대한흉부영상의학회 Weekly Chest Cases

Case No : 1359 Date 2023-11-07

Courtesy of Moon Young Kim, Ye Ra Choi, Kwang Nam Jin. / SMG-SNU Boramae Medical Center
Age/Sex 63 / M
Chief ComplaintAn incidental abnormality on the chest radiograph.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Diagnosis With Brief Discussion

Diagnosis: Solitary fibrous tumor of pleura
Radiologic Findings: Figure 1. Chest radiograph demonstrates a large mass in the left lower lung zone.
Figure 2-4 On the chest CT, a large heterogeneously enhancing lobulated mass with prominent internal vasculature is observed in the left lower hemithorax, accompanying passive atelectasis of the left lung. There are multifocal peripheral ill-defined low attenuating lesions suggesting necrosis on the coronal image.
Figure 5. On the PET/CT, the mass reveals with mildly elevated and heterogeneous metabolism.
Brief Review: Solitary fibrous tumors of the pleura (SFTP) are rare, accounting for less than 5% of all pleural tumors. SFTPs most commonly occur in the pleura, they can also arise in other parts of the body, such as the mediastinum, lung parenchyma, and even in extrathoracic locations. They are more frequently found between the ages of 50 and 70.
Although clinical findings may include chest pain, shortness of breath, and cough, many SFTPs are found incidentally during routine chest imaging.
SFTPs are usually well-circumscribed, with a fibrous pseudocapsule or serosal lining, and frequently pedunculated; the pedicle typically contains large feeder vessels for the tumor. Hemorrhage, necrosis, or calcification may be present, particularly in larger tumors.
Microscopically, SFTPs are characterized by a pattern of alternating hypocellular and hypercellular areas. They typically consist of spindle-shaped cells and a collagenous stroma. The hallmark feature of SFTPs is the presence of "staghorn" vessels, which are branching blood vessels that are often seen within the tumor.
In some cases, imaging may reveal the presence of "feeding vessels" or "vessels within the tumor." This can be a characteristic feature of SFTPs and is associated with their vascular nature.
Most SFTPs exhibit an indolent fashion and do not recur locally or distantly. However, high mitotic activity, hypercellularity, necrosis/hemorrhage, size >10 cm, sessile growth, and parietal pleural origin are associated with poor prognosis including the risk of recurrence or metastasis.
References: 1) Zhang J, Liu J, Zhang Z, Tian B. Solitary Fibrous Tumors of the Chest: An Analysis of Fifty Patients. Front Oncol 2021;11:697156
2) Cardinale L, Ardissone F, Garetto I, Marci V, Volpicelli G, Solitro F, et al. Imaging of benign solitary fibrous tumor of the pleura: a pictorial essay. Rare Tumors 2010;2:e1
3) Ginat DT, Bokhari A, Bhatt S, Dogra V. Imaging features of solitary fibrous tumors. AJR Am J Roentgenol 2011;196:487-495
Keywords

No. of Applicants : 77

▶ Correct Answer : 36/77, 46.8%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- , Japan HIROAKI ARAKAWA
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Oita university , Japan AYUMI KAMEI
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Other , Korea (South) SEONGSU KANG
- , Korea (South) JIN YOUNG LEE
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- The University of Tokyo Hospital , Japan WATARU GONOI
- Osaka University , Japan AKINORI HATA
- Ajou University Hospital , Korea (South) HAEIN LEE
- Ajou University Hospital , Korea (South) HYUNSEUNG LEE
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Gifu University Hospital , Japan Yo Kaneko
- , Japan KENTARO KOTANI
- Tokyo Medical and Dental University , Japan MIKIYA FUJII
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- Mie university , Japan MIYUKO FUJITA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Mie university , Japan SHIKO OKABE
- Kyoto university , Japan HIROKAZU SAWAMURA
- Kyoto University , Japan SHO KOYASU
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- Samsung Medical Center , Korea (South) SEONGUK KIM
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- Matsunami General Hospital , Japan TARO TAKEDA
- Shiga University of Medical Science , Japan RYO UEMURA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- Kyoto university , Japan AKIHIKO SAKATA
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 13/77, 16.9%

- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Yokkaichi municipal hospital , Japan HIKARI FUKUI
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Paras hospital, Panchkula , India SHALEEN RANA
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- , Japan YUMI MAEHARA
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1359 Date 2023-11-07

Discussion

No. of Applicants : 77