecture, and hypo- and hypercellular areas separated by dense collagenous fibrous stroma (H&E stain). 1F: Photomicrograph of tumour cells stained positive with CD34. 1F-inset: Electromicrograph depicting ultrastructural features of fibroblasts with abundant collagen.