대한흉부영상의학회 Weekly Chest Cases

Case No : 672 Date 2010-09-12

Courtesy of Hye Rin Kim, Sang Hyun Paik, Jai Soung Park / Soon Chun Hyang University Bucheon hospital
Age/Sex 50 / F
Chief ComplaintIncidental finding on chest ragiograph

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Diagnosis With Brief Discussion

Diagnosis: Localized fibrous tumor of pleura
Radiologic Findings: Chest radiograph shows a well-defined mass in left hemithoax, which is broadly based on left heart border. CT scans show a well-defined soft tissue density mass with homogeneous enhancement, which is broadly based mediastinal pleura and enveloped by mediastinal fat. At thoracotomy, the mass was removed, which is attached to the visceral pleura of the left upper lobe, could not be found a stalk. Histologically, the lesion was localized fibrous tumor of the pleura.
Brief Review: Localized fibrous tumors are slow growing, rare mesenchymal neoplasms that most commonly affect the pleura but have also been described in a number of other locations including the mediastinum and the lung. Clinically localized fibrous tumor of the pleura(LFTP) occurs in both sexes and in all age groups but predominantly affects persons more than 50 years old. Most patients are asymptomatic; cough, chest pain, and dyspnea occur occasionally, especially in association with large tumors. Extrathoracic manifestations include hypertrophic osteoarthropathy in 4-7 % and hypoglycemia. Hypoglycemia, noted in less than 5% of patients, is usually associated with very large tumor and is thought to be due to glucose consumption by the mass.
On chest radiography, localized fibrous tumor of pleura is seen as round or oval mass, often lobulated, located at the pleural surface. And the mass often arise from the visceral pleura and are attached to the pleural surface by a pedicle. In such instances, they project freely into the pleural surface, and changes in position and shape can be observed on inspiration and expiration radiographs and/or fluoroscopy. CT findings include well-delineated, often lobulated non-calcified enhancing soft tissue mass in close relation to the pleural surface or fissure, and absence of chest wall invasion. The margin at the junction of the mass with the pleura usually tapers smoothly. These tumors predominate in the middle and lower half of the chest. Calcification has been reported in 7% of tumors. pleural effusion was present in 8-17% of cases but is more likely to be associated with malignant tumors than the benign. CT findings that suggest a malignant fibrous tumor include a diameter larger than 10 cm, sessile, central necrosis, hemorrhage, chest wall invasion and ipsilateral pleural effusion.
References: 1. Ferretti GR, Chiles C, Choplin RH, Coulomb M. Localized benign fibrous tumor of the pleura. AJR 1997;169:683-686.

2. Rosado ML, Abbott GF, McAdams HP, Franks TJ, Galvin JR. Localized fibrous tumors of the pleura. Radiographics 2003;23:759-783.

3. Robinson LA. Solitary fibrous tumor of pleura Cancer Control 2003;13:264-269.
Keywords: Pleura, Benign tumor,

No. of Applicants : 98

▶ Correct Answer : 12/98, 12.2%

- Hangang sacred heart hospital , Korea (South) You Mie Han
- KRRS , Korea (South) usb
- Saga University , Japan Ryoko Egashira
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Radnet Teleradiology , Turkey Murat Ulusoy
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
- jobless , France jean-baptiste Noel
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Doctors Hospital , Bahamas muneesh sharma

▶ Correct Answer as Differential Diagnosis : 18/98, 18.4%

- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Onomichi municipal hospital , Japan Junya Itakura
- Oita University, Faculty of Medicine , Japan Fumito Okada
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- ministry of health and population , Egypt hanan tolba
- CHRU lille , France manuel toledano
- Chonnam university hospital , Korea (South) LEE HYUN
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun JunYeh
- Onomichi municipal hospital , Japan Ryotaro Kishi
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Chonnam national univ. hospital , Korea (South) Choi seul gi
- NIMS , India HARSHA KR
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- kovai medical centre , India k bhaskar
- NASA SCANS , India RAKESH BHATIA
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
- Assam Medical college , India samudra borah

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 672 Date 2010-09-12

Discussion

No. of Applicants : 98