Outcome of surgery in patients with solitary fibrous tumors of the pleura.

BACKGROUND: Solitary fibrous tumor of the pleura is rare, and the origin is submesothelial tissue. These tumors are seen in lung infrequently, and most are benign. We report our experience in the diagnosis and treatment of patients with solitary fibrous tumors of the pleura. METHODS: We studied 13 patients (6 men and 7 women, aged 26 to 76 years) with a diagnosis of benign solitary fibrous tumor of the pleura who were operated on from 2001 to 2014. One had a recurrent tumor after 10 years, and the others had primary tumors. Our approach was complete resection in all cases. RESULTS: After surgical excision, the most essential characteristic on histopathology was a neoplastic lesion composed of spindle-shaped tumor cells with hyperchromatic nuclei and eosinophilic bands of collagen. On immunohistochemical analysis, the cells were positive for desmin and negative for actin, synaptophysin, chromogranin, and CD117. CONCLUSIONS: The essential step in the treatment of a patient with a diagnosis of benign solitary fibrous tumor of the pleura is complete resection. These patients should be followed up for a long time because of the possibility of late recurrence. Due to the rarity of these tumors, there has been no systematic assessment of the role of adjuvant therapy for benign solitary fibrous tumor of the pleura.

Single port VATS resection of a sessile solitary fibrous tumour of the visceral pleura. A case report.

UNLABELLED: The solitary fibrous tumour of the visceral pleura is a rare neoplasm that derives from mesenchymal cells adjacent to the mesothelial tissue of pleura. Surgical resection is the treatment of choice in benign lesions and healing resulting in half of malignant. Local recurrence can occur in malignant cases, but it is very rare in solitary benign tumors. It may be a result of an incomplete or conservative surgery, lack of identification of a tumor during the operation or a growth of a synchronous neoplasm independent from that removed. Surgical resection is also burdened with some difficulty as the size of the tumor, the relationship with the adjacent structures and identification of the vascular peduncle. We report a case of 72 years-old male with a sessile left solitary fibrous tumour of the visceral pleura. The mass of 10 x 7 x 5 cm was attached, thanks to large planting base, to lateral basal segment of left lower lobe. The patient was treated by single port video assisted approach with a 4 cm skin incision. This case, in our knowledge, represents the first resection by single port VATS of a sessile SFTP with a large plating base and, more generally, the third SFTP resection treated by single portal access. KEY WORDS: Solitary fibrous tumour, Uniportal VATS.

Prognostic factors in solitary fibrous tumors of the pleura.

BACKGROUND: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms originating from submesothelial mesenchymal cells with fibroblastic differentiation. The clinical behavior of SFTPs is mostly benign; however, up to 20% of patients develop local recurrence and/or distant metastasis. Although different risk-stratification models have been described, definitive criteria to predict a malignant clinical course of SFTP are still lacking. METHODS: In a retrospective analysis at a single-institution, 25 patients with histologically proven SFTP were identified. Clinicopathologic and survival data were collected and pathologic sections reviewed. Different markers and risk-stratification models were correlated with disease- and overall-free survival by Kaplan-Meier analysis. RESULTS: Of 25 SFTP, 8 tumors (32%) were classified as malignant according to the World Health Organization criteria. Three patients (12%) developed recurrence. Cohort median follow-up was 28 mo, and median overall survival was 160 mo. Comparison of proliferation markers showed higher mitosis count per high-power field and MIB-1 labeling index (MIB) in malignant compared with nonmalignant SFTP. MIB was identified as a predictor for disease-free survival. Applying the previously reported classifications to categorize SFTP according to the probability to show malignant behavior, significant differences in disease-free survival were also present in our cohort. CONCLUSIONS: In the present analysis of rare SFTP, previously proposed staging systems were applicable for prediction of disease-free survival. Independently of treatment, MIB was the only sole predictive marker. A prospective multi-institutional database could be helpful in establishing detailed predictive criteria in patients diagnosed with SFTP.

Giant solitary fibrous tumor of the pleura.

Solitary fibrous tumors are rare mesenchymal tumors accounting for <5% of all neoplasms in the pleura and other sites. A 45-year-old man reported to us with cough and dyspnea. Radiological investigations revealed a giant mass displacing the mediastinum to the left. The tumor weighing 3.0 kg was successfully resected via a right thoracotomy. Histology and immunohistochemistry confirmed a benign tumor. Recurrence and malignant transformation of these benign tumors have been reported. Our patient has been followed up for 4 years with no recurrence.

Determinants of outcome of solitary fibrous tumors of the pleura: an observational cohort study.

