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Content
European Journal of Cardio-thoracic Surgery 14 (1998) 211–213
Case report
A case of giant benign localized fibrous tumor of the pleura1
¨ lg˘an
Mehmet Bic¸er*, Sadık Yaldız, Soner Gu¨rsoy, Metin U
Department of Thoracic Surgery, Chest Diseases and Thoracic Surgery Teaching Hospital
(Go¨g˘u¨s Hastalıkları ve Cerrahisi Egitim Hastanesi), ˙Izmir, Turkey
Received 15 December 1997; revised version received 28 April 1998; accepted 13 May 1998
Abstract
A 60-year-old man had noted exertional dyspnea and left anterior chest pain. A chest roentgenogram showed the presence of a giant mass
and computed tomography (CT) of the chest confirmed the mass with an inhomogeneous density in the left hemithorax. A transthoracic
TruCut needle biopsy of the mass showed benign fibrous tissue. The patient underwent a thoracotomy. A tumor arose from the visceral
pleura of left lower lobe and pedinculated. Size of the tumor was 19 × 18 × 7 cm and weighed 1500 g. It was successfully resected. The
pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura. 1998 Elsevier Science B.V. All rights reserved
Keywords: Benign mesothelioma; Pleural neoplasms
1. Case report
Localized fibrous tumors of the pleura are rare neoplasms. Previously these tumors have mostly been classified
as localized mesotheliomas of the pleura, either benign or
malignant [1]. Pleural fibrous tumors are generally malignant and are associated with asbestos exposure, but benign
tumors do occur. The cell origin of these tumors is a noncommitted mesenchymal cell present in the areolar tissue
subadjacent to the mesothelial cells of the pleura [1]. We
report the case of a patient with localized fibrous tumor of
the pleura, which is notable for its rare massive size.
A 60-year-old male patient complained of exertional dyspnea and left-sided chest pain at the time of admission to
hospital. PA and lateral chest roentgenograms showed presence of a giant mass and computed tomography (CT) of the
chest confirmed the mass to have an inhomogeneous density
and irregular central calcification in the left hemithorax
(Fig. 1). Hemogram and biochemical findings were normal.
At physical examination breath sounds were absent on left
lower zone. Bronchoscopy showed extrinsic compression at
* Corresponding author. 180/1 Sok. No. 3 A Blok D.1, 35040 Bornova
I˙zmir, Turkey. Tel.: +90 232 3428299.
1
Presented at the 1st International Congress of Thorax Surgery, Athens,
Greece, July 1–8, 1997.
1010-7940/98/$19.00 1998 Elsevier Science B.V. All rights reserved
PII S1010-7940 (98 )0 0166-3
the level of left lower lobe bronchus. Spirometry showed
restrictive pulmonary defect with a vital capacity of 1500
cm3. A transthoracic TruCut needle biopsy of the mass
showed benign fibrous tissue.
Left posterolateral thoracotomy was performed for the
resection of the tumor. The tumor was arising from the
visceral pleura on a stalk and projected into the pleural
space in a pedinculated manner. A thin membranous capsule
was present. Size of the tumor was 19 × 18 × 7 cm and
weighed 1500 g. On the cut section, the mass was composed
of dense, whorled fibrous tissue with irregular central calcification. A chest roentgenogram on the tenth postoperative
day showed reexpansion of the lung. Pathological diagnosis
of the tumor was benign localized fibrous tumor of the
pleura (Fig. 2).
2. Discussion
Localized benign fibrous tumors of the pleura are
approximately one-third of malignant mesothelioma [2].
Unlike malignant form, benign fibrous tumor of the pleura
appears to be unrelated to asbestos exposure [3]. There was
no asbestos exposure in our case. The localized form of the
fibrous tumors are usually considered benign, but malignant
cases have been reported [4].
212
M. Bic¸er et al. / European Journal of Cardio-thoracic Surgery 14 (1998) 211–213
Fig. 1. Computed tomography of the chest shows the mass with an inhomogeneous density and irregular central calcification in the left hemithorax.
Many patients with localized fibrous tumors are asymptomatic; cough, chest pain, and dyspnea occur occasionally,
especially with larger tumors [4]. It has slightly higher incidence in females than males. The peak incidence is in the
sixth and seventh decades of life [5].
These tumors appear as encapsulated, firm and lobulated
masses with a characteristic whorled appearance on cut surface. Watts et al. reported a giant benign mesothelioma
which was 1460 g [6]. In our case the tumor was also as
huge as the tumor Watts et al. reported, 1500 g. Briselli et al.
reported that the small tumors were usually nodular within
the lung and the large tumors tended to be pedinculated
within the pleural cavity, arising from the parietal pleura
[5]. A giant tumor arose from the visceral pleura in our case.
Diagnosis is difficult in these tumors. The nature of the
solitary lesion is established most often at the time of thor-
Fig. 2. Benign fibrous pleural tumor. Short spindle cells are poorly oriented within a fibrous stroma. (Hematoxylin and eosin stain; original magnification
×400).
