Solitary fibrous tumors of the pleura are rare and slow-growing neoplasms originating from the mesenchymal tissue underlying the mesothelial layer of the pleura. These tumors may have an unpredictable clinical course. Most cases occur in the sixth or seventh decades of life with no gender predilection, and more than 80% of cases are benign. The predominant clinical symptoms and signs are dyspnea, cough, chest pain, finger clubbing and hypoglycemia. However, because many patients are asymptomatic, the incidence rates are affected by the likelihood of its incidental detection, often through medical imaging of the chest. Surgical resection is the treatment of choice and is usually curative, even though local recurrence can occur many years after an adequate resection.
Methods
We reviewed the literature by performing a computerized search of MEDLINE, CANCERLIT and Embase with the terms fibrous tumor, pleura, surgery, immunohistochemical analysis. Articles and abstracts were also identified by back-referencing from other relevant papers.
Results
The clinical, radiological and pathological features of a 48-year-old woman with a primary solitary fibrous tumor of the pleura are reviewed and a literature search for other reported cases has been performed.
Conclusions
Although localized fibrous tumors of the pleura are considered histologically benign, there is a risk of recurrence and malignant transformation. Complete surgical resection is mandatory and long-term clinical and radiological follow-up is indicated in all patients. For malignant cases complete surgical resection may not be adequate and studies are needed to define the role of preoperative and postoperative systemic treatment. Diagnosis is very difficult in limited samples such as fine-needle aspiration or needle-core tissue biopsy, and immunohistochemical analysis may be useful to differentiate solitary fibrous tumor of the pleura from mesothelioma and other similar tumors.
BriselliM., MarkE.J., DickersinG.R.: Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature.Cancer, 47: 2678–2689, 1981.
HanauC.A., MiettinenM.: Solitary fibrous tumor: histological and immunohistochemical spectrum of benign and malignant variants presenting at different sites.Hum Pathol, 26: 440–449, 1995.
8.
KorsteinM.J.: Pleural tumors. In: Pathology of the thymus and mediastinum, KornsteinM.J., deBloisG.G. (Eds), pp 217–222, WB Saunders, Philadelphia, 1995.
9.
HernandezF.J., HernandezB.B.: Localized fibrous tumors of the pleura: a light and electron microscopic study.Cancer, 34: 1667–1674, 1974.
10.
Al-AzziM., ThurlowN.P., CorrinB.: Pleural mesothelioma of connective tissue type, localized fibrous tumor of the pleura, and reactive submesothelial hyperplasia: an immunohistochemical comparison.J Pathol, 158: 41–44, 1989.
11.
OkikeN., BernatzP.E., WoolnerL.B.: Localized mesothelioma of the pleura. Benign and malignant variants.J Thorac Cardiovasc Surg, 75: 363–372, 1978.
12.
LuC., JiY., ShanF., GuoW., DingJ., GeD.: Solitary fibrous tumor of the pleura: an analysis of 13 cases.World J Surg, 32: 1663–1668, 2008.
13.
NonakaM., KadokuraM., TakabaT.: Benign solitary fibrous tumor of the parietal pleura which invaded the intercostal muscle.Lung Cancer, 31: 325–329, 2001.
14.
ShakerW., MeatchiT., DusserD., RiquetM.: An unusual presentation of solitary fibrous tumor of the pleura: right atrium and inferior vena cava compression.Eur J Cardiothorac Surg, 22: 640–642, 2002.
15.
FerrettiG.R., ChilesC., ChoplinR.M., CoulombM.: Localized benign fibrous tumors of the pleura.Am J Roentgenol, 169: 683–686, 1997.
16.
ChaugleH., ParchmentC., GrotteG.J., KeenanD.J.M.: Hypoglycaemia associated with a solitary fibrous tumor of the pleura.Eur J Cardiothorac Surg, 15: 84–86, 1999.
de PerrotM., FischerS., BrundlerM.A., SekineY., KeshavjeeS.: Solitary fibrous tumors of the pleura.Ann Thorac Surg, 74: 285–293, 2002.
19.
