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Weekly Chest CasesArchive of Old Cases

Case No : 1132 Date 2019-07-08

  • Courtesy of Jae Min Shin, Chul Hwan Park, Tae Hoon Kim / Gangnam Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 64 / F
  • Chief ComplaintChronic cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Solitary fibrous tumor of pleura
Radiologic Findings
Figs 1-2. Chest CT images show a well-circumscribed mass at the T4-T7 levels of the left paraspinal area. It had an area of about 3.5×2.7 cm and featured a smoothly tapering angle obtuse to the adjacent pleura. After contrast media injection, heterogeneous enhancement was observed in the mass lesion. We found no sclerosis or cortical erosion of the abutting rib.
Figs 3-6. A well-circumscribed mass with an area of 3.5×2.7 cm situated at the left upper paraspinal area showed iso-to-low signal intensity on T1WI, high signal intensity on T2WI, heterogeneous strong enhancement on enhanced T1WI, and heterogeneous diffusion restriction on DWI.

A 64-year-old female patient underwent chest computed tomography (CT) because of chronic cough. The chest CT image with mediastinal window settings showed a well-circumscribed mass at the T4-T7 levels of the left paraspinal area; the mass had an approximate area of 3.5×2.7 cm and a smoothly tapering angle obtuse to the adjacent pleura. Magnetic resonance imaging visualized the mass lesion with iso-to-low signal intensity on T1-weighted images (T1WI), high signal intensity on T2WI, heterogeneous strong enhancement on enhanced T1WI, and heterogeneous diffusion restriction on diffusion-weighted imaging. Differential diagnoses included solitary fibrous tumor of the pleura and neurogenic tumor. Wedge resection was performed (A). A well-capsulated whitish pleura mass with an approximate area of 4cm was excised (B), and the pathologic diagnosis was confirmed to be solitary fibrosis tumor of the pleura.

(A)

(B)

Brief Review
Accounting for less than 5% of all pleural tumors, solitary fibrous tumor of the pleura (SFTP) is a rare neoplasm that originates in submesothelial mesenchymal cells; 80% of these tumors arise from the visceral pleura. SFTP may occur in various parts of the body, including the head, neck, thorax, abdomen, and extremities; however, the most prevalent site of origin is the thoracic pleura. Less common SFTP sites in the thorax include the mediastinum, lung parenchyma, and soft tissues (1). SFTP demonstrates soft tissue attenuation on unenhanced CT scans and shows relatively homogeneous intense enhancement on contrast-enhanced CT scans. Magnetic resonance imaging typically visualizes SFTP with low-to-intermediate signal intensity on T1WI and low signal intensity on T2-weighted images, which is thought to be due to high cellularity and abundant collagen (2). Necrosis, myxoid degeneration, or hemorrhage within the tumor may also be observed in cases of SFTP, which causes heterogeneous attenuation on CT or high SI on T2WI (2, 3). On positron emission tomography, SFTP shows minimal-to-no fluorine-18-fluorodeoxyglucose uptake (1). While SFTPs typically grow undetected for several years, they are usually benign and exhibit relatively indolent behavior. Its differential diagnosis is essentially similar to that of any mass lesion in the chest. A posterior paraspinal location might suggest a neurogenic tumor or round atelectasis. A more anterior and medial location might indicate a thymic neoplasm, germ cell tumor, or teratoma. The usually well-circumscribed appearance of the SFTP generally rules out malignant pleural mesothelioma (1). In the case of benign SFTP, complete surgical resection is the treatment of choice; the 10-year survival rate following surgical intervention is reported to be up to 98% (4). However, 12~37% of SFTPs are classified as malignant. The characteristic findings of malignant SFTP are masses with diameters of more than 10 cm, central necrosis, and ipsilateral pleural effusion. Metastasis reportedly recurs in 14~43% of cases of malignant SFTP, the 5-year survival rate after the treatment of which is 45-68% (5).
References
1. Cardinale L, Ardissone F, Garetto I, Marci V, Volpicelli G, Solitro F, et al. Imaging of benign solitary fibrous tumor of the pleura: a pictorial essay. Rare Tumors 2010;2:e1
2. Harris GN, Rozenshtein A, Schiff MJ. Benign fibrous mesothelioma of the pleura: MR imaging findings. AJR Am J Roentgenol 1995;165:1143-1144
3. Lee KS, Im JG, Choe KO, Kim CJ, Lee BH. CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients. AJR Am J Roentgenol 1992;158:983-986
4. Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control 2006;13:264-269
5. Gupta A, Souza CA, Sekhon HS, Gomes MM, Hare SS, Agarwal PP, et al. Solitary fibrous tumour of pleura: CT differentiation of benign and malignant types. Clin Radiol 2017;72:796.e799-796.e717
Please refer to
Case 43 Case 80 Case 121 Case 530 Case 694 Case 836 Case 940 Case 975 Case 981 Case 999 Case 1120
Keywords
pleura, solitary fibrous tumor ,

No. of Applicants : 67

▶ Correct Answer : 15/67,  22.4%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JUWON KIM
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 19/67,  28.4%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , Korea (South) CHOHEE KIM
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Gyeongsang National University Hospital , Korea (South) KWON HWANWOONG
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
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