Benign Localized Fibrous Tumor of the Pleura: Report of 25 New Cases

 

 Buy Article Permissions and Reprints All articles of this category

Abstract

Objective Benign localized fibrous tumors (BLFT) of the pleura are very rare slow-growing neoplasms that generally have a favorable prognosis. The aim of this manuscript is to evaluate the predictors of outcome with the review of the literature in a series of 25 patients with BLFT.

Methods Between January 1985 and November 2009, 25 patients underwent an operation due to BLFT. Of these patients, 14 (56%) were male; mean age was 41.1 (25 to 64) years. All patients underwent thoracotomy. Left thoracotomy approach was used in 16 patients. The mass lesions were totally excised. The histopathological examinations were performed with hematoxylin-eosin and immunohistochemical staining methods.

Results Of the patients, 18 (72%) were symptomatic. Symptoms were cough in 36%, shortness of breath in 32%, and chest pain in 20% of the patients. One patient (4%) appeared to have some symptoms (pain and swelling of the joints) associated with pulmonary osteoarthropathy. Seven patients (28%) underwent an operation due to mass lesion detected at routine control visits. None of the patients had a history of exposure to asbestos. Radiological investigations revealed 16 (64%) mass lesions in the left. Of the lesions found on exploration, 5 (20%) were intrapulmonary localized lesion without pedicle and 20 were pedicled. Of the pedicled masses, 5 were connected to parietal pleura and 15 to visceral pleura and all were intrathoracic extrapulmonary localized lesions. Eight (32%) lesions connected to left lower lobe. Additionally, three pedicled lesions were located in the lung fissure. Pedicled lesions were totally excised together with their pedicles. Intraparenchymal mass lesions were resected using wedge resection. The diameter of the resected masses was ranging between 3 and 22 cm (mean: 8.7). Macroscopically, all were encapsulated with a homogeneous cut surface. Intraoperative mortality and morbidity was not observed. The average hospitalization duration for all patients was 8.6 days (5 to 12). The mean follow-up was 33.6 (9 to 142) months with no recurrence.

Conclusions Benign localized fibrous tumors are uncommon and treated by surgical means. According to our data obtained from literature review, clinicians should be aware of recurrence possibility even after complete resection of benign localized fibrous tumor and the risk of malign transformation.

