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Correspondence |

Solitary Fibrous Tumors of the Pleura: An Estimation of Population Incidence FREE TO VIEW

Tryggvi Thorgeirsson, MD; Helgi J. Isaksson, MD; Hronn Hardardottir, MD; Hordur Alfredsson, MD; Tomas Gudbjartsson, MD, PhD
Author and Funding Information

From the Faculty of Medicine (Drs Thorgeirsson and Gudbjartsson), University of Iceland; and the Department of Pathology (Dr Isaksson), the Department of Respiratory Disease (Dr Hardardottir), and the Department of Cardiothoracic Surgery (Drs Thorgeirsson, Alfredsson, and Gudbjartsson), Landspitali University Hospital.

Correspondence to: Tomas Gudbjartsson, MD, PhD, Department of Cardiothoracic Surgery, Landspitali University Hospital, IS 101 Reykjavik, Iceland; e-mail: tomasgud@landspitali.is


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):1005-1006. doi:10.1378/chest.09-2748
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To the Editor:

Primary tumors of the pleura present as either diffuse malignant mesotheliomas or localized solitary fibrous tumors of the pleura (SFTPs), the majority of which are benign. We have used nationwide registries in Iceland to study SFTP and establish an age-standardized incidence rate ([ASR] world standard population), which has not been previously reported. All patients diagnosed with histologically proven SFTP in Iceland from 1984 to 2007 were identified through a centralized pathology registry. For comparison, information on mesotheliomas was obtained from the population-based Icelandic Cancer Registry.

Eleven patients were diagnosed with SFTP (mean age 60 years; eight women) compared with 35 with mesothelioma (mean age 68 years; four women) (Table 1). The ASRs for SFTP and mesothelioma were 1.4 and 4.0 per million (95% CI, 0.54-2.2 and 2.6-5.4), respectively. All cases of SFTP had a benign histology. Only three cases were symptomatic (dyspnea, pneumonia, pleuritic pain), with eight incidentally detected. Apart from one case diagnosed at autopsy, all patients with SFTP were treated with complete surgical resection of the tumor. Average tumor diameter was 6.5 cm (range, 1.3-20 cm) and weight was 130 g (range 5-3,260 g), with eight of the tumors arising from the visceral and three from the parietal pleura. At 70 months’ median follow-up, there has been no recurrence or disease-related death.

More than 800 cases of SFTP have been reported in the literature. Most cases occur between the sixth and seventh decades, with equal frequency in both sexes.1 Patients with benign SFTP have symptoms in 54% to 67% of cases compared with 75% with malignant tumors.2 Predictors of malignant behavior include increased mitoses and cellularity, nuclear pleomorphism, tumor size, necrosis, and stromal or vascular invasion.1,3

In this study, we found that during 24 years in Iceland, 46 cases of primary pleural tumors were diagnosed, one-fourth of these being SFTPs, which all had a benign course. Despite the small number of patients, this population-based study enables the calculation of ASR. This is, to our knowledge, the first calculation of an age-standardized population incidence for this disease, but it can be compared with the previously established incidence of 2.8 per 100,000 registered patients at a single institution.4 Because many patients with SFTP are asymptomatic, incidence rates are affected by the likelihood of incidental detection, primarily through medical imaging of the chest. Therefore, the ASR for SFTP in Iceland, with its single-payer health care system and comparatively easy access to imaging studies, is possibly in the higher range.

Table Graphic Jump Location
Table 1 —Summary of Clinical Data for 11 Patients Diagnosed With Solitary Fibrous Tumors of the Pleura in Iceland 1984-2007

CXR = chest radiograph; F = female; M = male; Max = maximum; N = no; N/A = information not available; NSCLC = non-small cell lung cancer; Y = yes.

de Perrot M, Fischer S, Bründler MA, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002;741:285-293. [CrossRef] [PubMed]
 
Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control. 2006;134:264-269. [PubMed]
 
England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;138:640-658. [CrossRef] [PubMed]
 
Okike N, Bernatz PE, Woolner LB. Localized mesothelioma of the pleura: benign and malignant variants. J Thorac Cardiovasc Surg. 1978;753:363-372. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Summary of Clinical Data for 11 Patients Diagnosed With Solitary Fibrous Tumors of the Pleura in Iceland 1984-2007

CXR = chest radiograph; F = female; M = male; Max = maximum; N = no; N/A = information not available; NSCLC = non-small cell lung cancer; Y = yes.

References

de Perrot M, Fischer S, Bründler MA, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002;741:285-293. [CrossRef] [PubMed]
 
Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control. 2006;134:264-269. [PubMed]
 
England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;138:640-658. [CrossRef] [PubMed]
 
Okike N, Bernatz PE, Woolner LB. Localized mesothelioma of the pleura: benign and malignant variants. J Thorac Cardiovasc Surg. 1978;753:363-372. [PubMed]
 
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