0
Lung Cancer: Thoracic Malignancies |

Pleural Solitary Fibrous Stromal Tumor: Beware of the Elevated Hemidiaphragm FREE TO VIEW

John Agzarian, MPH; Christine Fahim, MS; Yaron Shargall, MD
Author and Funding Information

McMaster University, Hannon, ON, Canada


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A336. doi:10.1016/j.chest.2016.02.349
Text Size: A A A
Published online

SESSION TITLE: Thoracic Malignancies

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 04:00 PM - 05:00 PM

INTRODUCTION: Solitary fibrous stromal tumors of the lung (SFTP) are rare indolent tumors arising from the submethothelial mesenchymal cells of the pleura, which comprise less than 5% of pleural tumors. Over 80% of SFTP are benign demonstrate indolent slow growth with symptoms being related to local tumor effect. Giant tumors grow silently prior to being diagnosed, creating substantial challenges to surgical resection.

CASE PRESENTATION: We present two cases of giant SFTP diagnosed and treated between September-December 2014. Both patients were female ages 89 and 78 respectively, who had been misdiagnosed on previous outpatient imaging as having elevated hemidiaphragms. One resection was performed electively (due to chronic cough), and the other urgently (after being admitted to the ICU with respiratory distress). Both surgeries were performed after transthoracic needle biopsy confirmation, via hemi-clamshell and clamshell incisions. The first resection of a 20cm SFTP included wedge resections of the right upper and middle lobes of the lung, as well as chest wall resection and reconstruction. The second resection of a 25cm SFTP included an en-bloc left lower lobectomy and diaphragmatic resection. Both cases required intra-operative transfusions of 10 and 14 units of packed red blood cells, and were associated with hospital length of stay of 85 and 136 days respectively. Both patients survived resection and are back to baseline function.

DISCUSSION: Despite the indolent growth of the tumors, SFTP can continue to grow reaching sizes that create substantial technical challenges. The diagnostic test of most importance is a chest computed tomography, demonstrating well-delineated heterogenous mass that often originate form the visceral pleura. The mainstay of treatment is surgical resection. Lung preservation is challenged by tumor size. In comparison to smaller sized tumors amenable to thoracoscopic resection, these two cases required extensive organ resection. Pre-operative embolization was not undertaken in these two cases, but has been described. Complete surgical resection is a strong positive prognostic predictor, which is challenged by large tumor size.

CONCLUSIONS: While SFTP are usually benign, their slow growth and late presentation can lead to giant tumors, creating a setting of challenging resection with associated morbidity. The two presented cases highlight key characteristics of giant SFTP, and the consequences of missed diagnoses. Physicians should be aware of characteristic radiographic features and have a low threshold for referral to thoracic surgeons.

Reference #1: Kohler M, Clarenbach CF, Kestenholz P, et al. Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura. Eur J Cardiothorac Surg. 2007 Sep;32(3):403-8.

Reference #2: Cardillo G1, Lococo F, et al. Solitary fibrous tumors of the pleura. Curr Opin Pulm Med. 2012 Jul;18(4):339-46.

Reference #3: Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control. 2006 Oct;13(4):264-9.

DISCLOSURE: The following authors have nothing to disclose: John Agzarian, Christine Fahim, Yaron Shargall

No Product/Research Disclosure Information


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543