ECR 2022 / C-12211
Pictorial review of solitary fibrous tumours of the pleura with pathological correlation
Congress:
ECR 2022
Poster Number:
C-12211
Type:
Educational Exhibit
Keywords:
Lung, Oncology, Thorax, CT, MR, PET-CT, Education, Surgery, Cancer, Education and training, Neoplasia
Authors:
A. Portella Alegre, E. Saez De Gordoa Elizalde, J. Andreu Soriano
DOI:
10.26044/ecr2022/C-12211
Conclusion
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912165?maxheight=150&maxwidth=150 "Fig 1: A 47-year-old woman was diagnosed 11 years ago with a fibrous tumor of the pleura through a pleural biopsy. Three years after diagnosis, without any imaging control, a mass was observed in the right upper lobe, with heterogeneous characteristics, measuring about 54 x 36 mm in diameter, with lobulated contours and without a clear invasion of the chest wall (a, b, c, d). It was decided to carry out a surgical resection, obtaining a lumpectomy piece of 94x85x34mm in diameter, weighing 3.2Kg, with an irregular external surface, that in section showed a whitish color with small yellowish foci and a fibroelastic consistency. CD34 +, Bcl-2+ and CK AE1/AE3- markers. In subsequent controls, she has not presented a recurrence.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 1:
A 47-year-old woman was diagnosed 11 years ago with a fibrous tumor of the...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912166?maxheight=150&maxwidth=150 "Fig 2: In the histological study of Figure 1, elongated tumor cells interspersed with thick bands of collagen (HE 4x)(a) are observed, as well as nuclear expression for STAT6, in the immunohistochemical study.
"Department of Pathological Anatomy, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 2:
In the histological study of Figure 1, elongated tumor cells interspersed with...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912167?maxheight=150&maxwidth=150 "Fig 3: A 60-year-old male with a well-differentiated neuroendocrine tumor who presented as an incidental finding a homogeneous extrapulmonary mass with lenticular morphology, soft tissue density, slightly irregular contours, located in the left posterobasal region, without invasion of the chest wall and about 61x21mm in diameter (d). The PET-CT study (a) (b) (c) presents a normometabolic character. It was decided to carry out a resection, obtaining a lumpectomy piece with a nodular morphology of 65x50x27mm in diameter, encapsulated, with a fibroelastic consistency, and pedunculated. In the section, it presented a heterogeneous multinodular appearance, with dense and whitish central areas. A malignancy criterion was observed: 4 mitoses per 10 high magnification fields, so it was decided to carry out close controls, which have not shown signs of recurrence. (e)
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 3:
A 60-year-old male with a well-differentiated neuroendocrine tumor who...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912168?maxheight=150&maxwidth=150 "Fig 4: A 77-year-old woman with a history of glaucoma, who in a preoperative chest x-ray (a) revealed an oval mass with well-defined contours, obtuse margins with the chest wall, located in the right pulmonary apex, of probable pleural origin. Subsequently, she underwent a chest CT in which an oval mass of heterogeneous density was attached to the chest wall through a pedicle, probably hypervascularized and measuring about 5cm in length (b)(c)(d).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 4:
A 77-year-old woman with a history of glaucoma, who in a preoperative chest...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912169?maxheight=150&maxwidth=150 "Fig 5: The patient in Figure 4 underwent mediastinal magnetic resonance imaging in T1, PD, TIRM, and T2-weighted sequences, and a diffusion study in coronal and transverse planes. Persistence of the solid mass was observed in the right pulmonary apex, probably dependent on the adipose tissue of the chest wall. It demonstrated low-intensity signal in T1-WI and hyperintensity in T2 and PD weighted sequences due to hypercellularity, as well as serpiginous signal voids inside them, due to the increase in blood vessels. Discrete remodeling of the costal arch of the first rib. The pathology diagnosis was a solitary fibrous tumor of the pleura with no signs of malignity, and there was no recurrence in subsequent controls.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 5:
The patient in Figure 4 underwent mediastinal magnetic resonance imaging in T1,...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912170?maxheight=150&maxwidth=150 "Fig 6: A 36-year-old woman with a history of multinodular goiter, who presented a right thoracic mass as an incidental finding, so it was decided to perform an MRI for its characterization. T1, T2, and T1 FS postcontrast weighted sequences were performed. Solid and heterogeneous voluminous mass that occupies practically the entire right hemothorax, with maximum diameters of 22x17x24mm (APxLLxCC). This mass conditioned a displacement of the mediastinal structures to the left side and a caudal displacement of the right diaphragmatic dome. After the administration of intravenous contrast, a heterogeneous contrast enhancement was observed, as well as some areas that could correspond to calcifications. A small amount of right pleural fluid.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 6:
A 36-year-old woman with a history of multinodular goiter, who presented a...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912171?maxheight=150&maxwidth=150 "Fig 7: Chest computed tomography of the patient in figure 5, in relation to a post-surgical chest CT, in which a post-surgical hydropneumothorax is observed. The lumpectomy specimen was diagnosed as a solitary fibrous tumor of the pleura with a 13 mm diameter area of malignant transformation associated with >4 mitoses per 10x field.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 7:
Chest computed tomography of the patient in figure 5, in relation to a...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912172?maxheight=150&maxwidth=150 "Fig 8: A 72-year-old woman with a history of pancreatic head neoplasm who presented as an incidental finding a mass with polylobulated morphology and heterogeneous density located in the lower lobe and lingula of the left hemothorax (a,b,c). It measured about 16x6cm in maximum diameter and with areas of condensation and air bronchogram.
