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Weekly Chest CasesArchive of Old Cases

Case No : 875 Date 2014-08-04

  • Courtesy of Bong Wan Noh, Kyung Hee Lee / Inha University Hospital
  • Age/Sex 83 / F
  • Chief Complaintchest discomfort for several years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Localized fibrous tumor of the pleura
Radiologic Findings
Chest PA shows a huge mass in left hemithorax with obliteration of left cardiac border.
CT scans show markedly increased size of the mass occupying left hemithorax, compared with CT scans about two years ago. The mass involves mediastinal fat, pericardium and pleura, but does not extend to lung or chest wall. Pericardial and pleural effusions are associated.
Localizaed (or solitary) fibrous tumor of pleura was diagnosed via percutaneous transthoracic needle biopsy.

two years ago

current CT with coronal reformation

Brief Review
Localized fibrous tumor (LFT) of the pleura was formerly known as benign mesothelioma, but it is not mesothelial in origin and not necessarily benign. Approximately 30% of these tumors are malignant, although they have a good prognosis. It is unassociated with asbestos exposure.
LFT is usually detected incidentally on chest radiographs. However, it can be associated with hypoglycemia (5% of cases) due to production of insulin-like growth factor type 2 (IGF-2), hypertrophic pulmonary osteoarthropathy (one third of cases), or chest pain. The symptoms resolve with resection.
LFT arises from the visceral pleura in 70%. It typically appears as a solitary, smooth, sharply defined, often large lesion, contacting a pleural surface. When small, LFT tends to have obtuse angles at the pleural surface; when large, the angles are usually acute. LFT can be seen within a fissure, mimicking the appearance of loculated fluid. A “beak” or “thorn” sign is often visible on plain radiographs in patients with an LFT originating in or projecting into a fissure. They may also arise on a stalk and move with change in patient position. Pleural effusion is not usually present.
On CT, even if acute angles are visible, slight pleural thickening is usually visible adjacent to the mass. This thickening may reflect a small amount of fluid accumulating in the pleural space at the point where the visceral and parietal pleural surfaces area separated by the tumor. Masses may appear homogeneous. Necrosis can result in a multicystic appearance with or without contrast infusion. Large arteries supplying the mass may be seen. Calcification may be present.
References
1. W. Richard Webb. The mediastinum: mediastinal masses. Thoracic imaging. 2nd ed. Lippincott Williams & Wilkins 2011: 646~647
Keywords
Pleura, Benign tumor,

No. of Applicants : 69

▶ Correct Answer : 22/69,  31.9%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - university of montreal , Canada Andrei Gorgos I
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - Radiology Department, Affiliated Union Hospital of Tongji Medical College of HUST , China Qiguang Cheng
  • - Saint Malo , France jean-baptiste Noel
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Pamukkale University, School of Medicine, Dept. of Radiology , Turkey Nevzat Karabulut
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - Japanese national center hospital of neurology and psychiatry , Japan Kaoru Sumida
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - SNUH , Korea (South) Eui Jin Hwang
  • - NASA SCANS , India RAKESH BHATIA
  • - Oita University , Japan Haruka Sato
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
▶ Correct Answer as Differential Diagnosis : 12/69,  17.4%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kyoto University , Japan Akihiko Sakata
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - chp st martin , France Mariotte benoit
  • - shengjing hospital china medical university , China yue yong
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - IRSA La Rochelle , France Denis Chabassiere
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Medicheck health care , Korea (South) Chae Lim
▶ Semi-Correct Answer : 2/69,  2.9%
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
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