Giant Solitary Fibrous Tumour of Pleura —An Uncommon Intrathoracic Entity— A Case Report and Review of the Literature

Abstract

A 43-year-old woman presented to us with progressive breathlessness, dry cough and weight loss. A chest radiograph showed homogeneous opacification of the entire left hemithorax. A contrast enhanced computed tomography (CECT) scan of the thorax showed a large intrathoracic mass occupying almost the entire left hemithorax and appeared grossly inoperable. A transcutaneous CT guided tru-cut biopsy revealed a solitary fibrous tumour. We reviewed the CT scans based on the biopsy report, and, in retrospect, the mediastinal vessels seemed more stretched and pushed by the tumor rather than directly infiltrated by it. We performed an exploratory thoracotomy and to our surprise, were able to dissect the mass quite easily off the mediastinum. She had an uneventful postoperative recovery, and the final histopathology confirmed a solitary fibrous tumor. We report this case to emphasize that a cursory clinico-radiological interpretation can dissuade surgical intervention in these patients.

Solitary Fibrous Tumor – Less Common Neoplasms of the Pleural Cavity

“…According to some authors, tumors of a larger size (>8-13 cm) infiltrating the surrounding area, with an increased cellularity, higher number of central necrosis and hemorrhage, or associated with effusion, have a higher tendency to show malignant behavior. 5,7,12,22) However, other studies refer to the fact that the size of the tumor, its location, the presence of symptoms, or the fact that it is based on the visceral or parietal pleura, are not unambiguous evidence of the increased possibility of tumor recurrence and shortened survival interval. 8,15) The expression of the p16 SFT protein is not significantly associated with its recurrence.…”

“…Nevertheless, in literature there are also descriptions of the incidence of variants with high malignant potential in the range of 7%-60%. 1,2,4,12,15) The mitotic activity of the tumor is not high, usually less than 5 mitoses per 2 mm 2 . A higher number of mitoses and hypercellularity is usually the sign of the aggressive behavior of the tumor.…”

“…10) The peak incidence rate is in those people in their 60s and 70s, whereby the proportion of men to women is approximately equal. 1,5,11,12) Solitary fibrous tumors usually represent themselves as an accidental finding as a result of an imaging examination for other reasons. Nevertheless, up to half of the cases present themselves through their clinical manifestation.…”

“…3). 12,14,21) From the point of view of the biological behavior, the majority of solitary fibrous tumors are with low malignant potential. Nevertheless, in literature there are also descriptions of the incidence of variants with high malignant potential in the range of 7%-60%.…”

“…The success rate is 38%-50% (27.3% in our sample). 1,2,4,7,8,12) SFTs are usually well-circumscribed having an ovoid or spherical shape, covered by a fibrous sheath of a whitish color, under which the rich vascular supply shines through. The sometimes also consist of multiple nodes.…”