Surgical management of giant solitary fibrous tumors of the pleura: Two case reports.

INTRODUCTION: Solitary fibrous tumor of the pleura (SFTP) is a rare primary tumor originating from mesenchymal cells located beneath the mesothelial-lined pleura. A special entity is the giant SFTP which presents unique challenges in surgical management. CASE PRESENTATION: Two cases of giant SFTPs in middle-aged patients are presented. Both patients presented with a recent worsening dyspnea and had imaging findings consistent with giant masses occupying the entire pleural cavity with a complete collapse of the homolateral lung and substantial contralateral deviation of heart and mediastinum. The pathological results of CT-guided transthoracic core needle biopsy was SFTP in both cases. Surgical resection was performed, and they both required two thoracotomies for complete tumor removal. Successful complete en bloc resection of the tumors was achieved with a total postoperative recovery. The first resected tumor was 30 × 20 cm and weighed 3500 g, the second was 33*x25 cm in size and weighed 4000 g. Both patients respiratory condition improved after the operation and no recurrence were noted in the follow-up. DISCUSSION: SFTPs are removed using various approaches: thoracotomy, sternotomy with the possibility of hemiclamshell extension, video-assisted thoracoscopic surgery (VATS), and robotic-assisted surgery. The challenge when operating giant SFTP (> 15 cm) is double: adhesions and compression to the lung tissue and surrounding mediastinal structures and the hyper vascular nature of the tumor. For giant SFTPs an open approach is preferable. Resection should be complete with negative margins due to the high risk of recurrence. CONCLUSION: These cases emphasize the significance of personalized surgical strategies for managing giant SFTPs, providing valuable insights for clinicians addressing similar cases.

[Non penetrating cardiac trauma]. / Les traumatismes fermés du coeur: revue de la littérature.

Traffic accidents are a very important leading cause of death in young adults in our country and the most cause of non penetrating cardiac trauma. Cardiac contusions represent the most common form of non penetrating cardiac trauma but a wide spectrum of cardiac injury ranging from, cardiac valve is not usually foremost in the minds of physicians dealing with acutely injured patients because initial screening is usually focused on others classic and common injuries. There is actually no controversies surrounding the fact that tnsoesophageal echocardiography is becoming the corner stone and the most useful modality of the evaluation of severe chest trauma with suspicion of cardiac injury. This paper describe the most important blunt cardiac injuries and emphasizes indirectly the need for early diagnosis that becomes an easy one, if the physician keeps in mind such a possibility in all traumatised patients. Another concern is to point out the importance of appropriate therapeutic approach that may significantly improve outcomes in patients with blunt cardiac trauma.