Giant solitary fibrous tumor pleura: Clinical dilemma and diagnosis

Abstract

Solitary fibrous tumors in the lung are rare neoplasms with distinct clinicopathological and immunohistochemical features. We report a giant solitary fibrous tumor of the pleura in a young male which remained silent clinically till it assumed gigantic proportions. Histology and immunohistochemistry were classical of a solitary fibrous tumor. Inspite of its appalling size it proved to be benign in behavior. This case depicts the vulnerability of this lesion to a clinical bungle. The report highlights the significance of clinical suspicion of this rare neoplasm and reveals the diagnostic associations and procedures to avoid emperical therapy and delay in curative surgical treatment.

Keywords: Clubbing; giant solitary fibrous tumour; pleura.

Figure 1

Contrast enhanced computed tomogram showing a huge mass in the left hemithorax. X-ray chest PA view (inset) providing an impression of a loculated pleural effusion

Figure 2

Cut section of the excised tumor revealing an encapsulated solid fleshy mass with whorling

Figure 3

Photomicrographs of the neoplasm showing (a) Subcapsular increased vascularity (H and E, ×200), (b) Cellular areas with relatively plump spindle cells and an occasional mitosis (H and E, ×400), (c) Parvicellular spindle cell areas, (H and E, ×400), (d) Variably hyalinised collagenous stroma, hyaline cuffs around vessels, and microcystic degeneration, (H and E, ×200)

Figure 4

Immunohistochemical profile showing (a, c, d) Diffuse positivity for CD34, vimentin, and SMA. (b) FVIIIAg immunohistochemistry revealed mild-sparse positivity with normal staining of vessels within the tumor. (DAB×200)