SESSION TYPE: Cancer Cases I
PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM
INTRODUCTION: The differential diagnosis of an anterior mediastinal mass depends on the patient’s age and clinical history as well as the radiographic appearance of the lesion. In this case report we describe a young man who presented with a large anterior mediastinal mass.
CASE PRESENTATION: A healthy 34 year-old man presented with a 5-day history of productive cough associated with dyspnea, nocturnal sweats and subjective fevers. Admission vital signs revealed BP=130/70, HR=75, RR = 12 and temperature=100.7F. Auscultation of the lungs revealed crackles at the left base. The remainder of the physical exam was unremarkable. Laboratory examination revealed a white blood cell count=13,000/µL with 70% neutrophils. The chest computed tomography is shown in figure 1. A fine needle aspiration of the mass revealed a benign spindle cell neoplasm. During thoracotomy the tumor was adherent to, but not invading, the heart, the lung and the mediastinal pleura. The gross specimen is shown on figure 2. Histology under low power revealed spindle cells and collagen fibrils arranged in a haphazard or storiform pattern. The tumor showed 3-4 mitoses/10 HPF. Immunostaining was positive for CD 34, CD99 and Bcl-2 and negative for desmin and cytokeratin. A diagnosis of a benign solitary fibrous tumor of the mediastinum was made.
DISCUSSION: This case describes a solitary fibrous tumor presenting as an anterior mediastinal mass. Solitary fibrous tumors are rare spindle cell neoplasms that usually arise from the pleural surface and can present as well circumscribed pleural based masses. Most solitary fibrous tumors are asymptomatic. However as they grow in size they may present with symptoms related to the site of tumor. Systemic symptoms such as clubbing, hypertrophic pulmonary osteoarthropathy and hypoglycemia have been described in case reports and are usually reversible with tumor removal. Computerized tomography imaging of solitary fibrous tumors reveals solid lobulated non-invasive soft tissue masses. On gross pathology the tumors are well-circumscribed, firm masses with a whorled appearance on the cut surface. Histology demonstrates “patternless” hyper and hypocellular spindle regions. Immunological stains are positive for vimentin, CD 34, CD99 and bcl-2 and negative for keratin. Diagnosis and treatment require complete surgical resection. Long term follow up for recurrence is mandatory.
CONCLUSIONS: Solitary fibrous tumor must be considered in the differential diagnosis of an anterior mediastinal mass. Imaging studies are helpful but diagnosis requires tissue biopsy. Complete surgical resection is usually curative, but long term follow up for recurrence is mandatory.
1) Goodlad J.R., Fletcher C.D.M. “Solitary fibrous tumour arising at unusual sites: analysis of a series.” Histopathology 1991; 19: 515-522.
DISCLOSURE: The following authors have nothing to disclose: Eugene Shostak, Dana Zappetti, Robert Kaner
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