This is case presentation together with literature review

1. Solitary Fibrous Tumor of Pleura
(Case Presentation + Literature Review)
Dr. K Khaing Saw Lwin
MBBS, MRCSEd, MMedSc(Thoracic Surgery)

2. • 62 year old , male, smoker
• Referred from the other hospital for Lt thorax
mass ( PCNB- spindle cell tumor)
• PMH- Hypertension (+)

3. CXR (PA) 24-11-15 CXR (PA) 17-10-17

6. Plan
• Excision for curative intent

7. Operation
• Surgeon – Prof Sook Whan Sung
• Operation Performed -Uniportal VATS wedge
resection (tumor resection),LUL under GA

8. Findings
• Moderate pleural adhesion
• No definite pleural effusion
• Complete fissure
• Moderate visceral pleural anthracosis
• No definite emphysematous change

9. Findings
• Pleura origin (stalk from lingular segment in
LUL) large- sized mass was noted.
- It consisted of two rounded masses
- It was well capsulated and had clear surface(red
to purple colored)
- Frozen section  solitary fibrous tumor of
pleura likely but it is showing hypercellularity.
Thus permanent section should be checked

14. Histology
• Malignant solitary fibrous tumor
• Histologic grade :II by FNCLCC system
• Mitosis: 4-5 MF/10 HFP
• Resection margin involvement – absent( 2.2cm
free from tumor)
• pTNM stage: T2b Nx Mx (7th AJCC)

15. Immunohistochemistry
• CD 34 – positive
• Ki 67 – 7%

16. Solitary Fibrous Tumor of Pleura

17. Literature Review

18. Solitary fibrous tumors most commonly arise on the visceral
side of the pleura and are usually ovoid in shape

19. • Incidence -2 per 100,000
• equally in men and women
• Age – 30 to 60 yrs
• 12% - Malignant
• Not associated with asbestos exposure
• Asymptomatic -in half of the cases
• Symptoms – intrathoracic or extrathoracic

20. • Intrathoracic symptoms
• related to the mass effect of the tumor - dyspnea,
chest pain, or a chronic cough.

21. • Extrathoracic manifestations - paraneoplastic,
• hypertrophic pulmonary osteoarthropathy or
clubbing
• of the digits in 20% (Pierre–Marie–Bamberg
syndrome),
• hypoglycemia in 5% (Doege–Potter syndrome),
gynecomastia,or galactorrhea.
• Constitutional symptoms such as fever, fatigue,
and weight loss.

24. Radiology ( Malignant vs benign)
• some radiographic criteria that can help
distinguish benign and malignant cases
• Malignant tumors are typically >10cm,
• have heterogeneous low attenuation regions of
necrosis,hemorrhage, cysts, or myxoid
degeneration,
• associated pleural or pulmonary metastases

25. Long term survival – (stage 0-3) 98%, 92%,86%, 37%
Recurrence – (stage 0-3) 2%, 8%, 14%,63% (first 24 mth following resection)

26. Histology
• Criteria for malignancy include
(1)high mitotic rate >4 mitoses per 10 HPF;
(2) high cellularity with crowding and overlapping
nuclei;
(3) presence of necrosis;and
(4) Pleomorphism
If any of these four characteristics are present in
the tumor, it is classified as malignant.

27. IHC (Malignant vs Benign)
• no reliable marker
• Some malignant tumors lose CD34 staining but
always retain bcl-2 positive staining.
• Ki-67 or proliferating cell nuclear
antigen(PCNA) (for diff)but no distinct
threshold has been determined

28. Treatment
• Complete surgical resection is the mainstay of
therapy for solitary fibrous tumor of the pleura.

29. • A margin of 1 to 2 cm is recommended with en
bloc resection of any involved structures.
• Pedunculated tumors arising from the lung may
include a wedge resection of the lung,
• But sessile or “inverted” tumors may require
lobectomy.

30. Thank you