AJR 2000; 174:42
© American Roentgen Ray Society
Radiologic-Pathologic Conferences
of The University of Texas
M. D. Anderson Cancer Center |
Localized Fibrous Tumor of the Pleura
Mylene Truong1,
Reginald F. Munden1 and
Bonnie L. Kemp2
1
Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer
Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030.
2
Division of Pathology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
From the weekly radiologic—pathologic correlation conferences
conducted by Gary J. Whitman.
Address correspondence to M. Truong.
Introduction
A 31-year-old man presented to his physician with a 2-month history of
persistent coughing. Chest radiographs
(Figs. 1A and
1B) and CT scans
(Fig. 1C) showed a 12-cm left
anterolateral chest wall mass with areas of calcification. Associated
periosteal reaction was noted involving the left fifth rib
(Fig. 1B). The mass was sharply
marginated and formed obtuse angles with the pleura. The patient underwent a
thoracotomy and the mass was resected. The final histopathologic diagnosis was
a localized fibrous tumor of the pleura
(Fig. 1D).
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Fig. 1. —31-year-old man with localized fibrous tumor of the pleura.
B, Left posterior oblique chest radiograph shows associated
periosteal reaction (arrow) of fifth rib. Mass forms obtuse angles
with pleura.
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Fig. 1. —31-year-old man with localized fibrous tumor of the pleura.
D, Photomicrograph of resected specimen shows irregularly arranged
spindle cells with variable amounts of interspersed extracellular collagen. (H
and E, medium power)
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Localized fibrous tumors of the pleura, also known as benign mesotheliomas,
localized fibrous mesotheliomas, and pleural fibromas, are rare tumors,
accounting for less than 5% of all neoplasms involving the pleura
[1,
2,
3]. Although these tumors
affect men and women of all ages, the mean age according to Briselli et al.
[2] is 51 years. The tumors are
composed of haphazardly arranged fascicles of spindle cells, separated by
variable amounts of collagen
[1,
2]. These tumors originate from
submesoepithelial mesenchymal cells, and approximately 80% arise from the
visceral pleura [1,
2]. They are not related to
asbestos exposure [1,
4].
Localized fibrous tumors of the pleura are round or oblong, and the margins
are circumscribed and sometimes lobulated. These tumors, commonly found in the
dependent portions of the thorax, may range from 1 to 39 cm in diameter
[1]. Large tumors usually
displace rather than invade adjacent structures. Because of the presence of a
vascular pedicle in 30-50% of patients, these tumors may show a change in
shape and location with changes in respiration or position
[1,
2,
3].
On unenhanced CT scans, localized fibrous tumors show soft-tissue
attenuation [1]. MR images show
intermediate to low signal intensity on T1-weighted images and low signal
intensity on proton density- and T2-weighted images
[1]. On CT and MR images,
marked enhancement caused by the rich vascularization is usually seen with the
administration of IV contrast material
[1,
3]. CT and MR images may show
associated cysts and regions of hemorrhage and necrosis
[3]. In a study by England et
al. [4] tumoral calcifications
were seen in 7% of patients and pleural effusions were identified in up to 17%
of patients. Rib erosion is rare.
Although approximately half the patients with localized fibrous tumors of
the pleura are asymptomatic, cough, chest pain, and dyspnea may be presenting
symptoms, especially in patients with large tumors
[1,
2]. Hypertrophic
osteoarthropathy was seen in 4-35% of patients, and hypoglycemia was noted in
up to 5% of patients according to Ferretti et al.
[1] and Briselli et al.
[2]. The fibrous acellular
nature of localized fibrous tumors makes diagnosis by transthoracic needle
biopsy difficult [1].
These tumors are usually slow-growing mass-es, and surgical excision is
usually curative [4]. Local
recurrence has been reported in 16% of patients, but malignant transformation
is rare [3].
References
-
Ferretti GR, Chiles C, Choplin RH, Coulomb M. Localized benign
fibrous tumors of the pleura. AJR
1997;169:683-686[Free Full Text]
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Briselli M, Mark EJ, Dickersin GR. Solitary fibrous tumors of the
pleura: eight new cases and review of 360 cases in the literature.
Cancer
1981;47:2678-2689[Medline]
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Lee KS, Im J-G, Choe KO, Kim CJ, Lee BH. CT findings in benign
fibrous mesothelioma of the pleura: pathologic correlation in nine patients.
AJR
1992;158:983-986[Abstract/Free Full Text]
-
England DM, Hochholzer L, McCarthy MJ. Localized benign and
malignant fibrous tumors of the pleura: a clinicopathologic review of 223
cases. Am J Surg Pathol
1989;13:640-658[Medline]
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