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Weekly Chest CasesArchive of Old Cases

Case No : 981 Date 2016-08-15

  • Courtesy of Yoonyoung Choi, Kun Il Kim / Pusan National University, Yangsan Hospital
  • Age/Sex 63 / M
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Localized fibrous tumor of pleura
Radiologic Findings
Chest pa/lateral radiography showed a huge mass in left hemithorax. On CT scan, the mass was arising from left upper pleura and was extending downward, with displacement of heart and pulmonary vessels. It showed soft tissue attenuation and relatively homogenous enhancement on contrast enhanced scans with focal non-enhancing areas. Pleural effusion was also seen.
This case showed increased cellularity, necrosis and pleural effusion. However, mitotic activity was not compatible with malignant SFT and only infarction type necrosis was seen.
Brief Review
Solitary fibrous tumors of the pleura (SFTP), are a rare benign pleural-based tumor that accounts for <5% of all tumors involving the pleura. It usually presents in the 6th to 7th decades and there is no recognized gender predilection. There may be a predilection towards the mid to lower zones of the chest. In ~80% of cases, they arise from visceral pleura, with the remainder arising from the parietal pleura.
On radiography, it presents as a pleural based mass and often forms an obtuse angle with the chest wall. Tumors may grow to a large size. Pedunculated lesions can change position and appearance with respiration or with a change in position. Calcification, rib destruction, and pleural effusions are typically not associated features
On CT scan, it tends to have soft tissue attenuation on unenhanced scans and show relatively homogenous intense background enhancement on contrast enhanced scans (from rich vascularization). Non-enhancing areas may be present corresponding to necrosis, myxoid degeneration, or hemorrhage within the tumor. A pedicular attachment may also be seen.
About 20% of SFTs are malignant. Proposed criteria for malignancy include increased cellularity, mitotic activity (>4/10hpf), and necrosis (coagulative necrosis associated with tumor cells).
References
1. Daniel T. G, Aqiba B, Shweta B. Imaging Features of Solitary Fibrous Tumors. AJR 2011;196: 487-495.
2. Cardinale L, Ardissone F, Volpicelli G. CT signs, patterns and differential diagnosis of solitary fibrous tumors of the pleura. J Thorac Dis 2010 Mar; 2(1): 21–25.
3. Cardillo G, Facciolo F, Cavazzana AO et-al. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann. Thorac. Surg. 2000;70 (6): 1808-12
Please refer to
Case 43 Case 80 Case 121 Case 179 Case 353 Case 405 Case 530 Case 672 Case 694 Case 702 Case 759 Case 775 Case 781 Case 836 Case 875 Case 940 Case 975
Keywords
Pleura, Benign tumor,

No. of Applicants : 78

▶ Correct Answer : 53/78,  67.9%
  • - university of montreal , Canada Andrei Gorgos I
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Ewha womans university , Korea (South) kyoungmin lee
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Kyoto University , Japan Akihiko Sakata
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Seoul National University Hospital , Korea (South) Sewoo Kim
  • - privato , Italy genchi enzo
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - GHICL , France manuel toledano
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - PGIMER , Chandigarh , India Karthik Rayasam
  • - Military service , Korea (South) Dongryul Jang
  • - Konkuk University Medical Center , Korea (South) Yongwonn Kwon
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Jangsung public clinic , Korea (South) Yongsub Song
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - , Korea (South)
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - &#65533;stanbul , Turkey Ayhan Yilmaz
  • - Ajou University Hospital , Korea (South) Young Keun Sur
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Private sector , Greece Vasilios Tzilas
  • - CHU Poitiers , France CHAN paul
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - University of Tsukuba Hospital , Japan Shioto Oda
  • - sunder lal jain hospital , India sanjeev vachher
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Qatif Central Hospital , Saudi Arabia Hani Alsalam
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 16/78,  20.5%
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - McGill University Health Center , Canada Alexandre Semionov
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Otsu Municipal Hospital , Japan Noriatsu Ichiba
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
▶ Semi-Correct Answer : 3/78,  3.8%
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Scans world , India Philson Mukkada
  • - Ondokuz Mayis University , Turkey Cetin Celenk
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