Mediastinal Solitary Fibrous Tumor Diagnosed by Endobronchial Ultrasound-Directed Biopsy

Abstract

Patient: Male, 32Final Diagnosis: Mediastinal solitary fibrous tumorSymptoms: Cough • dyspnea • progressive dysphagia • worsening intermittent chest painMedication: —Clinical Procedure: Flexible bronchoscopy • endobronchial ultrasound (EBUS)Specialty: PulmonologyObjective:Rare diseaseBackground:Solitary fibrous tumors of the middle mediastinal space are uncommon and often not discovered until symptoms secondary to compression of adjacent structures occur. Diagnosis requires surgical biopsy and histological tissue analysis. We describe the ECHO appearance of the solitary fibrous tumor and successful non-invasive EBUS diagnosis. This method of diagnosis allowed for surgical planning for resection and allowed us to exclude non-surgical diseases, such as small cell carcinoma.Case Report:A 32-year-old man presented to his primary care physician with worsening intermittent chronic chest pain with recent progressive dysphagia, cough, and dyspnea. Physical examination and routine laboratory work-up were unrevealing. Chest radiograph and computed tomography (CT) of the chest revealed a middle mediastinal mass. Flexible bronchoscopy confirmed extrinsic compression of right and left bronchial trees. Endobronchial ultrasound (EBUS) was used to biopsy the mass and the diagnosis of solitary fibrous tumor was confirmed. The patient underwent successful tumor resection and was discharged home after an uneventful postoperative period.Conclusions:Endobronchial ultrasound-directed tissue biopsy is an appropriate modality for suspected solitary fibrous tumors of the mediastinum. To our knowledge, this is only the second reported case of SFT diagnosed by EBUSTBNA. Our case uniquely demonstrates the advantages of pre-surgical diagnosis of mediastinal masses with EBUS-TBNA when the diagnosis SFT is suggested on CT and US imaging.

Perbaikan Kualitas Hidup pada Pasien Solitary Fibrous Tumor Mediastinum: Perspektif Kemoterapi Paliatif

“…Keluhan utama SFT mediastinum dapat berupa batuk, sesak napas atau nyeri dada, atau dapat terjadi sebagai asymptomatic incidental mass. [4][5][6] SFT mediastinum dapat memiliki perjalanan klinis yang lebih agresif, menurut Witkin dan Rosai, 64% dari SFT mediastinum menunjukkan perilaku klinis agresif, termasuk 3 dari 11 (27%) pasien yang meninggal karena progresivitas penyakit. Meskipun SFT merupakan tumor jinak, sekitar 20% SFT memiliki potensi ganas.…”

“…Pada kasus ini, pasien berusia relatif muda pada saat didiagnosis SFT mediastinum. 6,11 Pasien dapat mengeluhkan batuk, nyeri dada ataupun sesak napas, namun pada banyak kasus bersifat asimptomatik. 3,12 Pada kasus ini, pasien datang dengan keluhan utama nyeri dada kiri, nyeri dada kiri hingga menjalar ke punggung kiri, dan terasa memberat terutama ketika pasien batuk.…”

Chest Pain

“…Mediastinal tumor causes with chronic CP [57] and worsening intermittent, chronic CP with recent progressive dysphagia, cough, and dyspnea [58].…”

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

“…2 Other SFT cases sampled by EUS-FNA have been reported, but were located in the luminal gastrointestinal tract 4-6 ; one of which was described as a malignant SFT of the esophagus. A recent case report describes a mediastinal SFT diagnosed on EBUS-FNA.…”

“…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.…”