Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates

Hélage, Siegfried; Revel, Marie‐Pierre; Chabi, Marie‐Laure; Audureau, Étienne; Ferretti, G.; Laurent, François; Alifano, Marco; Lupo, Audrey; Vadrot, D

doi:10.1016/j.diii.2015.04.013

Cited by 19 publications

(26 citation statements)

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“…Heterogeneity may be more apparent on contrast-enhanced CT and CT angiography reconstruction, and nourishing vessels from distant areas, a common phenomenon in malignant neoplasms, may be detected 25. In addition to heterogeneity and enhancement by the contrast medium, along with hypervascularization, tumor size above a threshold diameter of 10 cm, presence of intratumoral hydric attenuation areas, and pleural effusion are CT features that help to distinguish malignant from benign SFTPs 26. Fludeoxyglucose 18 F-positron emission tomography ( 18 F-FDG-PET) is broadly used for its high negative predictive value for malignancy 27.…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura

Song¹,

Yang²,

Zhang³

et al. 2018

OTT

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BackgroundSolitary fibrous tumor of the pleura (SFTP) is a rare pleural neoplasm arising from mesenchymal cells, accounting for <5% of pleural neoplasms. Approximately 10% of cases of SFTP demonstrate malignant potential, leading to local recurrence after radical surgery and subsequent metastasis.MethodsA large malignant-like mass was found in the left thoracic cavity of a 61-year-old woman. Following radical resection of the mass, the patient was diagnosed with malignant SFTP by histologic and immunohistochemical analyses. In addition, a next-generation sequencing-based mutation test was used to reveal the mutational profile of the tumor. The genetic alteration panel was analyzed with reference to public data on the ClinVar and COSMIC databases, after which the public SFTP data were analyzed for frequency of altered genes. Finally, through overlay of the abovementioned two sets, the genetic alteration accounting for SFTP initiation was anticipated to be identified.ResultsIn the mutation panel of our malignant SFTP group, kinase insert domain receptor (KDR) and fms-related tyrosine kinase 1 (FLT1) scored high in pathogenesis but had only a medium frequency; the NAB2–STAT6 fusion appeared to be the dominant genetic alteration in public SFTP samples.ConclusionThe high frequency of NAB2–STAT6 fusion indicates its prominent role in SFTP, while somatic mutations such as FLT1-R593W and KDR-V297I may also contribute to the malignant angiogenic phenotype. The present study affirmed the heterogeneity of SFTP, and more sophisticated classification methods will be needed to explore its underlying mechanisms.SummaryWe believe that improvement in the prognosis of SFTP relies on early diagnosis, margin-free resection, and long-term follow-up. Through genetic analysis, it appears that both NAB2–STAT6 fusion and somatic mutations such as FLT1-R593W and KDR-V297I contribute to SFTP development.

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Section: Discussionmentioning

confidence: 99%

Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura

Song¹,

Yang²,

Zhang³

et al. 2018

OTT

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“…Broadly speaking, worse prognosis has been associated with large size, malignant histology and pathologic characteristics (7,9,14,27,60,61,62,63,64,65,66,67,68,69,70,71,72) (See Table 5). …”

Section: Prognosismentioning

confidence: 99%

Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective

Saynak

Veeramachaneni

Hubbs³

et al. 2017

Balkan Med J

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Solitary ﬁbrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary ﬁbrous tumor diagnosis. The signature marker of solitary ﬁbrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary ﬁbrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary ﬁbrous tumors. As solitary ﬁbrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary ﬁbrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended.

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“…The majority of the tumors mostly arise from the visceral pleura and seldom from the parietal pleura. Intratumoral necrosis, hemorrhage [1], [6], [20], neoangiogenesis with increased tumor's blood supply network [6], [20] could also be detected in CT scan. These findings may be indicative of malignancy [1], [6], [20].…”

Section: Discussionmentioning

confidence: 97%

“…However, paraneoplasmatic hypoglycemia is not often in SFTPs, occurring in 3–4% of the cases [1], [5], [6], [19]. It is more possible that the syndrome may present in cases of tumors with a diameter larger than 20cm [20]. In addition, paraneoplastic hypoglycemia may occur in other tumors, such as leiomyosarcoma, rhabdomyosarcoma or liposarcoma [1].…”

Section: Discussionmentioning

confidence: 99%

“…However, Hélage et al. reported that the presence of intratumoral calcifications and maximum post-contrast enhancement value are not significant for the recognition of a benign or a malignant SFTP [20]. In case of a large SFTP or a tumor arising from the mediastinal pleura it can be sometimes difficult to preoperatively distinguish the mass from a mediastinal tumor.…”

Section: Discussionmentioning

confidence: 99%

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Solitary fibrous tumor: A center's experience and an overview of the symptomatology, the diagnostic and therapeutic procedures of this rare tumor

Hohenforst-Schmidt

Grapatsas

Dahm

et al. 2017

Respiratory Medicine Case Reports

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Solitary Fibrous Tumor of the Pleura (SFTP) is a rare tumor of the pleura. Worldwide about 800 patients diagnosed with this oncological entity have been described in the existing literature. We report our center's 13 year experience. During this time three patients suffering from this rare disease have been treated in our department. All patients were asymptomatic and their diagnosis was initially triggered by a random finding in a routine chest x-ray. The diagnosis was set preoperatively through a needle biopsy under computer tomography (CT) guidance. The tumors were resected surgically though video-assisted thoracoscopic surgery (VATS) or thoracotomy. Because of the lack of specific guidelines due to the rarity of the disease a long-term, systematic follow-up was recommended and performed. Parallel an overview of the diagnostic and therapeutic procedures of the rare tumor is made.

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Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates

Abstract: A size greater than or equal to 10cm, hypervascularization, attenuation heterogeneity and association with pleural effusion are individual variables that suggest malignant SFT on CT.

Cited by 19 publications

References 19 publications

Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura

Surgical therapy and next-generation sequencing-based genetic alteration analysis of malignant solitary fibrous tumor of the pleura

Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective

Solitary fibrous tumor: A center's experience and an overview of the symptomatology, the diagnostic and therapeutic procedures of this rare tumor

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