M. Bic¸er et al. / European Journal of Cardio-thoracic Surgery 14 (1998) 211–213
acotomy and subsequent histologic examination [1]. When a
tumor is very large, however, the site of origin is frequently
difficult or impossible to establish on conventional roentgenograms and even on CT [7]. As a result of this, we tried
to diagnose the mass with thoracic CT and abdominal CT.
Although it is not recommended, we performed transthoracic TruCut needle biopsy but it was not sufficient for precise diagnosis.
Infrequently a pleural effusion may be present. England
et al. reported that 8% of 138 patients had a pleural effusion
[8]. We have demonstrated sanguineous pleural effusion at
the time of operation.
Treatments of benign fibrous tumors of the pleura consist
of adequate local excision. Great care must be taken at the
time of operation because of the highly vascular pedicle [6].
Although histologically benign, Briselli et al. reported that
the mortality rate is about 12% owing to operative mortality,
with removal or compression of mediastinal structures leading to fatal cardiopulmonary complications [5]. Periodic
long-term follow-up is necessary with these tumors. Five
in 78 cases which were diagnosed to be benign histologically at operation, had recurrence later in Japan [9]. After 2
years follow-up, our patient is healthy and has no sign of
recurrence.
213
References
[1] Shields TW. Localized fibrous tumor of the pleura. In: Shields TW,
ed. General thoracic surgery. Malvern: Williams and Wilkins, 1994:
722–730.
[2] Albelda SM, Sterman DH, Litzky LA. Malignant mesothelioma and
other primary pleural tumors. In: Fishman AP, Elias JA, Fishman JA,
Grippi MA, Kaiser LR, Senior RM, eds. Fishman’s pulmonary
diseases and disorders. New York: McGraw-Hill, 1998:1453–1466.
[3] Antman KH. Clinical presentation and natural history of benign and
malignant mesothelioma. Semin Oncol 1989;8:313–320.
[4] Okike N, Bernatz PE, Woolner LB. Localized mesothelioma of the
pleura: benign and malignant variants. J Thorac Cardiovasc Surg
1978;75:363–372.
[5] 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.
[6] Watts DM, Jones GP, Bowman GA, Olsen DJ. Giant benign
mesothelioma. Ann Thorac Surg 1989;48:590–591.
[7] Fraser RS, Pare JAP, Fraser RG, Pare PD, ed. Synopsis of diseases of
the chest. Philadelphia: WB Saunders, 1994:868–895.
[8] 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;13:640–644.
[9] Hatta T, Ohyabu H, Kurisu S, Tachibana S, Kita Y, Oki K, Okada M,
Uematsu M, Matsuda S, Eno K. A case of localized pleural mesothelioma. Kyobu Geka 1991;44 (4):344–346.
Case report
A case of giant benign localized fibrous tumor of the pleura1
¨ lg˘an
Mehmet Bic¸er*, Sadık Yaldız, Soner Gu¨rsoy, Metin U
Department of Thoracic Surgery, Chest Diseases and Thoracic Surgery Teaching Hospital
(Go¨g˘u¨s Hastalıkları ve Cerrahisi Egitim Hastanesi), ˙Izmir, Turkey
Received 15 December 1997; revised version received 28 April 1998; accepted 13 May 1998
Abstract
A 60-year-old man had noted exertional dyspnea and left anterior chest pain. A chest roentgenogram showed the presence of a giant mass
and computed tomography (CT) of the chest confirmed the mass with an inhomogeneous density in the left hemithorax. A transthoracic
TruCut needle biopsy of the mass showed benign fibrous tissue. The patient underwent a thoracotomy. A tumor arose from the visceral
pleura of left lower lobe and pedinculated. Size of the tumor was 19 × 18 × 7 cm and weighed 1500 g. It was successfully resected. The
pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura. 1998 Elsevier Science B.V. All rights reserved
Keywords: Benign mesothelioma; Pleural neoplasms
1. Case report
Localized fibrous tumors of the pleura are rare neoplasms. Previously these tumors have mostly been classified
as localized mesotheliomas of the pleura, either benign or
malignant [1]. Pleural fibrous tumors are generally malignant and are associated with asbestos exposure, but benign
tumors do occur. The cell origin of these tumors is a noncommitted mesenchymal cell present in the areolar tissue
subadjacent to the mesothelial cells of the pleura [1]. We
report the case of a patient with localized fibrous tumor of
the pleura, which is notable for its rare massive size.
A 60-year-old male patient complained of exertional dyspnea and left-sided chest pain at the time of admission to
hospital. PA and lateral chest roentgenograms showed presence of a giant mass and computed tomography (CT) of the
chest confirmed the mass to have an inhomogeneous density
and irregular central calcification in the left hemithorax
(Fig. 1). Hemogram and biochemical findings were normal.
At physical examination breath sounds were absent on left
lower zone. Bronchoscopy showed extrinsic compression at
* Corresponding author. 180/1 Sok. No. 3 A Blok D.1, 35040 Bornova
I˙zmir, Turkey. Tel.: +90 232 3428299.
1
Presented at the 1st International Congress of Thorax Surgery, Athens,
Greece, July 1–8, 1997.
