Disorders of the Pleura |

Giant Solitary Fibrous Tumor of the Pleura Presenting With Syncope Secondary to Hypoglycemia FREE TO VIEW

Anita Rajagopal, MD; Brent Toney, DO
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Department of Internal Medicine, St Vincent Medical Center, Indianapolis, IN

Chest. 2013;144(4_MeetingAbstracts):505A. doi:10.1378/chest.1679808
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SESSION TITLE: Pleural Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Solitary fibrous tumor of the pleura (SFTP) is a rare primary tumor arising from mesenchymal cells in areolar tissue subjacent to mesothelial lined pleura, commonly an incidental finding. Fewer than 900 cases have been reported in medical literature to date. We report a giant solitary fibrous tumor of the pleura presenting with syncope secondary to hypoglycemia.

CASE PRESENTATION: A 66 year old male, with no past medical history or tobacco use, presented with syncope. He was normoxic. Lab work noted new onset hypoglycemia (glucose 62mg/dL). Chest CT in initial workup revealed a giant right chest mass (Figures 1,2). Transthoracic excision of the mass was performed. Histology confirmed SFTP 20x15x15 cm with mitotic rate 8 mitoses/10 hpf. Hypoglycemia immediately resolved with resection of the mass (glucose 106mg/dL). Based upon a recent risk stratification model, the tumor was considered high risk of aggressive behavior, metastasis, and recurrence [1].

DISCUSSION: First described in 1931 [2], SFTP is a rare neoplasm accounting for 8% of benign pathologic diseases of the chest. 50-60% are symptomatic presenting with dyspnea, chest pain, or fatigue. 3-5% can present with hypoglycemia due to tumor secretion of insulin like proteins (IGF-II). The behavior of these tumors is often unpredictable. Treatment is surgical resection. When hypoglycemia is present, resection results in resolution of life threatening hypoglycemia. The prognosis is generally favorable. The majority of lesions behave in a benign fashion (88%), but approximately 12% of patients die of intrathoracic tumor growth or unresectable recurrence [3]. 10-15% of cases may remain silent for several years prior to transforming into a malignant form, thereby requiring close monitoring.

CONCLUSIONS: This case illustrates the need to consider rare SFTP in the presence of hypoglycemia. Recognition of this rare tumor is imperative given the benefits of removal, especially in those with symptomatic hypoglycemia.

Reference #1: Demicco EG et al. Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model. Mod Pathol. 2012 Sept 25(9): 1298-306

Reference #2: Klemperer P et al. Primary neoplasm of the pleura: a report of five cases. Arch Pathol 1931;11:385-412

Reference #3: Briselli M, et al. Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer 1981;47:2678-89

DISCLOSURE: The following authors have nothing to disclose: Anita Rajagopal, Brent Toney

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543