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    J Korean Soc Radiol. 2012 May;66(5):437-441. Korean.
    Published online May 31, 2012.
    https://doi.org/10.3348/jksr.2012.66.5.437
    Copyright © 2012 The Korean Society of Radiology
    Case Report

    Malignant Solitary Fibrous Tumor in Anterior Mediastinum with Pleural Metastasis Simulating Invasive Thymoma

    Jong Bum Kim, MD,1 Ju Won Lee, MD,1 Young Chae Chu, MD,2 Ju Young Song, MD,2 Yong Han Yoon, MD,3 Youn Jeong Kim, MD,1 Yeo Ju Kim, MD,1 and Kyung Hee Lee, MD1
      • 1Department of Radiology, Inha University School of Medicine, Inha University Hospital, Incheon, Korea.
      • 2Department of Pathology, Inha University School of Medicine, Inha University Hospital, Incheon, Korea.
      • 3Department of Cardiothoracic Surgery, Inha University School of Medicine, Inha University Hospital, Incheon, Korea.
    • Corresponding author: Kyung Hee Lee, MD. Department of Radiology, Inha University School of Medicine, Inha University Hospital, 7-206 Sinheung-dong 3-ga, Jung-gu, Incheon 400-711, Korea. Tel. 82-32-890-2769, Fax. 82-32-890-2743, Email: khlmay@hanmail.net
    Received November 14, 2011; Accepted March 08, 2012.

    Abstract

    Malignant solitary fibrous tumor, which arises in the anterior mediastinum, is rare. Its image findings simulate other mediastinal mass, such as malignant lymphoma, malignant thymic epithelial tumor or invasive thymoma. Here, we report a pleural malignant fibrous tumor of a 60-year-old man who is presented with a well-defined lobulating anterior mediastinal mass with pleural metastasis mimicking invasive thymoma with pleural seeding.

    Keywords
    Computed Tomography; Malignant Solitary Fibrous Tumor; Anterior Mediastinal Tumor

    Figures

    Fig. 1
    Initial imaging features of the anterior mediastinal malignant solitary fibrous tumor in a 60-year-old man.
    A. The chest radiograph shows an anterior mediastinal mass (arrows) obliterating right heart border.

    B. The axial non-enhanced CT image shows a well-defined low attenuated mass in the anterior mediastinum. No evidence suggesting hemorrhage or calcifications is seen.

    C. The axial contrast enhanced CT image shows a heterogeneously enhancing lobulated mass with focal low attenuated areas implying necrosis and cystic change.

    D. The axial contrast enhanced CT image reveals well-defined nodular enhancing lesions along the anterior pleura of the right lower thorax (white arrows). Small amount of right pleural effusion is seen (black arrow).

    E. The axial 18F-FDG PET/CT images show a lobular, intensely hypermetabolic mass in the anterior mediastinum (SUVmax = 10.7), and well-defined nodular hypermetabolic lesions along the anterior pleura of right lower thorax (arrows).

    Note.-SUV = standardized uptake value, 18F-FDG PET = 18F-fluorodeoxyglucose-positron emission tomography

    Fig. 2
    Follow-up CT scan 22 days after initial neoadjuvant chemotherapy. The axial contrast-enhanced CT scan demonstrates (A) increased size of the anterior mediastinal mass extending to the right anterior pleura, and (B) newly seen metastatic pleural nodules (arrows) in the right lower thorax.

    Fig. 3
    Micrographic features of the anterior mediastinal mass.
    A. The photomicrograph (H&E, × 40) shows sharp demarcation (dotted line) between cellular area (asterisk), and sparsely collagenous zone.

    B. The tumor is composed of collagen-forming atypical spindle cells showing mitotic activity (arrows), and pleomorphism (H&E stain, × 400).

    References

      1. De Raet J, Sacré R, Hoorens A, Fletcher C, Lamote J. Malignant giant solitary fibrous tumor of the mediastinum. J Thorac Oncol 2008;3:1068–1070.
      1. Khalifa MA, Montgomery EA, Azumi N, Gomes MN, Zeman RK, Min KW, et al. Solitary fibrous tumors: a series of lesions, some in unusual sites. South Med J 1997;90:793–799.
      1. Balassiano M, Reichert N, Rosenman Y, Hertcheg E, Lieberman Y, Yellin A. Localized fibrous mesothelioma of the mediastinum devoid of pleural connections. Postgrad Med J 1989;65:788–790.
      1. Suehisa H, Yamashita M, Komori E, Sawada S, Teramoto N. Solitary fibrous tumor of the mediastinum. Gen Thorac Cardiovasc Surg 2010;58:205–208.
      1. 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;13:640–658.
      1. Song SW, Jung JI, Lee KY, Kim MY, Park SH. Malignant solitary fibrous tumor of the pleura: computed tomography-pathological correlation and comparison with computed tomography of benign solitary fibrous tumor of the pleura. Jpn J Radiol 2010;28:602–608.
      1. Tecce PM, Fishman EK, Kuhlman JE. CT evaluation of the anterior mediastinum: spectrum of disease. Radiographics 1994;14:973–990.
      1. Kawashima A, Libshitz HI. Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol 1990;155:965–969.
      1. Mendelson DS, Meary E, Buy JN, Pigeau I, Kirschner PA. Localized fibrous pleural mesothelioma: CT findings. Clin Imaging 1991;15:105–108.
    MeSH Terms
    Humans
    Lymphoma
    Mediastinum
    Middle Aged
    Neoplasm Metastasis
    Neoplasms, Glandular and Epithelial
    Seeds
    Solitary Fibrous Tumors
    Thymoma
    Thymus Neoplasms
    Metrics
    Share
    Figures
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