대한흉부영상의학회 Weekly Chest Cases

Case No : 836 Date 2013-11-04

Courtesy of Tae Eun Kim, Jeung Sook Kim / Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
Age/Sex 42 / M
Chief Complaintincidental finding on chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Localized fibrous tumor of the pleura
Radiologic Findings: Chest PA shows a sharply marginated ovoid nodule in right lower lung zone.
CT images show a 2.5cm well-defined ovoid mass in right lower lung zone, extending from the right lower lobe to the right middle lobe. The nodule measures about 48 ~ 53 H.U. and does not contain visible fat or calcification. This well-defined nodule abuts and bulges the right major fissure.
Percutaneous needle biopsy under the fluoroscopic guidance was performed and the nodule was diagnosed as localized fibrous tumor. In the operation, this mass was located at the pleural space adjacent to right major fissure and totally separated from lung parenchyma. Pathology with immunohistochemical staining confirmed this mass as a benign form of localized fibrous tumor of the pleura.
Brief Review: Localized fibrous tumor of the pleura (LFTP) is an uncommon mesenchymal neoplasm that most commonly affect the pleura, but also been described in other locations including lung and mediastinum. There are benign and malignant types of LFTP, and malignant forms are less common. The tumor is potentially resectable despite its large size.
The radiographic features of LFTP are variable; well-circumscribed, homogeneous soft-tissue mass located near the periphery of lung or in the projection of an interlobar fissure. The angle with the chest wall or mediastinum is either acute or obtuse.
CT of small LFTP typically demonstrated homogeneous, well-defined, soft-tissue masses which abut a pleural surface. It may form obtuse or acute angles against the adjacent pleura or located within a fissure. Some tumors located within the fissures appear to grow into the adjacent lung (so-called inverted tumor). Large lesions are usually enhanced heterogeneously and may not exhibit CT features suggestive of focal pleural tumors. The attenuation likely depends on the collagen content, in which hyperdense lesions have abundant collagen. Low-attenuating lesion correlates with hemorrhage, necrosis, cystic or myxoid degeneration. Calcification is uncommon. Pedicle or change in lesion position is may rarely detected. 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.Korean Society of Thoracic Radiology, Imaging of Lung Cancer, Koonja Publishing Inc., p.216-218
2.Rosado-de-Christenson ML, Abbott GF, McAdams HP et al. Localized Fibrous Tumors of the Pleura, RadioGraphics 2003; 23:759
Keywords: Pleura, benign tumor,

No. of Applicants : 92

▶ Correct Answer : 7/92, 7.6%

- Niigata City General Hospital , Japan Takao Kiguchi
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Niigata University , Japan Atsushi Uehara
- 異⑸ , Korea (South) sooncheul baek
- 異⑸ , China ZHANG YING
- okayama university , Japan takumi sakamoto
- Northern Yokohama Showa university , Japan Kota Watanabe

▶ Correct Answer as Differential Diagnosis : 12/92, 13.0%

- Onomichi municipal hospital , Japan Hirofumi Mifune
- , Korea (South) park ji hoon
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
- chungbuk national university hospital , Korea (South) soojung lee
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- CHU Poitiers , France CHAN paul
- IRSA La Rochelle , France Denis Chabassiere
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- SNUH , Korea (South) Eui Jin Hwang

▶ Semi-Correct Answer : 1/92, 1.1%

- Medicheck health care , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 836 Date 2013-11-04

Discussion

No. of Applicants : 92