1010-7940/98/$19.00 1998 Elsevier Science B.V. All rights reserved
PII S1010-7940 (98 )0 0166-3
the level of left lower lobe bronchus. Spirometry showed
restrictive pulmonary defect with a vital capacity of 1500
cm3. A transthoracic TruCut needle biopsy of the mass
showed benign fibrous tissue.
Left posterolateral thoracotomy was performed for the
resection of the tumor. The tumor was arising from the
visceral pleura on a stalk and projected into the pleural
space in a pedinculated manner. A thin membranous capsule
was present. Size of the tumor was 19 × 18 × 7 cm and
weighed 1500 g. On the cut section, the mass was composed
of dense, whorled fibrous tissue with irregular central calcification. A chest roentgenogram on the tenth postoperative
day showed reexpansion of the lung. Pathological diagnosis
of the tumor was benign localized fibrous tumor of the
pleura (Fig. 2).
2. Discussion
Localized benign fibrous tumors of the pleura are
approximately one-third of malignant mesothelioma [2].
Unlike malignant form, benign fibrous tumor of the pleura
appears to be unrelated to asbestos exposure [3]. There was
no asbestos exposure in our case. The localized form of the
fibrous tumors are usually considered benign, but malignant
cases have been reported [4].
212
M. Bic¸er et al. / European Journal of Cardio-thoracic Surgery 14 (1998) 211–213
Fig. 1. Computed tomography of the chest shows the mass with an inhomogeneous density and irregular central calcification in the left hemithorax.
Many patients with localized fibrous tumors are asymptomatic; cough, chest pain, and dyspnea occur occasionally,
especially with larger tumors [4]. It has slightly higher incidence in females than males. The peak incidence is in the
sixth and seventh decades of life [5].
These tumors appear as encapsulated, firm and lobulated
masses with a characteristic whorled appearance on cut surface. Watts et al. reported a giant benign mesothelioma
which was 1460 g [6]. In our case the tumor was also as
huge as the tumor Watts et al. reported, 1500 g. Briselli et al.
reported that the small tumors were usually nodular within
the lung and the large tumors tended to be pedinculated
within the pleural cavity, arising from the parietal pleura
[5]. A giant tumor arose from the visceral pleura in our case.
Diagnosis is difficult in these tumors. The nature of the
solitary lesion is established most often at the time of thor-
Fig. 2. Benign fibrous pleural tumor. Short spindle cells are poorly oriented within a fibrous stroma. (Hematoxylin and eosin stain; original magnification
×400).
M. Bic¸er et al. / European Journal of Cardio-thoracic Surgery 14 (1998) 211–213
acotomy and subsequent histologic examination [1]. When a
tumor is very large, however, the site of origin is frequently
difficult or impossible to establish on conventional roentgenograms and even on CT [7]. As a result of this, we tried
to diagnose the mass with thoracic CT and abdominal CT.
Although it is not recommended, we performed transthoracic TruCut needle biopsy but it was not sufficient for precise diagnosis.
Infrequently a pleural effusion may be present. England
et al. reported that 8% of 138 patients had a pleural effusion
[8]. We have demonstrated sanguineous pleural effusion at
the time of operation.
Treatments of benign fibrous tumors of the pleura consist
of adequate local excision. Great care must be taken at the
time of operation because of the highly vascular pedicle [6].
Although histologically benign, Briselli et al. reported that
the mortality rate is about 12% owing to operative mortality,
with removal or compression of mediastinal structures leading to fatal cardiopulmonary complications [5]. Periodic
long-term follow-up is necessary with these tumors. Five
in 78 cases which were diagnosed to be benign histologically at operation, had recurrence later in Japan [9]. After 2
years follow-up, our patient is healthy and has no sign of
recurrence.
213
References
[1] Shields TW. Localized fibrous tumor of the pleura. In: Shields TW,
ed. General thoracic surgery. Malvern: Williams and Wilkins, 1994:
722–730.
[2] Albelda SM, Sterman DH, Litzky LA. Malignant mesothelioma and
other primary pleural tumors. In: Fishman AP, Elias JA, Fishman JA,
Grippi MA, Kaiser LR, Senior RM, eds. Fishman’s pulmonary
diseases and disorders. New York: McGraw-Hill, 1998:1453–1466.
[3] Antman KH. Clinical presentation and natural history of benign and
malignant mesothelioma. Semin Oncol 1989;8:313–320.
[4] Okike N, Bernatz PE, Woolner LB. Localized mesothelioma of the
pleura: benign and malignant variants. J Thorac Cardiovasc Surg
1978;75:363–372.
[5] 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.
[6] Watts DM, Jones GP, Bowman GA, Olsen DJ. Giant benign
mesothelioma. Ann Thorac Surg 1989;48:590–591.
[7] Fraser RS, Pare JAP, Fraser RG, Pare PD, ed. Synopsis of diseases of
the chest. Philadelphia: WB Saunders, 1994:868–895.
[8] 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;13:640–644.
[9] Hatta T, Ohyabu H, Kurisu S, Tachibana S, Kita Y, Oki K, Okada M,
Uematsu M, Matsuda S, Eno K. A case of localized pleural mesothelioma. Kyobu Geka 1991;44 (4):344–346.
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