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• W2557576925 abstract "For one unfortunate patient, benign histopathology did not lead to a good outcome. A 74-year-old woman presented with dyspnea on exertion and altered mental status. She had no history of lung disease and denied other cardiopulmonary, abdominal, or constitutional symptoms. Her past medical history, besides many years of tobacco abuse, was unremarkable. While the patient did not appear to be in respiratory distress, a physical examination revealed hypoxemia on room air, with an initial oxygen saturation of 86%. Percussion of the right lower and middle fields produced stony dull sounds, and breath sounds were absent in these areas. Mild wheezing accompanied by prolonged expiration was audible in all lung fields on the left side. Arterial blood gas demonstrated chronic respiratory acidosis and hypoxemia. A radiograph of the chest showed a large opacity occupying the right mid to lower thorax (Figure 1). Computed tomography (Figure 2) identified a giant 18 cm × 13 cm × 15 cm mass in the right hemithorax. The growth appeared to compress the right middle lobe and restrict expansion of the right upper and lower lobes. No infiltrates, effusion, or evidence of metastases were seen. A computed tomography-guided biopsy was performed to investigate the suspected neoplastic process (Figure 3). No complications occurred.Figure 2Computed tomography of the chest disclosed the sizable tumor and its extensive occupation of the right hemithorax. (A) This is the axial view. (B) A coronal view is provided. (C) The sagittal view is also impressive.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3(A) Computed tomography shows the mass in the axial view. (B) Placement of the biopsy needle within the tumor is illustrated.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The pathology study classified the mass as a solitary fibrous tumor, a diagnosis confirmed by CD34-positive staining (Figure 4). These rare primary tumors of the pleura originate from the mesenchymal layer.1Cardillo G. Facciolo F. Cavazzana A.O. Capece G. Gasparri R. Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients.Ann Thorac Surg. 2000; 70: 1808-1812Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar, 2Cardillo G. Lococo F. Carleo F. Martelli M. Solitary fibrous tumors of the pleura.Curr Opin Pulm Med. 2012; 18: 339-346Crossref PubMed Scopus (52) Google Scholar, 3Ali S.Z. Hoon V. Hoda S. Heelan R. Zakowski M.F. Solitary fibrous tumor. A cytologic-histologic study with clinical, radiologic, and immunohistochemical correlations.Cancer. 1997; 81: 116-121Crossref PubMed Scopus (160) Google Scholar, 4de Perrot M. Kurt A.M. Robert J.H. Borisch B. Spiliopoulos A. Clinical behavior of solitary fibrous tumors of the pleura.Ann Thorac Surg. 1999; 67: 1456-1459Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar, 5Khan J.H. Rahman S.B. Clary-Macy C. et al.Giant solitary fibrous tumor of the pleura.Ann Thorac Surg. 1998; 65: 1461-1464Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Overall, primary tumors of the pleura can be diffuse or localized.5Khan J.H. Rahman S.B. Clary-Macy C. et al.Giant solitary fibrous tumor of the pleura.Ann Thorac Surg. 1998; 65: 1461-1464Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Diffuse pleural neoplasms arise from mesothelial cells, are associated with asbestos exposure, and have a highly malignant potential, while localized neoplasms, termed solitary fibrous tumors, arise from the submesothelial layer and tend to follow a more benign course; 10%-20% are malignant.1Cardillo G. Facciolo F. Cavazzana A.O. Capece G. Gasparri R. Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients.Ann Thorac Surg. 2000; 70: 1808-1812Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar, 2Cardillo G. Lococo F. Carleo F. Martelli M. Solitary fibrous tumors of the pleura.Curr Opin Pulm Med. 2012; 18: 339-346Crossref PubMed Scopus (52) Google Scholar, 3Ali S.Z. Hoon V. Hoda S. Heelan R. Zakowski M.F. Solitary fibrous tumor. A cytologic-histologic study with clinical, radiologic, and immunohistochemical correlations.Cancer. 1997; 81: 116-121Crossref PubMed Scopus (160) Google Scholar More than 50% of benign solitary fibrous tumors are asymptomatic, but others can manifest with intrathoracic or constitutional symptoms.2Cardillo G. Lococo F. Carleo F. Martelli M. Solitary fibrous tumors of the pleura.Curr Opin Pulm Med. 2012; 18: 339-346Crossref PubMed Scopus (52) Google Scholar Our patient's case appears to be the first reported solitary fibrous tumor diagnosed within the Veterans Health Administration. It reminds us to consider benign pleural tumors in the differential diagnosis of lung masses. Wide surgical resection without adjuvant chemotherapy is, if feasible, the optimal treatment strategy for patients with a solitary fibrous tumor.2Cardillo G. Lococo F. Carleo F. Martelli M. Solitary fibrous tumors of the pleura.Curr Opin Pulm Med. 2012; 18: 339-346Crossref PubMed Scopus (52) Google Scholar, 5Khan J.H. Rahman S.B. Clary-Macy C. et al.Giant solitary fibrous tumor of the pleura.Ann Thorac Surg. 1998; 65: 1461-1464Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The likelihood of recurrence and mortality mainly depends on whether the tumor is benign or malignant and whether the tumor location and patient's health status permit resection. Benign pedunculated tumors that are excised with clear margins have a recurrence rate of 2%.1Cardillo G. Facciolo F. Cavazzana A.O. Capece G. Gasparri R. Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients.Ann Thorac Surg. 2000; 70: 1808-1812Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar In contrast, sessile malignant tumors can recur up to 63% of the time. Our patient's tumor proved benign, but its large size caused marked compressive atelectasis and associated severe symptoms. As solitary fibrous tumors continue to grow, they inevitably squeeze the bronchi further, producing a mass effect on the mediastinum.4de Perrot M. Kurt A.M. Robert J.H. Borisch B. Spiliopoulos A. Clinical behavior of solitary fibrous tumors of the pleura.Ann Thorac Surg. 1999; 67: 1456-1459Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar Cardiothoracic surgeons were consulted on the potential for resection of our patient's tumor. A clamshell thoracotomy was the only surgical option, and given her greatly diminished respiratory reserve, she was deemed to be at high risk for intraoperative mortality and thus, a poor candidate. She was discharged home with her family." @default.
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• W2557576925 date "2017-04-01" @default.
• W2557576925 modified "2023-09-24" @default.
• W2557576925 title "Benign but Not Harmless: Solitary Fibrous Tumor" @default.
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