대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Solitrary fibrous tumor of the pleura

Radiologic Findings

Chest radiograph shows ill-defined nodular increased opacity in the left perihilar area.

Dynamic enhanced chest CT scans show about 2 cm nodular lesion in the superior segment of left lower lobe with 51.0 HU, 81.7 HU, and 65.1 HU at precontrast, postcontrast 2 min, and 4 min, respectively.

On lung setting, well-marginated ovoid mass with beaking along the left major fissure, suggesting pleura-originated mass.

Brief Review

This rare tumor occurs more often in women and about 50 years at presentation.
The etiology is unknown, but in some cases, tumor developed after radiation therapy to the chest wall.
Symptomatic hypoglycemia has been documented in about 5% of patients and more common in malignant rather than benign tumors and three times in women.

Approximately 70% of solitary fibrous tumors arise in relation to the visceral pleura.
Most project into the pleural space and compress the adjacent lung.
Some tumors arising in mediastinal pleura extend into the mediastinum and those in a fissure extend into pulmonary parenchyma like this case.

These tumors are spherical or oval and well circumscribed;
many are attached to the pleura by a short vascular pedicle;
tapering margin and forming obtuse angles with the chest wall or mediastinum.

A change in position of pedunculated tumor with respiration or change in body position is considerable diagnostic point.
Cystic formation, calcification, hemorrhage, and necrosis can be present in all benign nature, however,
although these findings are seen in large tumors, especially, last two findings should rise the possibility of malignancy.

Pleural effusion is uncommonly seen, but occurs more commonly in malignant tumors.
A greater portion of malignant tumor arise in the parietal pleura.

Enhancement is equal to or greater than that of muscle after contrast administration.
But some reported that the tumor less than 6 cm showed homogeneous, whereas larger one had inhomogeneous, related to myxoid or cystic degeneration or hemorrhage.

Surgical excision usually results in complete cure, particularly when the tumor possesses a well-defined pedicle; however, local recurrence can occur if initial surgery is inadequate.

References

1. Lee KS, Im JG, Choe KO, et al. CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients. AJR 1992;158:983

2. Saifuddin A, Da Costa P, Chalmers AG, et al. Primary maliginant localized fibrous tumors of the pleura: Clinical, radiological, and pathological features. Clin Radiol 1992;45;13

Keywords

Pleura, Benign tumor,