Solitary fibrous tumors of the pleura: Eight new cases and review of 360 cases in the literature

Abstract

Three-hundred-sixty cases of solitary fibrous tumor of the pleura from the literature are analyzed, and eight new cases are described. Of patients reported on prior to 1972, 72% had symptoms due to the tumor at the time of diagnosis, but only 54% of patients reported on since then were symptomatic. This probably reflects earlier diagnosis as a result of increased use of chest radiographs in asymptomatic populations. Cough, chest pain, dyspnea, and/or pulmonary osteoarthropathy are each found in at least one-third of patients who have symptoms. Approximately 80% of solitary fibrous tumors of the pleura originate in the visceral and 20% in the parietal pleura. In the literature and in this experience these tumors are on the whole circumscribed. The range in size from 1-36 cm with a mean of 6 cm. Many are pedunculated on pleural-based pedicles that contain hypertrophic arteries and veins. Histologic examination of the tumor usually discloses cellular areas alternating with hyalinized and/or necrotic areas. Spindle-shaped cells typically have minimal nuclear pleomorphism and rare or absent mitoses. Numerous thin-walled vessels constitute an additional feature of large tumors. Electron microscopical examination reveals features of both fibroblasts and mesothelial cells. Solitary fibrous tumors behave in a benign fashion in 88% of cases after surgical resection. In 12% of the cases the tumor is responsible for the patient's death because of its extensive intrathoracic growth, by virtue of either late diagnosis or unresectable recurrence. No single histologic feature allows a definite prognosis. The best indicator of a good prognosis is the presence of a pedicle supporting the tumor. Also favorable in circumscription of the tumor without invasion of lung, mediastinum, or chest wall. Nuclear pleomorphism and a high mitotic rate are seen in larger tumors but do not necessarily indicate a poor prognosis if the tumor is circumscribed. Solitary fibrous tumors of the pleura are not associated with asbestos.

Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model

“…19 However, older series also found higher metastatic rates in hemangiopericytoma and pleural solitary fibrous tumor-from 18 to 50%. 2,3,16,20 This variability may be due in part to differences in follow-up time as well as referral bias. Adequate follow-up time is required to determine metastatic frequency.…”

“…[3][4][5][6][7]10,18,[20][21][22] This may be due to the large number of intra-abdominal tumors in our cohort. Previous studies have suggested that tumor size 410 cm is predictive of poor prognosis.…”

A patient with fatigue and subfebrile temperature

“…Clinical reports indicate a good prognosis after treatment. Surgical resection cures~90% of these patients, but recurrent disease occurs in the remaining 10% [5].…”

Solitary fibrous tumor of the orbit, a poorly‐recognized orbital lesion

“…Solitary fibrous tumors in pleura, peritoneum and other nonvisceral soft tissue are known to present with painless masses and affect older persons between the fourth and seventh decades of life (Goodlad & Fletcher 1991;Young et al 1990;Briselli et al 1981;England et al 1989). Solitary fibrous tumors are usually benign, rarely recur locally with invasion of adjacent tissues and rarely metastasize.…”

“…Solitary fibrous tumors with these aggressive features may manifest with invasion of adjacent tissue, recurrence or distant metastases (England et al 1989). Solitary fibrous tumors of the pleura are known to be responsible for patient death in 12% of the cases because of late diagnosis or unresectable recurrence (Briselli et al 1981).…”