Atypical lobectomy of the left lower lobe and lingula was performed, obtaining a whitish and yellowish lumpectomy piece with multiple cysts inside and a fibroelastic consistency. CD-34+, Bcl-2+, AE1/AE-, S100- and smooth muscle actin markers. Diagnosis of solitary fibrous tumor of the pleura.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 8:
A 72-year-old woman with a history of pancreatic head neoplasm who presented as...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912173?maxheight=150&maxwidth=150 "Fig 9: A 45-year-old woman with a history of breast neoplasia who presented as an incidental finding an extrapulmonary mass in the anterior region of the left hemithorax. Oval morphology, with defined and slightly irregular margins, in contact with the chest wall without clear signs of invasion (a,b,c). Subsequently, a chest CT was performed, in which the mass of fusiform morphology, slightly hyperdense and 65x20x40mm in diameter was visualized (d,e,f). Six months later, a second chest CT was performed in which the chest mass had a different morphology (g). She underwent a resection of the mass, obtaining a lumpectomy piece, with a diagnosis of solitary fibrous tumor of the pleura.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 9:
A 45-year-old woman with a history of breast neoplasia who presented as an...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912174?maxheight=150&maxwidth=150 "Fig 10: A 66-year-old woman presented in the chest radiography a left pleural effusion associated with a polylobulated mass with partially defined margins in the ipsilateral lower lung field (a) (b).
Subsequently, a CT scan of the chest showed an oval mass with irregular margins, heterogeneous, predominantly hypodense density, with a maximum diameter of about 9 cm. It was associated with left pleural effusion and passive atelectasis of the underlying lung parenchyma (c, d,e). A resection of the mass was performed, obtaining a tumor with extensive areas of necrosis and intratumoral hemorrhage. Diagnosis of solitary fibrous tumor of the pleura.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 10:
A 66-year-old woman presented in the chest radiography a left pleural effusion...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912175?maxheight=150&maxwidth=150 "Fig 11: A 68-year-old man with a history of resection of a solitary fibrous tumor of the pleura in the left hemithorax, with signs of benignity. Six years later, he presented a tumor recurrence in form of pleural and mediastinal nodules on the left hemithorax, for which it was decided to reoperate, obtaining a nodule with malignant characteristics. Postoperative chest CT shows the resection cavity with herniation of the gastric content into the thoracic cavity. (a) (b).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 11:
A 68-year-old man with a history of resection of a solitary fibrous tumor of...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912176?maxheight=150&maxwidth=150 "Fig 12: One year later, in the patient in Figure 11, a tumor progression was observed in the form of multiple nodules and pleural masses, of heterogeneous density, in the left hemithorax, presenting invasion of the chest wall and affecting the costal, mediastinal, and diaphragmatic pleura (a,b).
There is an increase of the mass in the pancreatic head in relation to a tumor implant at that level (c).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 12:
One year later, in the patient in Figure 11, a tumor progression was observed...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912177?maxheight=150&maxwidth=150 "Fig 13: A 47-year-old man with a history of testicular teratocarcinoma who presented as an incidental finding a small left pleural tumor in the region of the lingula (a, b,c) that in later studies showed a slight increase in size (d), so it was decided to perform a resection. The lumpectomy specimen had a whitish surface and fibroelastic consistency. A microscopic study revealed collagenized bundles in a “patternless pattern”, with vessels with a hemangiopericytoid appearance. He had no recurrence in control studies.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 13:
A 47-year-old man with a history of testicular teratocarcinoma who presented as...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912178?maxheight=150&maxwidth=150 "Fig 14: A 48-year-old woman presented with a lenticular lesion of probable pleural origin in the left hemithorax (a, b), which in the PET-CT study was normometabolic. After surgical resection, a whitish nodular morphology lumpectomy piece is obtained, measuring about 3.5x5.2cm, and in section, it has a fibrous and swirled appearance. Positive markers for STAT6 and CD34.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 14:
A 48-year-old woman presented with a lenticular lesion of probable pleural...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912179?maxheight=150&maxwidth=150 "Fig 15: A 54-year-old man presented with a discreetly heterogeneous polylobulated mass measuring 49x47mm in diameter, located adjacent to the major fissure of the left lung and in contact with the diaphragmatic pleural portion (a,b,c). ). In the PET-CT study, he presented a slight increase in metabolism with a maximum SUV of 2.6 (d).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 15:
A 54-year-old man presented with a discreetly heterogeneous polylobulated mass...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912180?maxheight=150&maxwidth=150 "Fig 16: A 28-year-old man with a history of melanoma and Crohn's disease presented as an incidental finding a right paracardiac mass, homogeneous, oval in shape and probably of pleural origin. In the PET-CT study, it presents normometabolism (b). The control chest X-ray shows how the tumor has grown in one year (previous (a), posterior (b)). In the chest CT 2 months later, a slight growth of the tumor was observed, so surgical resection was decided (d, e,f).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 16:
