Malignant Giant Solitary Fibrous Tumor of the Mediastinum

Abstract

Malignant giant solitary fibrous tumor (SFT) of the mediastinum is a rare neoplasm derived from mesenchymal tissue. Owing to its large size, a complete resection of the tumor can present many challenges, particularly given its proximity to vital neighboring structures. We report a successful en-bloc resection of a massive mediastinal SFT, which was compressing the inferior trachea and heart, by means of a median sternotomy and an anterior left thoracotomy. We emphasize the rarity of this uncommon mediastinal mass. Key points of mediastinal SFT are discussed.

Solitary fibrous tumor of the mediastinum

“…5,8 Hosono et al reported three-port video-assisted thoracic surgery (VATS) resection of a SFT in the mediastinum; and they noted that if there is no invasion of the surrounding nearly organs/structures, VATS could be one of the options of choice for the resection of SFTs. 9 At our hospital, VATS is performed for mediastinal tumors measuring <4 cm in diameter without invasion of the major vessels.…”

“…As in our case, the diagnostic accuracy of a CT-guided aspiration biopsy has been shown to be poor, and this procedure may not be useful for the diagnosis. 5 There are several reports of high accuracy of FDG-PET in the diagnosis of SFTs. Benign SFTs do not show increased FDG-uptake in most cases.…”

Solitary Fibrous Tumor of the Chest Wall in an Infant- A Rare Case Report

“…1,2 Although SFTs mostly occur in a pleural location, up to one-third of cases has been reported in various extrapleural sites such as mediastinum 3 , lung 4 , meninges 5 , prostate, urinary bladder, kidney 6 , liver 7 , nasal cavity 8 , thyroid 9 ,salivatory glands, upper respiratory tract, peritoneum,spinal cord 10 and esophagus 11 . Extrapleural malignant SFT, especially those arising from chest wall, represent an exceedingly rare subset of soft tissue neoplasms.…”

Enormous thoracic solitary fibrous tumor with inferior vena cava compression: A case report

“…[1] Mediastinal SFT may arise in any compartment of the mediastinum [3] and account for 1 to 8% of intrathoracic SFTs. [6] Huang et al [1] from Taiwan retrospectively reviewed 52 cases of intrathoracic SFTs over a 14-year period and found pleural involvement on the top of the list (n=31, 60%) followed by the mediastinum/pericardium (n=12, 23%) and lastly the lung (n=9, 17%). It is noteworthy that there was only a single case of SFT arising from the pericardium indicating the extreme rarity of the tumor.…”

“…Therefore, terms such as benign or localized fibrous mesothelioma, pleural fibroma, submesothelial fibroma, or localized fibrous tumor were used. [2][3][4][5][6][7][8] Later, immunohistochemical studies revealed that intrathoracic SFTs were derived from pluripotent fibroblastic cells in the submesothelial connective tissue rather than from the mesothelial cells. [7] The term SFT was mentioned for the first time by Wagner in 1870 [7] to distinguish it from the malignant diffuse pleural mesothelioma.…”