Localized fibrous pleural tumour of the interlobular pleura

Abstract

Localized fibrous tumours of the pleura (LFTP) are rare, generally benign and asymptomatic neoplasms, which originate from the pleural layers. We report on the case of a 67 year old woman who had a 1.5 cm diameter pulmonary nodule in the right upper lobe, which had been found by chance.Video-assisted thoracoscopy (VAT) was used to excise the nodule. The diagnosis of localized fibrous tumour of the interlobar pleura was made on microscopic evaluation.After 17 months, the patient is well and her chest radiographic image is normal. Eur Respir J., 1996Respir J., , 9, 1094Respir J., -1096 CASE STUDYLocalized fibrous tumours of the pleura (LFTP) are rare neoplasms that generally arise from the visceral layer and project into the pleural cavity [1]. Although benign variants are more frequent, malignant forms have been described. In most cases, they are asymptomatic and discovered by chance on chest radiograph images taken for other reasons.We report on a case of benign LFT of the interlobar pleura, in which the tumour was recognized arising from the pleura and was removed with video-assisted thoracoscopy (VAT). Case reportA 67 year old, white, nonsmoking, asymptomatic woman came to our department for evaluation of a pulmonary nodule (1.5 cm diameter), which had been discovered by chance in the right upper lobe on a chest radiography performed during a general check-up for hypertension, which was being well-controlled by nifedipine. Upon admission, her physical examination, pulmonary function tests, blood chemical values, and electrocardiographic activity (ECG) were all normal.Computed tomography (CT) of the chest confirmed the presence of a pulmonary nodule, which had a smooth, round appearance with no evidence of calcifications; the mediastinum was not involved ( fig. 1). No previous chest radiograph was available for comparison with the current one. Brain and abdominal CT and mammography were normal.The nodule was not visible on bronchoscopy (Olympus BF TD20) due to its peripheral location. It was, therefore, sampled with fluoroscopically-guided fine needle aspiration (FNA) of the lung and the cytological examination showed only normal alveolar and bronchiolar cells. The patient was then sent to a thoracic surgeon for VAT to remove the lesion. During exploration, the tumour was found just under the visceral pleura of the right upper lobe and was easily removed thoracoscopically.Macroscopically, the tumour was a 1.5 cm diameter nodule, with a rounded, bosselated surface. Its parenchyma was greyish-white, without haemorrhage or necrosis; and areas with a whorled pattern were evident. Microscopically, fibrous areas of moderate cellularity were observed, with loosely arranged spindle-shaped or oval cells scattered haphazardly among strands of collagen. In other areas, the cells were closely packed and sometimes appeared to have anastomosing or interdigitating fascicles ( fig. 2a). These areas of increased cellularity displayed a small number of mitotic figures and also some nuclear pleomorphism ( fig. 2c and...

Retrospective analysis for thirty-nine patients with solitary fibrous tumor of pleura and review of the literature

“…Small pedunculated tumors located on the visceral pleura can be safely removed by VATS [18,21]. And some authors have also recommended the VATS to obtain a more precise view of the resection margins in some large, broad-based tumors of the parietal pleura [18].…”

Video-Assisted Thoracoscopic Surgery Is a Promising Treatment for Solitary Fibrous Tumor of the Pleura

“…The malignant variant was macroscopically similar to the benign tumor, but contained high mitotic activity, which was defined as at least four mitotic figures per 10 high-power fields (HPFs), necrosis, and mild-to-marked pleomorphism, based on nuclear size, irregularity, and the presence of nuclear atypia. 5,7,12,15 Clinical information was obtained by means of hospital records and telephone calls to patients.…”

Solitary fibrous tumours of the pleura

“…Thoracoscopic approaches can be safely used to excise small pedunculated tumours located on the visceral pleura [54,93]. Cardillo et al [54] described 55 patients with SFTPs who underwent resection via video-assisted thoracoscopic surgery (VATS) and thoracotomy with no operative deaths.…”