A 28-year-old man with a history of melanoma and Crohn's disease presented as...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912181?maxheight=150&maxwidth=150 "Fig 17: An 83-year-old woman with a history of infiltrating ductal carcinoma of the left breast, who incidentally presented a small, well-defined, oval-shaped, small extrapulmonary mass in the upper field of the left hemithorax on chest X-ray (d). In a control radiograph 4 years later, a growth of the mass (e) was observed, so it was decided to perform a CT study of the chest (a, b, c), which showed an extrapulmonary mass, of lenticular morphology, defined margins, and heterogeneous density, because of this a CT-guided biopsy was performed(f). The definitive diagnosis was a solitary fibrous tumor of the pleura.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 17:
An 83-year-old woman with a history of infiltrating ductal carcinoma of the...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912182?maxheight=150&maxwidth=150 "Fig 18: A 69-year-old woman with a history of excised pleural fibrous tumor (a). Three years later, she observed pulmonary, hepatic, and peritoneal recurrence, now with malignant features (b,c,d). CT of the chest and abdomen shows a voluminous tumor mass that occupies almost the entire base of the right hemithorax, heterogeneous, with well-defined margins and some peripheral calcifications, measuring 15x14x11cm in diameter. Multiple peritoneal implants are located in the right subhepatic and perihepatic space, as well as in the left subphrenic region, mesentery, and pelvis.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 18:
A 69-year-old woman with a history of excised pleural fibrous tumor (a). Three...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912183?maxheight=150&maxwidth=150 "Fig 19: The histological study shows a solitary fibrous tumor that presents nuclear atypia and mitotic figures (a)(b) (arrows), as well as a diffuse nuclear expression for STAT6 in the immunohistochemical image (c) and proliferation of elongated cells that form medium-sized fascicles and that are arranged on a myxoid stroma, together with dilated vessels (d). (4x HE).
"Department of Pathological Anatomy, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 19:
The histological study shows a solitary fibrous tumor that presents nuclear...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912184?maxheight=150&maxwidth=150 "Fig 20: A 56-year-old woman presented with a tumor in the posterior segment of the right upper lobe, of lenticular morphology, well-defined margins, heterogeneous density with hyperdense areas inside that could suggest a hypervascular lesion (a, b, c). The PET-CT study did not has an increased metabolism (d). Surgical resection of the lesion was decided, obtaining a lumpectomy piece with a polylobed morphology, whitish in color, with some areas of myxoid appearance, well-defined contour and firm consistency from a 1 cm from the surgical margin.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 20:
A 56-year-old woman presented with a tumor in the posterior segment of the...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912185?maxheight=150&maxwidth=150 "Fig 21: The histological study shows a proliferation of elongated cells that occasionally form medium-sized fascicles and that are arranged on a collagenized stroma. (10x HE) (a,c,d). Tumor cells show diffuse nuclear expression for STAT6 on immunohistochemical study (b). A mitotic figure can be seen.(e)
"Department of Pathological Anatomy, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 21:
The histological study shows a proliferation of elongated cells that...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912186?maxheight=150&maxwidth=150 "Fig 22: An 80-year-old woman who, in the PET-CT study performed, shows an extrapulmonary lesion in the right lower lobe (a), well defined, highly vascularized (c), which presents moderate-discrete glucose metabolism SUVmax 3.8, with some dimensions of 71x43x80mm in diameter. This lesion appears to be in close contact with the pleura (b, d), with a broad base on the diaphragmatic, paravertebral, and fissural pleura, with no signs of chest wall invasion. The definitive diagnosis was a solitary fibrous tumor of the pleura.
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 22:
An 80-year-old woman who, in the PET-CT study performed, shows an...
![](https://epos.myesr.org/posterimage/esr/ecr2022/159893/media/912187?maxheight=150&maxwidth=150 "Fig 23: A 59-year-old woman who underwent surgery 20 years ago for a perineal malignant hemangiopericytoma. The current chest CT study shows a pulmonary mass located in the right lower lobe, measuring about 32 x 20 x 37 mm in diameter, peripherally located, polylobulated, which seems to be in contact with the pleural wall and without chest wall involvement.(a)(c).As well as another pulmonary nodule with well-defined margins of 11 x 12 x 11 mm in diameter in the right upper lobe.(b) Both lesions in the context of the patient are suggestive of metastasis, which in the pathology study were a malignant, lipomatous fibrous tumor of the pleura. Post-surgical changes in the control study. (d,e).
"Department of Radiology, Vall d’Hebron Hospital, Medical University of Barcelona/ Spain 2022"")
Fig 23:
A 59-year-old woman who underwent surgery 20 years ago for a perineal malignant...
