대한흉부영상의학회 Weekly Chest Cases

Case No : 530 Date 2007-12-24

Courtesy of Bae Young Lee, MD. / St. Paul's Hospital, The Catholic University of Korea, Korea.
Age/Sex 47 / F
Chief ComplaintIncidental mass on plain chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Solitary fibrous tumor of pleura
Radiologic Findings: Chest plain films revealed well defined ovoid mass in lingular division abutting diaphragm. Precontrst CT scan showed well defined peripheral low and centrally dense mass with broad contact to pleura. After contrast enhancement, central portion of this mass showed good enhancement and peripheral portion showed poor or no enhancement.
Surgical exploration was done, and this mass was confirmed to be solitary fibrous tumor of pleura.
Gross specimen revealed firm and solid in central portion with hypervascularity and soft and myxoid in peripheral portion with hypovascularity.
Brief Review: Solitary fibrous tumor of pleura (SFTP) is a slow growing and primary pleural neoplasm, not associated with asbestosis and smoking exposure. Incidence is fewer than 5% of pleural tumors. This tumor showed wide age range (5-87 years), but predominantly occurs in the sixth and seventh decades with equal frequency of sex. Common symptoms of SFTP are cough, chest pain, or dyspnea. But many patients (43~67%) are asymptomatic. Hypertrophic pulmonary osteoarthropathy is the most common paraneoplastic syndrome of this tumor. Hypolycemia is rare and usually associated with large tumors. SFTP appears to arise from mesenchymal cells subjacent to the mesenchymal lined pleura and is composed of haphazardly arranged fascicles of elongated spindle cells separated by variable amounts of collagen. Myxoid or cystic degeneration may occur in this tumor, which is seen to be low density on CT. Most SFTP is benign (80~90%), and malignant tumors commonly have hemorrhage, necrosis, myxomatous change, and vascular or stromal invasion.
Radiologic finding of SFTP is nonspecific. SFTP predominates in the middle and lower half of chest. CT shows well defined and often lobulated mass. Nonenhancing areas correspond to necrosis, myxoid degeneration, or hemorrhage. Well enhancing area is a result of rich vascular tissue of mass. Large tumors show more heterogenous nature. Calcifications are principally noted in large tumors. Malignant tumors have tendency to show sessile and large mass (>10cm), atypical location, necrosis, and hemorrhage. MRI is often useful in evaluating chest wall invasion.
Percutanous transthoracic needle biopsy of SFTP is questionable because success rate is low (43%) and biopsy does not influence the need for surgery. Bronchoscopy or sputum cytology is not helpful. Tumor recurrence is low in benign pedunculated tumors (2%) and high in malignant sessile tumors (63%).
In conlusion, SFTP should be considered in solitary mass abutting the pleura, which have lower thoracic location, sharp contour, lobulation, obtuse angle to chest wall, or mobility of mass. Sessile mass have high recurrence rate.
Please refer to
References: 1. Robinson LA. Solitary fibrous tumor of pleura Cancer Control 2003;13::264-269.
2. Ferretti GR, Chiles C, Choplin RH, Coulomb M. Localized benign fibrous tumor of the pleura. AJR 1997;169:683-686.
Keywords: Pleura, Benign tumor,

No. of Applicants : 56

▶ Correct Answer : 17/56, 30.4%

- Shiga University of Medical, Japan Norihisa Nitta
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
- Mauritius Jeevak Almast
- Sree chitra tirunal, kerala, India Santhosh Kannath
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- IRSA La Rochelle, France Jean-Luc BIGOT
- Gimpo Woori Hospital, Korea Son Youl Lee
- Dept. of radiology, Assam medicalcollege, Assam, India Karunakaran M
- Chandigarh, India Sonali Jain
- Anandnagar, Hingne Khurd, Pune, India Bankim J. Amin
- Dae-gu Fatima Hospital, Korea Sang Hee Cho
- Mokpo Hankook Hospital, Korea Sang Uk Park
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Annecy hospital, France Gilles Genin
- Ultra Care Coimbatore, India Debabrata Das
- Pulmonologist, Medical College Chest Hospital, Thrissur, India Raveendran T.K

▶ Correct Answer as Differential Diagnosis : 10/56, 17.9%

- Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora
- E-Da Hospital, Taiwan Yu-Feng Wei
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Max Hospital, New Delhi, India Vickrant Malhotra

▶ Semi-Correct Answer : 8/56, 14.3%

- Oswal Cancer Hospital, Ludhiana, Punjab, India Lovkesh Mittal
- EKH-Berlin, Germany Michael Weber
- Aarthi Advanced CT and MRI scans, Tirunelveli, India Sivasubramanian Srinivasan
- D.Y. Patil Medical College, Pune, India Anubhav Khandelwal
- IRSA, La Rochelle, France Denis Chabassiere
- Vital imaging centre, Mumbai, India Ganesh Agrawal
- Aims, New Delhi, India Ashish Gupta
- CHU Grenoble, France Bing Fabrice

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 530 Date 2007-12-24

Discussion

No. of Applicants : 56