EnglandD.M., HochholzerL., McCarthyM.J.: Localized benign and malignant fibrous tumours of the pleura. A clinicopathologic review of 223 cases.Am J Surg Pathol, 13: 640–658, 1989.
20.
CardilloG., FaccioloF., CavazzanaA.O., CapeceG., GasparriR., MartelliM.: Localized (solitary) fibrous tumours of the pleura: an analysis of 55 patients.Ann Thorac Surg, 70: 1808–1812, 2000.
21.
ChunlaiL., YuanJ., FeiS., WeigangG., JianyongD., DiG.: Solitary fibrous tumor of the pleura: an analysis of 13 cases.World J Surg, 32: 1663–1668, 2008.
22.
NagahiroI., AndouA., AoeM., SanoY., DateH., ShimizuN.: Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure.Ann Thorac Surg, 72: 362–365, 2001.
23.
MagdeleinatP., AlifanoM., PetinoA., Le RochaisJ.P., DulmetE., GalateauF., IcardP., RegnardJ.F.: Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome.Eur J Cardiothorac Surg, 21: 1087–1093, 2002.
24.
SuterM., GebhardS., BoumgharM., PeloponisiosN., GentonC.Y.: Localized fibrous tumours of the pleura: 15 new cases and review of the literature.Eur J Cardiothorac Surg, 14: 453–459, 1998.
25.
MitchellJ.D.: Solitary fibrous tumor of the pleura.Semin Thorac Cardiovasc Surg, 15: 305–309, 2003.
RobertsonH.E.: “Endothelioma” of the pleura.J Cancer Res, 8: 317–375, 1924.
28.
StoutA.P., MurrayM.R.: Localized pleural mesothelioma. Investigation of its characteristics and histogenesis by the method of tissue culture.Arch Pathol, 34: 951–964, 1942.
29.
Alvarez-FernandezE., Diez-NauM.D.: Malignant fibrosarcomatous mesothelioma and benign pleural fibroma (localized fibrous mesothelioma) in tissue culture: a comparison of the in vitro pattern of growth in relation to the cell of origin.Cancer, 43: 1658–1663, 1979.
30.
SkinM.L., FirmingerH.I.: Acute and chronic effects of intraperitoneal injection of two types of asbestos in rats with a study of the histopathogenesis and ultrastructure of resulting mesotheliomas.Am J Pathol, 70: 291–314, 1973.
31.
OsamuraR.Y.: Ultrastructure of localized fibrous mesothelioma of the pleura. A report of a case with histogenetic considerations.Cancer, 39: 139–142, 1977.
32.
RobinsonL.A.: Solitary fibrous tumor of the pleura.Cancer Control, 13: 264–269, 2006.
MoatN.E., TealeJ.D., LeaR.E., MatthewsA.W.: Spontaneous hypoglycaemia and pleural fibroma: role of insulin like growth factors.Thorax, 46: 932–933, 1991.
36.
BouchiJ., GhariosE., CortbawiE.: Tumeur fibrose solitaire de la pleure avec coma et hypoglicemie.Rev Pneumol Clin, 49: 243–246, 1993.
37.
RenaO., FilossoP.L., PapaliaE., MolinattiM., Di MarzioP., MaggiG., OliaroA.: Solitary fibrous tumour of the pleura: surgical treatment.Eur J Cardiothorac Surg, 19: 185–189, 2001.
38.
TateishiU., NishiharaH., MorikawaT., MiyasakaK.: Solitary fibrous tumor of the pleura: MR appearance and enhancement pattern.J Comput Assist Tomogr, 26: 174–179, 2002.
AltinokT., TopçuS., TastepeA.I., YaziciU., CetinG.: Localized fibrous tumors of the pleura: clinical and surgical evaluation.Ann Thorac Surg, 76: 892–895, 2003.
41.
RuckertR., SchwarzH.: Das lokafisierte Pleuramesotheliom.Helv Chir Acta, 60: 475–481, 1993.
42.
DaltonW.T., ZollikerA.S., McCaugheyW.T.E., JacquesJ., KannersteinM.: Localized primary tumors of the pleura. An analysis of 40 cases.Cancer, 44: 1465–1475, 1979.
43.