BACKGROUND: Solitary fibrous tumors of the pleura (SFTP) are rare and their long-term outcome is difficult to predict, as there are insufficient data which allow accurate characterization of the malignant variant. Thus the aim of this study was to describe the outcome and possible determinants of malignant behavior of SFTPs. METHODS: Data were collected retrospectively from medical records of patients treated at the University Hospital Zurich from 1992 to 2012. Kaplan-Meier and Cox regression analysis were performed to define disease-free survival time (defined as survival without tumor-recurrence or tumor-related death) using the classical histo-morphological criteria (tumor size, localization, pedunculation, tumor necrosis or hemorrhage, mitotic activity and nuclear pleomorphism) and immunohistochemical parameters. RESULTS: 42 patients (20 males) with SFTP (median (IQR) age 62 (56-71) years) could be identified. SFTP were associated with symptoms in 50% of all cases. Complete resection was achieved by video-assisted thoracic surgery or thoracotomy in 20 and 22 patients, respectively. Three SFTP-related deaths (7.1%) and four tumor recurrences (9.5%) were observed. Mean disease-free survival time was 136.2 (± 13.1) months, and 2-, 5- and 10-year disease-free survival was 91%, 84%, and 67%, respectively. Mean disease-free survival inversely correlated with the mean tumor diameter, number of mitotic figures and proliferation rate (Ki-67 expression). Other criteria (tumor necrosis, atypical localization, sessile tumor, and pleomorphism) were not statistically significant prognostic parameters. CONCLUSIONS: Patients with large SFTP with a high mitotic index and high proliferation rate should be followed-up closely and over a prolonged time period in order to recognize recurrence of the SFTP early and at a treatable stage. Future research on this topic should focus on the prognostic role of immunohistochemistry including Ki-67 expression and molecular parameters.

Synchronous cerebral and pleural solitary fibrous tumour.

Solitary fibrous tumours of the pleura (SFTPs) are rare mesenchymal neoplasms usually originating from the visceral pleura, but they have been reported in many other sites. To the best of our knowledge, this report describes the first known case of synchronous SFTP in the left visceral pleura and brain. The SFTP of the brain was resected via craniotomy, whereas the SFTP of the pleura, widely compressing and displacing the left lower lung lobe, was resected via left thoracotomy.

Two cases of giant solitary fibrous tumor of the pleura: a not-so-rare tumor?

Solitary fibrous tumors of the pleura are rare intrathoracic neoplasms, especially in the giant form. The treatment of choice remains complete surgical resection which provides a benign clinical outcome. All patients need long-term follow-up due to the possibility of late recurrences. We describe 2 new cases of giant pleural fibrous tumor, which underwent resection via thoracotomy, and discuss the diagnostic and therapeutic modalities.

Malignant solitary fibrous tumor of pleura accompanied with first symptoms of chest pain and hemoptysis: a case report.

Solitary fibrous tumor of the pleura (SFTP) is a rare tumor especially presents malignant features. Such symptoms of hemoptysis and dyspnea were rarely seen and take 5% and 4% respectively in malignant SFTP. A 26-year-old Chinese man, presenting with hemoptysis in the emergency room, was hospitalized because of dyspnea. The X-ray examination revealed a tumor in the right chest cavity. The patient refused treatment, and the tumor grew rapidly, which complicated the symptoms of the patient. En-bloc excision of tumor plus the involved lung was performed. There was at least a 5000-ml mixture of blood and tumor tissue in the right chest cavity because of continuous bleeding, leading to a tumor capsule split. Histopathology and immunohistochemistry identified the tumor as malignant SFTP, but CD34 was negative. In this case, the tumor grew rapidly and aggressively in two months, indicating that close follow-up and active treatment are needed.

Huge malignant solitary fibrous tumor of the pleura.

INTRODUCTION: Solitary fibrous pleural tumors are rare mesenchymal tumors that can be mistaken for mesothelioma. A positive staining of vimentin, negative staining of cytoplasmic keratin, and expression of the CD34 antigen can confirm their diagnosis. These tumors should be surgically excised although they are benign because they have malignant potential and tendency for recurrence. PATIENTS AND METHODS: We present here a 63-year-old patient who had an inconclusive biopsy of a huge right intrathoracic lesion. Further testing after radical surgical resection revealed a malignant solitary fibrous pleural tumor. Surgery was complicated with injury of the thoracic duct. Patient was re-operated upon for ligation of the thoracic duct. He is doing well with no recurrence after 18 months of follow-up. CONCLUSION: In conclusion, definitive treatment for solitary fibrous tumor is radical surgical resection with close follow-up for the recurrences. Follow-up of this tumor is essential especially when it showed malignant features on pathological examination.

Localized malignant pleural mesothelioma.

