Solitary fibrous tumour of the pleura - cases analysis

Abstract

Background: Isolated fibrous tumor of the pleura (SFTP - Solitary fibrous tumour of the pleura/localized fibrous tumour of the pleura) is a rare primary tumour of the pleura of mesenchymal origin. In most cases, it is a benign lesion. It is composed of spindle cells similar to fibroblasts and derives probably from submesothelial mesenchyme. The aim of the study was to analyze clinical symptoms, incidence, possibility of suggesting the diagnosis on the basis of imaging tests, and confirmation of the diagnosis in pathological tests with regard to studies of histochemistry examination.

Material/methods: Clinical and morphological material obtained from 14 patients from Department of Thoracic Surgery of Subcarpathian Chest Disease Center treated between year 2004 and 2010 was analysed. In the first stage, selected cases of patients with isolated fibrous tumour of the pleura were chosen from the archives and the analysis of their medical history was carried out. Basic information about age, gender, medical history, smoking habit, physical examination and results of imaging, endoscopic and morphological examinations were noted. The second parallel component of the study was pathomorphological examinations of the surgical material obtained from the patients, including the assessment of morphology and immunohistochemistry.

Results: Of the 14 examined patients, fibrous tumour occurred in 8 men and 6 women. The age range of the patients was 37-73 years, with a peak attributable to the 6(th) decade of life. In 8 patients the tumour was detected incidentally during routine examinations. In 7 patients there were no clinical signs of respiratory disease, and if present, then the most common complaint was shortness of breath. Regarding symptoms not connected with the respiratory system, anemia occurred most frequently. Fibrous tumour of the pleura was more often associated with the visceral pleura than with the parietal pleura. The largest lesion was approximately 20 cm in size.

Conclusions: Fibrous tumour of the pleura is a pleura-based neoplasm which is usually detected incidentally, and is often asymptomatic or poorly symptomatic. Computed tomography imaging allows to suggest a correct diagnosis. Histopathological diagnosis is based on immunohistochemical examinations.

Keywords: Immunohistochemistry; Pleural –blood; Solitary Fibrous Tumor; Spiral Computed; Tomography.

Figure 1

A 46-year-old female patient, with no clinical history. (A) A routine chest X-ray – a round 12-mm opacification (asterisk) in the right upper lung field. (B) Chest CT, axial plane of the right upper lobe, a 10×12×10 mm nodule adjacent (asterisk) to an oblique fissure, no obvious enhancement after administration of contrast medium. Histopathological diagnosis of intrapulmonary solitary fibrous tumour.

Figure 2

A 49-year-old female patient. Shortness of breath, weight loss, anemia. (A) Chest X-ray – an opacification (asterisk) in the left lung. (B) Chest CT, axial plane. A giant tumour (asterisk) of the left lung (upper lobe and superior segment of the lower lobe) with heterogeneous enhancement after administration of contrast medium.

Figure 3

A 37-year-old male patient. (A, B) Routine chest X-ray. Tumour (asterisk) in the left lower lung field. (C, D) Chest CT, axial plane. In the left lower lobe there is a 8×7×5 cm tumour (asterisk) adjacent to the diaphragmatic pleura, with heterogeneous enhancement after administration of contrast medium.

Figure 4

A 59-year-old male patient, with no respiratory tract symptoms. Chest CT, axial plane. (A) In the lateral segment of the right middle lobe there is a 41×20×29 mm oval tumour (asterisk) adjacent to the chest wall, (B) with heterogenous enhancement after administration of contrast medium and no rib destruction. It forms an obtuse angle with the chest wall.