Solitary fibrous tumour of mediastinum: an often asymptomatic neoplasm

Abstract

Solitary fibrous tumours (SFTs) are rare neoplasms derived from mesenchymal cell lines. They are often asymptomatic, follow an indolent growth pattern and are more often benign than malignant. Here, we present a case of a very large, asymptomatic mediastinal SFT in an otherwise healthy man. A 67-year-old Irish man was referred for workup of an asymptomatic murmur. Auscultation of the lung fields revealed diminished breath sounds on the right side. Chest X-ray identified a 20 cm mass localised within the thorax. CT of the thorax confirmed a pleural based, solid lesion with no local invasion. CT-guided core biopsies were reported as consistent with SFT. Primary excision of the lesion was undertaken via median sternotomy. Histological examination confirmed a diagnosis of SFT. The patient remains well at this time. Primary excisive surgery is a safe and effective treatment modality for SFTs.

An unusual location of solitary fibrous tumor in heart—A case report and review of literature

“…Our PubMed search from inception till January 2022, showed most cases reported to be of pericardial origin of cardiac SFT and few reported from the epicardium as shown in Table 1 2,5–10,12–27 . The most accurate predictors of malignancy in SFT on histopathology is nuclear pleomorphism, cellular atypia, necrosis, high cellularity, hemorrhage, cystic degeneration, crowding and overlapping of nuclei within the cytoplasm, a diameter 10 cm or more than 4 mitoses per 10 high‐power fields 4,9,28 . Our case was considered benign based on the lack of mitotic activity and no necrosis.…”

“…2,[5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The most accurate predictors of malignancy in SFT on histopathology is nuclear pleomorphism, cellular atypia, necrosis, high cellularity, hemorrhage, cystic degeneration, crowding and overlapping of nuclei within the cytoplasm, a diameter 10 cm or more than 4 mitoses per 10 highpower fields. 4,9,28 Our case was considered benign based on the lack of mitotic activity and no necrosis. Recent speculation surrounding markers p53 and Ki67 and their ability to predict the malignant potential of SFTs has gained attraction; however, this is not universally accepted at this time.…”

“…Pericardial SFTs present most commonly with exertional dyspnea. 4 Advances in immunohistochemistry (IHC) and cytogenetics have allowed pathologists to more accurately diagnose SFTs. IHC markers such as CD34, Bcl2, CD99, vimentin, and STAT 6 are often expressed in SFTs.…”

“…Cardiac SFT are exceedingly rare with limited cases of SFT involving the pericardium documented in the literature. [4][5][6][7][8] Chest radiography, echocardiography, computed tomographic scan (CT scan), positron emission tomography (PET)-CT and magnetic resonance imaging (MRI) are each useful in the diagnosis and origin of the cardiac SFTs. 9 Pericardial and epicardial cases of cardiac SFTs are mostly benign with only four reported malignant Kristen Fain and Kanak Parmar contributed equally to this work.…”

“…They mostly originate from the pleura however, extra‐pleural locations including deep soft tissue, peritoneum, mediastinum, bones, orbit, and parotid glands have been reported. Cardiac SFT are exceedingly rare with limited cases of SFT involving the pericardium documented in the literature 4–8 . Chest radiography, echocardiography, computed tomographic scan (CT scan), positron emission tomography (PET)‐CT and magnetic resonance imaging (MRI) are each useful in the diagnosis and origin of the cardiac SFTs 9 .…”