FlintA.Q., WeissS.W.: CD-34 and keratin expression distinguishes solitary fibrous tumor (fibromesothelioma) of pleura from desmoplastic mesothelioma.Human Pathol, 26: 428–431, 1995.
WroblewskiJ., EngströmM., Edwall-ArvidssonC., SjöbergG., SejersenT., LendahlU.: Distribution of nestin in the developing mouse limb bud in vivo and in micro-mass cultures of cells isolated from limb buds.Differentiation, 61: 151–159, 1997.
46.
YokoiT., TsuzukiT., YatabeY., SuzukiM., KurumayaH.H., KoshikawaT.: Solitary fibrous tumour: significance of p53 and CD34 immunoreactivity in its malignant transformation.Histopathology, 32: 423–432, 1998.
47.
DemiccoE.G., ParkM.S., AraujoD.M., FoxP.S., BassettR.L., PollockR.E., LazarA.J., WangW.L.: Solitary fibrous tumor: a clinicopathological study of 110 cases and proposed risk assessment model.Mod Pathol, 25: 1298–1306, 2012.
48.
SchirosiL., LantuejoulS., CavazzaA., MurerB., BrichonP., MigaldiM., SartoriG., SgambatoA., RossiG.: Pleuro-pulmonary solitary fibrous tumors: a clinicopathologic, immunohistochemical, and molecular study of 88 cases confirming the prognostic value of de Perrot staging system and p53 expression, and evaluating the role of c-kit, BRAF, PDGFRs (alpha/beta), c-met, and EGFR.Am J Surg Pathol, 32: 1627–1642, 2008.
49.
MiraccoC., de SantiM.M., PacentiL., SchürfeldK., LauriniL., PirtoliL., LuziP., NinfoV.: Telomerase activity, Ki-67, cyclin D1 and A expression, and apoptosis in solitary fibrous tumors: additional features of a predictable course?Pathol Res Pract, 197: 475–481, 2001.
50.
MiettinenM.M., el-RifaiW., Sarlomo-RikalaM., AnderssonL.C., KnuutilaS.: Tumor size-related DNA copy number changes occur in solitary fibrous tumors but not in hemangiopericytomas.Mod Pathol, 10: 1194–1200, 1997.
51.
CardilloG., LococoF., CarleoF., MartelliM.: Solitary fibrous tumors of the pleura.Curr Opin Pulm Med, 18: 339–346, 2012.
52.
VeronesiG., SpaggiariL., MazzarolG., De PasM., LeoF., SolliP., PastorinoU.: Huge malignant localized fibrous tumor of the pleura.J Cardiovasc Surg, 41: 781–784, 2000.
De PasT., ToffalorioF., ColomboP., TrifiròG., PelosiG., VignaP.D., ManzottiM., AgostiniM., de BraudF.: Brief report: activity of imatinib in a patient with plateled-derived-growth-factor receptor positive malignant solitary fibrous tumor of the pleura.J Thorac Oncol, 3: 938–941, 2008.
55.
PrunottoM., BoscoM., DanieleL., MacrìL., BonelloL., SchirosiL., RossiG., FilossoP., MussaB., SapinoA.: Imatinib inhibits in vitro proliferation of cells derived from a pleural solitary fibrous tumor expressing plateled-derived growth factor receptor-beta.Lung Cancer, 64: 244–246, 2009.
56.
ParkM.S., PatelS.R., LudwigJ.A., TrentJ.C., ConradC.A., LazarA.J., WangW.L., BoonsirikamchaiP., ChoiH., WangX., BenjaminR.S., AraujoD.M.: Activity of temozolomide and bevacizumab in the treatment of locally advanced, recurrent, and metastatic hemangiopericytoma and malignant solitary fibrous tumor.Cancer, 117: 4939–4947, 2011.
57.
SantosR.S., HaddadR., LimaC.E., LiuY.L., MisztalM., FerreiraT., BoasquevisqueC.H., LuketichJ.D., LandreneauR.J.: Patterns of recurrence and long-term survival after curative resection of localized fibrous tumors of the pleura.Clin Lung Cancer, 7: 197–201, 2005.
