Intrathoracic giant solitary fibrous tumor

Abstract

BackgroundSolitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management.Case Report:A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient’s death was confirmed.Conclusions:We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.

Giant solitary fibrous tumor of the pleura: A case report

“…Giant SFTP is a rare form of pleural disease that is only occasionally cited in the literature, usually in single cases . Larger tumors, more than 10 cm or 15 cm in diameter, occupying a larger space, and compressing other thoracic structures, may cause symptoms such as dyspnea, chest pain, cough, and fatigue .…”

Preoperative embolization to reduce morbidity and mortality in hypervascular mediastinal tumor surgery

“…[12,13] There are many cases reported in the literature showing that the surgeons were unable to complete tumor resection operations due to massive bleeding. [10,14,15] Neuroendocrine tumors are highly vascular in nature, and many patients experience intraoperative hemorrhagic complications. [16] Morandi et al [14] reported that, during right thoracotomy, the mass which was reported as a hemangiopericytoma was highly vascularized and massive bleeding from the tumor tissue occurred during the dissection.…”

“…Aydemir et al [15] reported a patient with a giant (15 cm) solitary fibrous tumor supplied by multiple intercostal arteries and an aberrant artery branched off the celiac trunk in his subdiaphragmatic region in whom embolization failed due to a high number of arteries. The authors decided to control possible bleeding by inducing total circulatory arrest through cardiopulmonary bypass.…”

Enormous thoracic solitary fibrous tumor with inferior vena cava compression: A case report

“…The surgical excision of giant intra-thoracic SFTs is considered a surgical challenge due to poor exposure, significant tumor blood supply, and heavy adhesions, among other characteristics. [9,12] Aydemir et al [12] from Turkey reported a 59-year-old female with a giant intrathoracic SFT that almost completely filled the right hemithorax for whom the operation was terminated after taking a biopsy because of excessive bleeding during dissection. Later on, angiography showed that the tumor was supplied by multiple intercostal arteries as well as an aberrant branch from the celiac trunk.…”

“…We think that excessive bleeding from the raw chest wall in our patient could be due to a similar blood supply via intercostal arteries and we agree with the authors that CPB and total circulatory arrest are not valid alternatives to control the bleeding. We share the advice of many authors [9,[12][13][14] to perform a preoperative CT angiography for such huge tumors to reveal the feeding arteries and perform preoperative embolization to reduce the intraoperative blood loss. In addition, we recommend auto-transfusion as a good intraoperative measure to save the patients' lives.…”