대한흉부영상의학회 Weekly Chest Cases

Case No : 702 Date 2011-04-11

Courtesy of Soo-Youn Ham, M.D., Ph. D., Yu-Whan Oh, M.D., Ph.D. / Dept. of Radiology, Korea University Anam Hospital, Seoul, Korea.
Age/Sex 21 / M
Chief ComplaintIncidentally detected neck mass (onset: 2mo ago)

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Figure 1

Diagnosis With Brief Discussion

Diagnosis: Solitary fibrous tumor
Radiologic Findings: Enhanced axial (Figure 1) and coronal CT scan (Figure 2) revealed well defined relatively low attenuation mass lesion (6.6 by 4cm), right supraclavicular fossa with slight heterogeneous enhancement, displacing right jugular vein without invading vascular structures. PET-CT (Figure 3) revealed mild hyperrmetabolic mass lesion, right supraclavicular area with some areas of photon defects. On superficial US (Figure 4), well defined oval shaped slightly hypoechoic mass lesion with internal low echoic strand, displacing jugular vein is seen in the right supraclavicular fossa.
Brief Review: Solitary fibrous tumor (SFT) is a rare tumor initially believed to be a benign localized pleural tumor of mesothelial origin. Solitary (localized) fibrous tumors in the pleura were first described by Klemperer and Rabin in 1931. Solitary fibrous tumors (SFT) are uncommon neoplasms of mesenchymal origin that can be benign or malignant. Although SFT most commonly occur in the pleura, numerous extrapleural sites of involvement have been reported. SFT most commonly present during the fifth and sixth decades of life, and there is no significant sex predilection. The most common extrapleural sites of the tumor are the orbits and the extremities. Tumors are often well-circumscribed masses, and vary in size from 1 cm to over 30 cm. The admixture of histological components in the tumor, namely, fibrous tissue, cellular components, and highly vascularized areas consisting of numerous closely packed small to medium-sized blood vessels, influence the imaging appearances of the tumor. The attenuation likely depends on the collagen content, in which hyperdense lesions have abundant collagen. The presence or absence of calcifications is not necessarily a helpful distinguishing feature. In addition, there is considerable overlap in the type of enhancement at CT, during which 100% of malignant and 60% of benign SFT exhibit heterogeneous enhancement. On magnetic resonance imaging (MRI), the diagnosis of solitary fibrous tumor is suggested by a well-circumscribed mass that has smooth margins, and focal or diffuse hypointense signal on T2-weighted imaging due to fibrous content in the tumor. SFTs demonstrate strong focal or diffuse contrast enhancement due to the highly vascularized areas in the tumor.
References: 1. Klemperer P, Rabin CB. Primary neoplasms of the pleura. Arch Pathol 1931;11 : 385-412
2. Cardillo G, Facciolo F, Cavazzana AO, Capece G, Gasparri R, Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann Thorac Surg 2000;70 : 1808-1812
3. Rosado-de-Christenson ML, Abbott GF, McAdams HP, Franks TJ, Galvin JR. From the archives of the AFIP: localized fibrous tumor of the pleura. RadioGraphics 2003;23 : 759-783
4. Ginat Dt, Bokhari A, Bhatt S, Dogra V. Imaging Features of Solitary fibrous tumors. Am J Roentgenol. 2011;2011:487-495
5. MusyokiFN, Nahal A, Powell TI. Solitary fibrous tumor: an update on the spectrum of extrapleural manifestations. Skeletal Radiol. 2010 Oct 16. [Epub ahead of print]
Keywords: Pleura, Benign tumor,

No. of Applicants : 90

▶ Correct Answer : 3/90, 3.3%

- Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
- Samsung Medical Center , Korea (South) Eun Kim
- Seoul St Mary Hospital , Korea (South) Chaehun Lim

▶ Correct Answer as Differential Diagnosis : 8/90, 8.9%

- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- All India Institute of Medical Sciences , India Ashish Gupta
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
- Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
- Kizawa memorial Hospital , Japan Yo Kaneko
- All India Institute of medical sciences , India Justin Moses
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa

▶ Semi-Correct Answer : 31/90, 34.4%

- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Hangang sacred heart hospital , Korea (South) You Mie Han
- CHRU lille , France manuel toledano
- Okayama University , Japan Akihiro Tada
- , Korea (South) Pyeong Guk Kang
- Radiologie Brabois adultes , France ROPION helene
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Istanbul , Turkey Armagan Sarac
- IRSA , France jean-luc BIGOT
- Chonnam National University Hospital , Korea (South) Jung hyun Kim
- Kobe City Medical Center General Hospital , Japan Hitomi Nagano
- assam medical college , India shantiranjan sanyal
- Chonnam National University , Korea (South) se hee Jung
- Assam Medical college , India samudra borah
- Severance hospital , Korea (South) Saerom Hong
- Az Osp Santa Maria , Italy angelo carloni
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Chonnam university hospital , Korea (South) LEE JI HYUN
- Severance hospital , Korea (South) Beomseok Sohn
- IRSA La Rochelle France , France Denis Chabassiere
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- NDMVP Nashik , India Imran Jindani
- Homs National Hospital , Syria Rami Abou Zalaf
- KUMC ansan , Korea (South) kihwan kim
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Hotel-Dieu Montreal , Canada nicolas gautier
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- NASA SCANS , India RAKESH BHATIA
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- chonnam national university , Korea (South) Byung Hyun Baek

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 702 Date 2011-04-11

Discussion

No. of Applicants : 90