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Weekly Chest CasesArchive of Old Cases

Case No : 1098 Date 2018-11-13

  • Courtesy of Su Yeon Ahn, MD. Jeong Geun Yi ,MD / Konkuk University Medical Center
  • Age/Sex 51 / M
  • Chief ComplaintDyspnea for 1 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Malignant solitary fibrous tumor
Radiologic Findings
Chest radiograph shows large mass occupying left hemithorax and multiple masses in right lung. Chest CT shows a huge heterogeneous enhancing mass with serpiginous intratumoral vessels in left hemithorax. The mass was arising from left pleura and extending to mediastinum. There are multiple masses in right lung. Pericardial effusion was also seen. The lesions show increased FDG uptake.
The patient underwent CT-guided percutaneous biopsy for the mass. Mitotic activity was 5/10HPF.
Brief Review
Solitary fibrous tumors of the pleura (SFTP), are a rare benign pleural-based tumor that accounts for <5% of all tumors involving the pleura. It usually presents in the 6th to 7th decades and has no significant sex predilection. Although approximately half of SFTP patients are asymptomatic, cough, chest pain, and dyspnea may be presented, especially in patients with relatively large tumors. There may be a predilection towards the mid to lower zones of the chest. In ~80% of cases, they arise from visceral pleura, with the remainder arising from the parietal pleura.
On CT scan, it tends to have soft tissue attenuation on unenhanced scans and show relatively homogenous intense background enhancement on contrast enhanced scans (from rich vascularization). Non-enhancing areas may be present corresponding to necrosis, myxoid degeneration, or hemorrhage within the tumor. A pedicular attachment may also be seen.
About 20% of SFTs are malignant. Proposed criteria for malignancy include increased cellularity, mitotic activity (>4/10hpf), and necrosis (coagulative necrosis associated with tumor cells). Malignant form is hardly distinguishable from benign forms, but tends to be larger than 10 cm and more likely to be associated with internal low attenuation and pleural metastasis.
References
1. Daniel T. G, Aqiba B, Shweta B. Imaging Features of Solitary Fibrous Tumors. AJR 2011;196: 487-495.
2. Cardinale L, Ardissone F, Volpicelli G. CT signs, patterns and differential diagnosis of solitary fibrous tumors of the pleura. J Thorac Dis 2010 Mar; 2(1): 21.
Keywords

No. of Applicants : 78

▶ Correct Answer : 13/78,  16.7%
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JAE WOO SONG
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Gifu University Hospital , Japan Yo Kaneko
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
▶ Correct Answer as Differential Diagnosis : 9/78,  11.5%
  • - , Japan SHINTARO ICHIKAWA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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