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. 2013 Apr 2:14:91-3.
doi: 10.12659/AJCR.883867. Print 2013.

Intrathoracic giant solitary fibrous tumor

Bülent Aydemir  1 , Sezai Celik, Tamer Okay, Ilgaz Doğusoy
Affiliations

Intrathoracic giant solitary fibrous tumor

Bülent Aydemir et al. Am J Case Rep. .

Abstract

Background: Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management.

Case report: A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient's death was confirmed.

Conclusions: We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.

Keywords: benign; benign tumors; fibrous; giant tumor; intrathoracic; solitary fibrous; therapy; tumors.

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Figures

Figure 1
Figure 1
Initial chest radiograpy showing, the right hemithorax was completely opaque and there was a mediastinal shift towards the left side. On the thoracic computed tomography (CT) image, there was a giant heterogeneous mass that filled the right hemithorax almost completely and pushed the heart to the left and the diaphragm downwards.
Figure 2
Figure 2
The thoracic CT angiogram showing that the mass was supplied by multiple intercostal arteries as well as aberrant artery that branches off the celiac trunk in the subdiaphragmatic region.
Figure 3
Figure 3
The gigantic encapsulated solitary tumor of the pleura, weighed 2870 g and measured 25×18×15 cm
See this image and copyright information in PMC

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