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PA
BIDMC, PACS
Lateral
BIDMC, PACS
Well-circumscribed, ~10cm mass, in the apex of the right upper lung lobe
BIDMC, PACS
The reconstructions that follow this axial image further confirm the location of the soft tissue
mass, and portray its relation to lung fissures, structures of the mediastinum and the airways.
BIDMC, PACS
BIDMC, PACS
http://fau.pearlashes.com/anatomy/Chapter%2036/Chapter%2036.htm
Note the relation of the lung fissures and hilar contents to the lobes of the right and left lung
ABriefReviewofPleuralAnatomy
http://www.breader.com/diagram-teaching-files/index.html
Note the divisons of the visceral and parietal pleura as they would appear
on a frontal chest x-ray and on axial images from CT chest scan.
80% arise from visceral pleura and 20% from parietal pleura
Calcification present in 5%, central necrosis is common in the larger tumors.
Behavior is unpredictable with ~10-15% behaving aggressively so follow-up is
mandatory
RepresentativePathologySpecimen
Well-circumscribed
Often pedunculated
Remarkable blood supply
Treatment of choice is
complete surgical
resection
No established systemic
therapy for malignant
form
Dr. Moulay Meziane
http://www.emedicine.com/RADIO/topic448.htm
T1
T2
Ultrasound:
Little role in the work-up.
May be used to guide procedures.
Fibrous tumor tends to
demonstrate homogenous low
echogenicity in general (unless it
has calcifications)
Future: Role of FDG-PET scan. Case report of high FDG uptake noted in portion
of mass that had malignant features histopathologically, thus may be helpful to
determine presence of malignancy preoperatively.
ReturningtoourPatient
InitialCXR
BIDMC, PACS
BIDMC, PACS
BIDMC, PACS
BIDMC, PACS
OurPatient:PathologyReport
Gross pathology (no photo
available) showed smooth,
glistening, tan pink and
encapsulated mass measuring up to
11.1 cm
Low-power shows wellcircumscribed border of tumor with
adjacent normal lung. Also
characteristic staghorn shaped
vessels.
High-power further elucidates the
characteristic spindle cells of a
solitary fibrous tumor of pleura
Diffusely positive for CD34 (not
shown)
Confirmed diagnosis of solitary
fibrous tumor of pleura
Courtesy of Dr.Justin Hilson, BIDMC
References:
Gallardo et al. Benign pleural diseases. Eur Journal of Rad 34 (2000) 87-97.
Janssen et al. Quiz case of the month. Eur Radiol. (2001) 11:527--528.
Karbulut N, Goodman LR - Pedunculated Solitary Fibrous Tumor of the
Interlobar Fissure: A Wandering Chest Mass. AJR:173, August 1999)
Kouki et al. Solitary fibrous tumor of the lung. Gen Thorac Cardiovasc Surg
(2008) 56:249-251.
McLoud, Theresa. CT and MR in Pleural Disease. Clinics in Chest Medicine
1998; 19(2): 261-276.
Meziane et al. Localized Fibrous Tumor of the Pleura. eMedicine. Accessed
6/10/2008.
Qureshi NR, Gleeson FV. Imaging of Pleural Disease. Clin Chest Med 27
(2006): 193-213.
Stark, Paul. Imaging of pleural plaques, thickening, and tumors. UpToDate.
Accessed 6/9/2008.
Sung et al. Solitary Fibrous Tumors of the Pleura: Surgical Outcome and Clinical
Course. Ann Thorac Surg 2005;79:303-7
Acknowledgments:
Daniel Siegal, MD Department of Radiology
Justin Hilson, MD Department of Pathology
Maria Levantakis - Department of Radiology