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Weekly Chest CasesArchive of Old Cases

Case No : 992 Date 2016-10-31

  • Courtesy of Jin Young Kim, Dong Jin Im, Hye-Jeong Lee / Severance Hospital
  • Age/Sex 77 / F
  • Chief ComplaintAbnormal chest radiographic finding on health check-up
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Solitary fibrous tumor of the pleura
Radiologic Findings
Chest radiograph demonstrates a well-marginated large mass in the left upper hemithorax. Contrast-enhanced chest CT scan demonstrates a homogenously enhancing soft-tissue mass in the left upper hemithorax with serpiginous branching linear areas of enhancement consistent with intralesional vessels.
Brief Review
Solitary fibrous tumor (SFT) is a rare neoplasm that typically presents as a well-defined lobulated soft tissue mass commonly arising from the visceral pleura. The tumors typically affect the pleura but can develop in a number of other locations including the mediastinum, lung, tracheobronchial tree, abdomen, head, neck, and central nervous system. It is common in the fifth and sixth decades of life but can develop at all ages and occur equally in males and females. Chest pain is the most common symptom, and enlarging tumors can compress bronchus, causing atelectasis.
Chest radiographs of a patient with SFT of the pleura characteristically demonstrate a peripheral, well-defined, solitary nodule or mass. CT images of small SFTs typically show homogeneous, well-defined, lobular, non-invasive, soft-tissue nodules or masses. SFTs usually enhance strongly after contrast injection, which can be heterogeneous, particularly for large tumors. Heterogeneous attenuation of the tumor after contrast enhancement is correlated with hemorrhage, necrosis, or cystic change. Tumoral calcification occurs in 7% to 25% of patients, typically in those with larger tumors, and is often related to necrosis.
Surgical resection is the best treatment option. More than half are pedunculated, and video-assisted thoracic surgery (VATS) is preferred to open surgery. Histologically, SFTs appear benign, although large tumors can show central necrosis and some atypia.
References
1. 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.
2. Solitary Fibrous Tumor of the Pleura, Lary A. Robinson, MD, cancer control, October 2006, Vol. 13, No. 4
Keywords
pleura, Benign tumor,

No. of Applicants : 97

▶ Correct Answer : 69/97,  71.1%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Otsu Municipal Hospital , Japan Noriatsu Ichiba
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Shanghai Jiao Tong University Affiliated Sixth People , China Jiayin Zhang
  • - , Korea (South) Seon-Young Park
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Seoul national university , Korea (South) Boram Kim
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - , Korea (South)
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Scans world , India Philson Mukkada
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - �stanbul , Turkey Ayhan Yilmaz
  • - The Jikei university , Japan Taku Gomi
  • - university of montreal , Canada Andrei Gorgos I
  • - , Korea (South) BAEK YOOLIM
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - CNUH , Korea (South) LEE HYO JAE
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - 異⑸ , Korea (South) 蹂€
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Samsung medical center , Korea (South) Ran Kim
  • - Chungbuk national university , Korea (South) Yong Kim
  • - Medicheck health care , Korea (South) Chae Lim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - University of Toronto , Canada Micheal McInnis
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Maimonides Medical Center , United States naomi twersky
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - CHU Poitiers , France CHAN paul
  • - GHICL , France manuel toledano
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - 以‘ , Korea (South) Jang Won
  • - christian medical college , India Prateek Malik
  • - Ewha womans university hospital , Korea (South) WONKYUNG LEE
  • - Konkuk University Medical Center , Korea (South) Yong Wonn Kwon
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Private sector , Greece Vasilios Tzilas
  • - CNUH , Korea (South) LEE JONG EUN
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Ajou University Hospital , Korea (South) Youngjin Yoo
▶ Correct Answer as Differential Diagnosis : 12/97,  12.4%
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - 異⑸ , Korea (South) Junghwan Kim
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - chungbuk university hospital , Korea (South) 瑜˜
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