대한흉부영상의학회 Weekly Chest Cases

Case No : 940 Date 2015-11-02

Courtesy of Geewon Lee, Ji Won Lee / Pusan National University Hospital
Age/Sex 69 / F
Chief ComplaintChest pain for several months

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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: 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,

No. of Applicants : 93

▶ Correct Answer : 61/93, 65.6%

- Juntendo University Hospital , Japan Akifumi Hagiwara
- university of montreal , Canada Andrei Gorgos I
- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- Otsu Red Cross Hospital , Japan Hirotsugu Nakai
- NIMS, HYDERABAD , India bhaskar kakarla
- University of Tsukuba Hospital , Japan Hiroaki Takahashi
- University of Tsukuba Hospital , Japan Sodai Hoshiai
- �stanbul , Turkey Ayhan Yilmaz
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- privato , Italy genchi enzo
- University of British Columbia , Canada Amr Ajlan
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Ajou University Hospital , Korea (South) Young Keun Sur
- Ajou university hospital , Korea (South) Pae Sun Suh
- Ajou University Hospital , Korea (South) Taeyang Ha
- , Korea (South)
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
- Goa Medical College , India Paresh Desai
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Avrasya Hospital , Turkey Murat Ulusoy
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- McGill University Health Center , Canada Alexandre Semionov
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Niigata City General Hospital , Japan Takao Kiguchi
- Ondokuz Mayis University , Turkey Cetin Celenk
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Asan Medical Center , Korea (South) Jooae Choe
- Hopital du Sacre Coeur , Canada Andrea Ojanguren
- Ajou University Hospital , Korea (South) Seulgi You
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- , Korea (South) BAEK YOOLIM
- Wuhan Union Hospital , China Qiguang Cheng
- Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
- Kizawa Memorial Hospital , Japan Yo Kaneko
- KG hospital & PG Institute , India SANAL KUMAR
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- IRSA La Rochelle , France Denis Chabassiere
- NASA SCANS , India RAKESH BHATIA
- CLCC Rennes , France nicolas gautier
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Santosh hospital,Bengaluru , India Pravin Mahadevappa
- Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Samsung Medical Center , Korea (South) Jeonghyun Lee
- Pusan national university hospital , Korea (South) Jin Joo Kim
- Asan , Korea (South) Sania ALBlushi
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Gifu Central Hospital , Japan Haruo Watanabe
- Busan national univercity hospital radiology department , Korea (South) Il-wan Son
- pusan national university hospital , Korea (South) kim jeongmyeong
- PNUH , Korea (South) Seungbaek Hong
- Pusan national university hospital , Korea (South) Minkyu Kwak
- Pusan national university hospital , Korea (South) SeungHyun Lee
- Nasaret Hospital , Korea (South) Hee Seok Choi
- Medicheck health care , Korea (South) Chae Lim
- Chonnam national university hospital , Korea (South) INSOO JANG
- Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki

▶ Correct Answer as Differential Diagnosis : 23/93, 24.7%

- Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
- Kyoto University , Japan Akihiko Sakata
- Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- Himeji Redcross Hospital , Japan Soichiro Okamoto
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Niigata University , Japan Atsushi Uehara
- KEM ,MUMBAI,INDIA , India SHAH ALAM
- Okayama University Hospital , Japan Toshiyuki Komaki
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- the first affiliatited hospital of nanjing medical univercity , China Hai Xu
- chp st martin , France Mariotte benoit
- Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
- GHICL , France manuel toledano
- the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
- CHRU Lille , France Paul Lebert
- chungbuk national university hospital , Korea (South) lee jung hwan
- chungbuk university hospital , Korea (South) Hyeonmi Ryu
- CHU Poitiers , France CHAN paul
- Kizawa Memorial Hospital , Japan Shoji Okuda
- Northern Yokohama Showa university , Japan Kota Watanabe

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 940 Date 2015-11-02

Discussion

No. of Applicants : 93