CASE 14388 Published on 05.02.2017

Giant Solitary Fibrous Tumor of the Pleura(SFTP)

Section

Chest imaging

Case Type

Clinical Cases

Authors

Dr. Abdelhamid Abdu - Core Medical Trainee
Dr. Vijay Pakala - Consultant Radiologist

Princess Royal Hospital,Apley Castle, Apley, Telford TF1 6TF,Shrewsbury and Telford Hospital NHS Trust; 117 Ford Road TF10 7UL NEWPORT; Email:abduabdelhamid@gmail.com
Patient

51 years, female

Categories
Area of Interest Thorax, Lung ; Imaging Technique CT
Clinical History
A 51-year-old non-smoking female hairdresser, presented to her primary care physician with a 3-4 month history of increased shortness of breath especially on exertion. Upon examination she was found to have dullness to percussion and reduced air entry to the left lung base, and oxygen saturation of 99% on air.
Imaging Findings
Changes in the left hemi-thorax are due to a large soft tissue mass measuring a maximum of 15cm AP, 10 cm transverse and approximately 20 cm cranial causal. This appears to be based in the pleura and has a slightly heterogeneous attenuation. No obvious feeding vessels are seen within, with a dilated left upper lobe vein draining from it into the left atrium. In retrospect, the mass was present on the chest radiograph in 2010 and has increased in size since. No significant intrathoracic lymphadenopathy is identified, no pulmonary deposits seen. Solid upper abdominal organs look unremarkable. No metastases were identified, no significant upper abdominal lymph nodes seen. The appearances would suggest a slow growing soft tissue mass which may be a sarcoma of some sort.
Discussion
Solitary Fibrous Tumours of the Pleura (SFTP) account for <5% of all pleural tumours. They are usually asymptomatic (despite being very large (up to 40mm)) and consequently are usually an incidental finding on chest radiograph. Alternatively they can present with either cough, shortness of breath or chest pain. They most commonly present between 60-70 years of age [3].

They are usually slow growing benign lesions and commonly affect the mid/lower zones of the chest. In 80% of cases they arise from the visceral pleura, the rest arise form parietal pleura [2]. They are associated with hypertrophic pulmonary osteoarthropathy and hypoglycemia (Doege-Potter syndrome) but are not associated with asbestos exposure [3].

Chest radiograph usually uncovers a relatively transcribed mass that often forms an obtuse angle with the chest wall. Calcification, pleural effusions and rib destruction are not associated features. On non-enhanced CT they tend to show soft tissue attenuation and on enhanced scans they tend to show relatively homogeneous intense background enhancement (due to rich vascularization) [3].

Treatment of both benign and malignant SFTP is by way of complete surgical excision.

Prognosis for the benign type is excellent (about 8% will recur but recurrence is cured following additional surgery). About 63% of patients with the malignant type experience a recurrence of their tumour, half of which will die due to disease progression within 2 years [1].
Differential Diagnosis List
A solitary fibrous tumour of the pleura was confirmed on histology.
pleural lipoma
intercostal neurilemoma (schwannoma)
Final Diagnosis
A solitary fibrous tumour of the pleura was confirmed on histology.
Case information
URL: https://www.eurorad.org/case/14388
DOI: 10.1594/EURORAD/CASE.14388
ISSN: 1563-4086
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