Localized malignant pleural mesothelioma (LMPM) is a rare tumor; previously only 52 cases have been reported in the English literature. This type of tumor should be distinguished from diffuse malignant pleural mesothelioma, because a good outcome may be obtained by surgical resection. We report a case of LMPM which grew rapidly within 1 year. Surgical resection was performed, and at present, 6 months since the operation, the patient remains free of the disease.

Benign localized fibrous tumor of the pleura: report of 25 new cases.

OBJECTIVE: Benign localized fibrous tumors (BLFT) of the pleura are very rare slow-growing neoplasms that generally have a favorable prognosis. The aim of this manuscript is to evaluate the predictors of outcome with the review of the literature in a series of 25 patients with BLFT. METHODS: Between January 1985 and November 2009, 25 patients underwent an operation due to BLFT. Of these patients, 14 (56%) were male; mean age was 41.1 (25 to 64) years. All patients underwent thoracotomy. Left thoracotomy approach was used in 16 patients. The mass lesions were totally excised. The histopathological examinations were performed with hematoxylin-eosin and immunohistochemical staining methods. RESULTS: Of the patients, 18 (72%) were symptomatic. Symptoms were cough in 36%, shortness of breath in 32%, and chest pain in 20% of the patients. One patient (4%) appeared to have some symptoms (pain and swelling of the joints) associated with pulmonary osteoarthropathy. Seven patients (28%) underwent an operation due to mass lesion detected at routine control visits. None of the patients had a history of exposure to asbestos. Radiological investigations revealed 16 (64%) mass lesions in the left. Of the lesions found on exploration, 5 (20%) were intrapulmonary localized lesion without pedicle and 20 were pedicled. Of the pedicled masses, 5 were connected to parietal pleura and 15 to visceral pleura and all were intrathoracic extrapulmonary localized lesions. Eight (32%) lesions connected to left lower lobe. Additionally, three pedicled lesions were located in the lung fissure. Pedicled lesions were totally excised together with their pedicles. Intraparenchymal mass lesions were resected using wedge resection. The diameter of the resected masses was ranging between 3 and 22 cm (mean: 8.7). Macroscopically, all were encapsulated with a homogeneous cut surface. Intraoperative mortality and morbidity was not observed. The average hospitalization duration for all patients was 8.6 days (5 to 12). The mean follow-up was 33.6 (9 to 142) months with no recurrence. CONCLUSIONS: Benign localized fibrous tumors are uncommon and treated by surgical means. According to our data obtained from literature review, clinicians should be aware of recurrence possibility even after complete resection of benign localized fibrous tumor and the risk of malign transformation.

Giant solitary fibrous tumor of the pleura.

Fibrous tumors of the pleura are rare, accounting for <5% of all pleural neoplasms. Although over 80% of pleural fibrous tumors have a benign course, local recurrence postsurgery and occasional malignant transformation have been reported; complete excision of the tumor together with postsurgery follow-up of all patients is therefore recommended. We report on a solitary fibrous tumor of the pleura measuring 30 cm and weighing 3560 g.

Solitary fibrous tumors of the pleura: clinicopathological characteristics, immunohistochemical profiles, and surgical outcomes with long-term follow-up.

BACKGROUND: Solitary fibrous tumors of the pleura (SFTP) are rare. The aims of this study were (1) to characterize their clinicopathological features more precisely; (2) to determine whether an immunohistochemical (IHC) study can be helpful in distinguishing benign from malignant SFTPs; and (3) to provide more complete information to better predict prognosis. METHODS: Microscopic examinations of tumorous specimens from 15 patients were repeated and the tumors were reclassified. In addition to evaluating clinicopathological variables, expressions of p16, p53, Ki-67, CD-117, estrogen receptor (ER), and progesterone receptor (PR) biomarkers were studied and their clinicopathological and prognostic significance analyzed. RESULTS: Of the 15 enrolled patients (mean age 57 years; 8 men and 7 women), 8 were symptomatic when diagnosed. Eight patients underwent CT-guided needle biopsies before surgery and two had positive findings. All cytologic studies of pleural effusion were negative for malignant cells. Complete pleural resection with adequate safe margins was performed for all patients. Eleven cases proved to have benign tumors and 4 had malignancies. Local recurrence occurred in 3 cases and distant metastasis in one. Conventional factors, including tumor size, tumor shape, symptomatic presentation, and histological type did not affect prognosis. Interestingly, p16 expression was significantly associated with tumor recurrence ( P = 0.009). CONCLUSION: Complete pleural resection with adequate safe margins can achieve satisfactory outcomes in a majority of cases, but long-term follow-up for all patients is recommended due to the potential for late tumor recurrence. Conventional clinicopathological variables do not affect prognosis. However, IHC studies of the CD-34 and bcl-2 biomarkers can be important for further differential diagnosis, and p16 expression can be used to predict tumor recurrence.