• References

• 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 (8) 640-658
  Google Scholar
• 2 Okike N, Bernatz PE, Woolner LB. Localized mesothelioma of the pleura: benign and malignant variants. J Thorac Cardiovasc Surg 1978; 75 (3) 363-372
  PubMedGoogle Scholar
• 3 Briselli M, Mark EJ, Dickersin GR. Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer 1981; 47 (11) 2678-2689
  CrossrefPubMedGoogle Scholar
• 4 Robinson LA, Reilly RB. Localized pleural mesothelioma. The clinical spectrum. Chest 1994; 106 (5) 1611-1615
  CrossrefPubMedGoogle Scholar
• 5 Martini N, McCormack PM, Bains MS, Kaiser LR, Burt ME, Hilaris BS. Pleural mesothelioma. Ann Thorac Surg 1987; 43 (1) 113-120
  CrossrefPubMedGoogle Scholar
• 6 Cardillo G, Carbone L, Carleo F , et al. Solitary fibrous tumors of the pleura: an analysis of 110 patients treated in a single institution. Ann Thorac Surg 2009; 88 (5) 1632-1637
  CrossrefPubMedGoogle Scholar
• 7 de Perrot M, Fischer S, Bründler MA, Sekine Y, Keshavjee S. Solitary fibrous tumors of the pleura. Ann Thorac Surg 2002; 74 (1) 285-293
  CrossrefPubMedGoogle Scholar
• 8 Hanau CA, Miettinen M. Solitary fibrous tumor: histological and immunohistochemical spectrum of benign and malignant variants presenting at different sites. Hum Pathol 1995; 26 (4) 440-449
  CrossrefPubMedGoogle Scholar
• 9 Suter M, Gebhard S, Boumghar M, Peloponisios N, Genton CY. Localized fibrous tumours of the pleura: 15 new cases and review of the literature. Eur J Cardiothorac Surg 1998; 14 (5) 453-459
  CrossrefPubMedGoogle Scholar
• 10 Mitchell JD. Solitary fibrous tumor of the pleura. Semin Thorac Cardiovasc Surg 2003; 15 (3) 305-309
  CrossrefPubMedGoogle Scholar
• 11 Mezzetti M, Panigalli T, Giudice FL , et al. Surgical experience of 15 solitary benign fibrous tumor of the pleura. Crit Rev Oncol Hematol 2003; 47 (1) 29-33
  CrossrefPubMedGoogle Scholar
• 12 Kalebi AY, Hale MJ, Wong ML, Hoffman T, Murray J. Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome. J Cardiothorac Surg 2009; 4: 45-53
  CrossrefPubMedGoogle Scholar
• 13 Masson EA, MacFarlane IA, Graham D, Foy P. Spontaneous hypoglycaemia due to a pleural fibroma: role of insulin like growth factors. Thorax 1991; 46 (12) 930-931
  CrossrefPubMedGoogle Scholar
• 14 Moat NE, Teale JD, Lea RE, Matthews AW. Spontaneous hypoglisemia and pleural fibroma. Thorax 1991; 46: 932-933
  CrossrefPubMedGoogle Scholar
• 15 Rena O, Filosso PL, Papalia E , et al. Solitary fibrous tumour of the pleura: surgical treatment. Eur J Cardiothorac Surg 2001; 19 (2) 185-189
  CrossrefPubMedGoogle Scholar
• 16 Guo J, Chu X, Sun YE, Zhang L, Zhou N. Giant solitary fibrous tumor of the pleura: an analysis of five patients. World J Surg 2010; 34 (11) 2553-2557
  CrossrefPubMedGoogle Scholar
• 17 Lee KS, Im JG, Choe KO, Kim CJ, Lee BH. CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients. AJR Am J Roentgenol 1992; 158 (5) 983-986
  PubMedGoogle Scholar
• 18 Lewis MI, Horak DA, Yellin A, Rotter A, Belman MJ, Benfield JR. The case of the moving intrathoracic mass. Pedunculated benign localized pleural mesothelioma. Chest 1985; 88 (6) 897-898
  CrossrefPubMedGoogle Scholar
• 19 Ginat DT, Bokhari A, Bhatt S, Dogra V. Imaging features of solitary fibrous tumors. AJR Am J Roentgenol 2011; 196 (3) 487-495
  CrossrefPubMedGoogle Scholar
• 20 Versluis PJ, Lamers RJ. Localized pleural fibroma: radiological features. Eur J Radiol 1994; 18 (2) 124-125
  CrossrefPubMedGoogle Scholar
• 21 Alexander M, Yang S, Yung R, Brasic JR, Pannu H. Diagnosis of benign solitary fibrous tumors by positron emission tomography. South Med J 2004; 97 (12) 1264-1267
  CrossrefPubMedGoogle Scholar
• 22 Sanguinetti CM, Marchesani F, Ranaldi R, Pela R, Cecarini L. Localized fibrous pleural tumour of the interlobular pleura. Eur Respir J 1996; 9 (5) 1094-1096
  CrossrefPubMedGoogle Scholar
• 23 Taştepe I, Alper A, Ozaydın HE, Memiş L, Cetin G. A case of multiple synchronous localized fibrous tumor of the pleura. Eur J Cardiothorac Surg 2000; 18 (4) 491-494
  CrossrefPubMedGoogle Scholar
• 24 Utley JR, Parker Jr JC, Hahn RS, Bryant LR, Mobin-Uddin K. Recurrent benign fibrous mesothelioma of the pleura. J Thorac Cardiovasc Surg 1973; 65 (5) 830-834
  CrossrefPubMedGoogle Scholar
• 25 Takagi M, Kuwano K, Watanabe K, Akiba T. A case of recurrence and rapid growth of pleural solitary fibrous tumor 8 years after initial surgery. Ann Thorac Cardiovasc Surg 2009; 15 (3) 178-181
  PubMedGoogle Scholar