대한흉부영상의학회 Weekly Chest Cases

Case No : 1294 Date 2022-08-08

Courtesy of Youkyung Lee / Hanyang University Guri Hospital
Age/Sex 74 / F
Chief ComplaintAbnormal chest X ray

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Diagnosis With Brief Discussion

Diagnosis: Solitary fibrous tumor of the pleura
Radiologic Findings: Chest X-ray PA (Fig. 1) and lateral (Fig. 2) show a well-defined pleura or extrapleural origin mass without bone destruction in the left upper hemithorax. The mass is 7.3 cm and shows heterogenous enhancement in contrast-enhanced CT with no chest wall invasion on axial (Fig. 3) and coronal (Fig.4,5) images. In MRI, the mass has T1 hypointense signal with heterogeneous enhancement, heterogeneous T2 signal, and restricted diffusion (Fig. 6,7). The mass shows mild hypermetabolism (SUVmax=1.86) on 18F-FDG PET/CT scan (Fig 8).
Brief Review: The tumor was resected with LUL. The tumor originated from LUL apex visceral pleura, showed no invasion to around structures, and its capsule was intact. The pathologic diagnosis was solitary fibrous tumor of the pleura, low risk (total score 2: patient age>55 (score 1), tumor size (score 1), mitosis (score 0), tumor necrosis (score 0)).

Solitary fibrous tumors (SFTs) are rare fibroblastic mesenchymal tumors. They can develop in any organ due to their spindle cell origin. The tumor is currently defined by the presence of NAB2-STAT6 gene fusions.

Most SFTs have low mitotic counts and show little nuclear pleomorphism. The presence of mitotic figures (greater than 10 per high power field), necrosis, infiltrative growth pattern, and large size is associated with aggressive (malignant) behavior. Age above 55 years is also a risk factor.

Most SFTs grow slowly and form large masses, which could be asymptomatic or cause variable compression symptoms depending on the tumor size and location. Large SFTs are associated with paraneoplastic syndromes. Secretion of insulin-like growth factor 2 by the neoplastic cells may result in refractory hypoglycemia (Doege-Potter syndrome). More rarely, IGF2 production can produce an acromegaly-like syndrome. Thoracic lesions may be associated with hypertrophic osteoarthropathy.

Local or distant recurrence of SFTs has been documented in about 10
References
Keywords: Solitary fibrous tumor of the pleura,

No. of Applicants : 76

▶ Correct Answer : 44/76, 57.9%

- Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
- Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
- Jichi Medical University Hospital , Japan JUN KANZAWA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Ajou University Hospital , Korea (South) SUNG HYUN AN
- Mayo Clinic , United States AKITOSHI INOUE
- Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
- , Italy PAOLO BALDASSARI
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- Other , Korea (South) HWANGHEE JO
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Ajou University Hospital , Korea (South) KYUNGMIN LEE
- Other , Korea (South) SEONGSU KANG
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Osaka University , Japan AKINORI HATA
- Ajou University Hospital , Korea (South) HAEIN LEE
- Shimada General Medical Center , Japan HAYATO NOZAWA
- Other , Korea (South) HYEON IL CHOI
- , Korea (South) HYUNSEUNG LEE
- Ajou University Hospital , Korea (South) MINJI KIM
- Yamanashi Prefectural Hospital , Japan HIROAKI WATANABE
- Gifu University Hospital , Japan Yo Kaneko
- , Japan KENTARO KOTANI
- Kyoto University Hospital , Japan YASUHISA KURATA
- Other , Korea (South) CHAEHUN LIM
- Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Other , Korea (South) SEONG WON JANG
- Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
- Holy Family Hospital , India RAJESH GOTHI
- Kyoto University Hospital , Japan SATOSHI IKEDA
- Nishida Hospital , Japan SHOJI OKUDA
- Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- , Japan YUMI MAEHARA
- , Japan YUKI HAYASHI
- , Korea (South) HM PARK
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 16/76, 21.1%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan HIROAKI ARAKAWA
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa General Hospital , Japan MASAFUMI KAIUME
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
- Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
- Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Ajou University Hospital , Korea (South) YOU NA KIM
- , Japan SHUNJIRO NOGUCHI
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
- Other , Korea (South) KYU-CHONG LEE

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1294 Date 2022-08-08

Discussion

No. of Applicants : 76