Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Localized fibrous tumor of pleura
- Radiologic Findings
- PA chest radiograph demonstrates a right mid-thoracic mass with incomplete border sign. Lateral chest radiograph shows that the lesion abuts the anterior chest and exhibits a sharply marginated posterior border.
Axial pre- and post-contrast CT images show a heterogeneously enhancing lobular mass in the right anterior hemithorax that forms obtuse angles with the adjacent pleural surfaces. Post-contrast scans demonstrate multiple intratumoral vessels. Coronal scan shows that the mass is attached to the visceral pleura by a vascular pedicle.
The patient underwent CT-guided percutaneous biopsy for the mass. During biopsy procedure, the mass exhibited positional change in both lesion shape and location. At the surgical field for VATS resection, a vascular pedicle attaching to the mass was confirmed.
- Brief Review
- Localized fibrous tumor of the pleural (LFTP) is the 2nd most common primary pleural neoplasm accounting for <5% of pleural neoplasm. LFTP occurs in a wide range of patients with a mean age of 50-57 years. Up to 50% of affected patients are asymptomatic, while large tumors may cause cough, dyspnea, chest pain, and discomfort.
At radiography, LFTP patients may show a well-defined peripheral nodule or mass of variable size which abuts the pleural surface. At CT scans, LFTP appears as a soft tissue nodule or mass with well-defined lobular contours and heterogeneous enhancement. Low attenuation within the mass corresponds to cysts, hemorrhage, and necrosis. Contrast-enhanced CT scans may exhibit visualization of enhancing intratumoral vessels. Although the mass may be large, there is no evidence of local invasion or lymphadenopathy. Best diagnostic clues are a pleural based mass with positional change.
Complete excision is typically curative with favorable prognosis of 5-year survival rates of 97%. 12-37% of LFTP are malignant and may produce distant metastasis. Recurrence occurs in up to 23% of patients with LFTP, more likely with malignant and sessile LFTP.
- Please refer to
Case 80, Case 121, Case 179, Case 353, Case 405, Case 530, Case 672, Case 694, Case 702, -
KSTR Imaging conference 2010 Summer Case 16
,
KSTR Imaging conference 2009 Summer Case 15
,
KSTR Imaging Conference 2008 Summer Case 1,
- References
- 1. Rosado-de-Christenson et al. Diagnostic Imaging: Chest. Second edition. 2012
2. Rosado-de-Christenson ML et al. From the archives of the AFIP: Localized fibrous tumor of the pleura. Radiographics. 2003;23:759-83
- Keywords
- Pleura, Benign tumor,