Chylothorax after endoscopic ultrasound with fine-needle aspiration causing migrating appearance of a solitary fibrous tumor of the pleura

Mongelli, Francesco; FitzGerald, Maurice; Cafarotti, Stefano; Inderbitzi, Rolf

doi:10.4103/atm.atm_340_17

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…However, our patient's may be linked to increased exudation and infection caused by tumor compression on the lung and large blood vessels. Iatrogenic chylothorax has also been reported due to the more massive lymphatic vessel injury following endoscopic ultrasound and fine-needle aspiration (22). As our patient, all cytological results of pleural effusion were negative, which may be related to the complete capsule of the tumor, and the cells are difficult to shed (23).…”

Section: Discussionmentioning

confidence: 53%

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Zuo¹,

Zhou²,

Sun³

et al. 2020

Ann Transl Med

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A solitary fibrous tumor (SFT) is a rare spindle cell tumor-derived from mesenchymal cells. It may be linked to the fusion of the NAB2-STAT6 gene caused by 12q chromosome rearrangement. It can occur in the connective tissue of any part of the body; however, it is most common in the pleura. Solitary fibrous tumors of the pleura (SFTP) are a persistent painless mass with slow growth. With the increase of the tumor, there will be corresponding compression symptoms. Pleural effusion is rare, and the cytology of pleural effusion is mostly negative. Occasionally, SFTP can induce paraneoplastic syndrome, distant metastasis, and malignant transformation. Lung function may have mild to moderate restrictive ventilation dysfunction. CT is a crucial method for the clinical diagnosis of SFTP. The histopathological features of SFTP are the coexistence of sparse and dense areas. CD34, CD99, Bcl-2, and vimentin are the most valuable immunohistochemical markers.The positive expression rate of STAT6 in benign SFT was even 100%. Adhesion or unclear boundary with surrounding tissues, pleural effusion or calcification, tumors with a maximum diameter greater than 10 cm, invasive growth, uneven density, metastasis or recurrence, paraneoplastic syndrome, moderate to severe cell heterogeneity, high Ki67 proliferation index, and low STAT6 expression suggest SFTP may be a malignant tumor. Gene analysis on next generation sequencing may help reveal the mutation characteristics of SFTP. Complete tumor resection is the gold standard of SFTP. Resectability is the most important prognostic factor. Age, size, mitosis, and necrosis are considered risk stratification factors for prognosis. Fortunately, 80% of SFTP are benign and have anexcellentprognosis but need long-term follow-up.We report a case of rapidly growing tumor with pleural effusion within 9 months, who was surgically treated and is currently under follow-up. And the literature is reviewed.

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Section: Discussionmentioning

confidence: 53%

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Zuo¹,

Zhou²,

Sun³

et al. 2020

Ann Transl Med

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“…Esophageal perforation and concomitant chylothorax due to UGIE have not been reported in the medical literature before. Chylothorax has been reported after esophagectomy, endoscopic sclerotherapy, and endoscopic ultrasound-guided esophageal biopsy[ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Two-stage surgery for delayed esophageal perforation and concomitant chylothorax secondary to upper gastrointestinal endoscopy

Chaudhry

Ghamdi

Fraih

et al. 2022

Annals of Medicine &Amp; Surgery

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“…A recent case report describes a mediastinal SFT diagnosed on EBUS-FNA. 2 Other SFT cases sampled by EUS-FNA have been reported, but were located in the luminal gastrointestinal tract [4][5][6] ; one of which was described as a malignant SFT of the esophagus. 4 To our knowledge, this is the first cytomorphology-based case series comparing two malignant mediastinal SFT cases-one of which was a primary diagnosis by EBUS-FNA and the other, a recurrent diagnosis by EUS-FNA.…”

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confidence: 99%

Cytomorphologic features of malignant solitary fibrous tumor with mediastinal involvement sampled by endoscopic and endobronchial ultrasound‐guided fine‐needle aspiration: A comparison of two cases

Hupp

Najmuddin

Dinçer

et al. 2019

Diagnostic Cytopathology

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Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm with considerable risk of local recurrence. SFT is histologically characterized by bland spindled-to-epithelioid cells in alternating hyper-and hypocellular zones, a "patternless pattern," ectatic "staghorn" vessels with variable edematous perivascular stroma, and thick ropey collagen.Cytologically, smears are variably cellular with spindled-to-epithelioid cells with oval nuclei, wispy cytoplasm, multiple inconspicuous nucleoli, and occasional nuclear pseudoinclusions. Small vessels and bare/stripped nuclei are generally present while mild atypia is not uncommon. STAT6 nuclear expression is the most useful immunohistochemical stain and is the product of a NAB2-STAT6 gene fusion. SFTs with mediastinal involvement may be diagnostically challenging due to proximity to vital structures and anticipated patient risks. Endobronchial and endoscopic ultrasound-guided fineneedle aspiration (EBUS/EUS-FNA) are minimally-invasive tissue sampling methods that provide diagnostic material while minimizing patient risk, and the mediastinum is accessible by both procedures. Small aspirate samples and SFT nonspecific features can compound the diagnostic difficulty, although familiarity with the cytologic, morphologic, immunophenotypic, and genetic features of SFTs assist the pathologist in confirming the diagnosis. Pathologists must also be aware of high-risk SFT features to ensure appropriate therapy and management. Case #1 describes a recurrent mediastinal SFT with high-risk features sampled by EUS-FNA. Case #2 describes a primary diagnosis of mediastinal SFT with malignant behavior made on an EBUS-FNA specimen. K E Y W O R D S endoscopic ultrasound, fine-needle aspiration, mediastinum, solitary fibrous tumor, STAT6

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Chylothorax after endoscopic ultrasound with fine-needle aspiration causing migrating appearance of a solitary fibrous tumor of the pleura

Cited by 4 publications

References 5 publications

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature

Two-stage surgery for delayed esophageal perforation and concomitant chylothorax secondary to upper gastrointestinal endoscopy

Cytomorphologic features of malignant solitary fibrous tumor with mediastinal involvement sampled by endoscopic and endobronchial ultrasound‐guided fine‐needle aspiration: A comparison of two cases

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