SESSION TYPE: Cancer Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: First described in 1767, solitary fibrous tumor of pleural (SFTP) is a rare primary tumor arising from the visceral pleura. The benign form is a very rare slow growing neoplasm with a high cure rate while malignant SFTP is less common with the majority of patients dying within 2 years. It accounts for 8% of benign pathologic diseases of the chest and 10% of pleural neoplasms. We present a case of an elderly woman with benign SFTP which showed radiographic progression over 11 years.
CASE PRESENTATION: An 82 year old woman with a history of breast cancer and asthma was noted to have an incidental 1.5 cm right sided pulmonary nodule on a preoperative chest radiograph in 2001. She was lost to follow-up and subsequent chest radiograph and chest CT scan in 2009, revealed a 4x3.8 cm pleural mass along the right major fissure. Transthoracic fine needle aspiration of the mass in 2010 revealed a benign SFTP. Due to her advanced age and no respiratory symptoms, she elected radiographic monitoring instead of resectional surgery. Over several years, she complained of increased dyspnea. Serial CT scans showed progressive enlargement of the mass now measuring 10x7.1 cm with a restrictive pattern on spirometry. PET-CT of the pleural mass in 2012 was avid (SUV 3.2) while in 2009 it was non-avid (SUV 1.). Given her increased dyspnea, increasing size of the SFTP, and new PET-CT avidity, she is scheduled for resectional surgery.
DISCUSSION: SFTPs originate from the submesothelium and only about 850 cases are reported to date. The benign form of SFTP comprises 80% of reported cases and is commonly found in the right hemothorax. Thoracic symptoms are secondary to large tumor burden and location. These tumors on presentation can be benign but may show malignant degeneration at a later time. PET/CTs are typically nonavid but the malignant form has significant uptake. Benign histopathological appearance is characterized by fibroblast spindle cells and connective tissue with low mitotic activity while the malignant form has high mitotic activity. Treatment is surgical resection with close follow-up of 15 to 20 years due to recurrence. (15-20 years!!!)
CONCLUSIONS: SFTPs are commonly benign up to 80% of the time however there is a malignant potential and thus should be excised.
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2) Sung, SH. Solitary Fibrous Tumor of the Pleura: Surgical Outcome and Clinical Course. Ann Thorac Surg. 2005;79:303-307.
3) Enon S. Benign Localized Fibrous Tumor of the Pleura: Report of 25 New Cases. Thorac Cardiovasc Surg. 2011
DISCLOSURE: The following authors have nothing to disclose: Richard Hedelius, Gilbert Seda, Daniel Gramins
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