Solitary fibrous tumour of the pleura: surgical treatment

Objective: Solitary fibrous rumours (SFT) of the pleura are rare rumours or iginated from the mesenchimal tissue underlying the mesothelial layer of th e pleura. This tumours present unpredictable clinical course probably relat ed to their histological and morphological characteristics. Methods: Twenty -one patients affected by SFT of the pleura were referred to us for surgica l resection from September 1984 to April 2000. They were 15 males and six f emales with median age of 51 (range 15-73) years. Nine patients (43%) were symptomatic and predominant clinical symptoms or signs were dyspnoea (19%), coughing (14.3%), chest pain (28.5%), finger clubbing (14.3%) and hypoglyc aemia (14.3%). Hypoglycaemia was related to a pathological incretion of ins ulin-like growth factor 2 by the tumour. Chest radiograph and computed tomo graphy of the chest revealed intra-thoracic homogeneous sharply delineated round or lobulated mass sometimes associated with ipsilateral pleural effus ion (19%) or causing pulmonary atelectasis with opacification of the comple te hemithorax (19%). Surgical excision required 14 posterolateral thoracoto mies, six anterior thoracotomies and one video-assisted thoracoscopy. Thirt een tumours arose from visceral pleura and wedge resection was performed, s even tumours arose from parietal pleura and extrapleural resection was carr ied out without any chest-wall resection, one tumour growth within the uppe r left lobe and required lobectomy. Tumours weighted from 22 to 1942 g and measured from 22 x 12 x 8 to 330 x 280 x 190 mm. At cut section seven cases (34%) revealed focal necrosis and hemorrhagic zones and on light microscop y six cases (28.5%) were characterized by high mitotic count: characteristi cs related with uncertain clinical behaviour. Immuno-histochemical reaction s were in all cases positive for CD34. Results: In all our patients resecti ons were complete. Paraneoplastic syndromes like hypoglycaemia and clubbing receded after surgery. No intraoperative or perioperative medical or surgi cal complications occurred. Median chest-drain duration timed 3 (range 2-5) days and median hospital stay was 5 (range 4-7) days. Perioperative mortal ity rate was 0%. Median follow-up was 68 (range 2-189) months: during this period patients were submitted to chest Xray with 6-months interval to eval uate possible local recurrence. Only one patient experienced tumour recurre nce after 124 months followup: the tumour was suspected after observation o f finger clubbing. The tumour was detected and excised by redo-thoracotomy. Conclusions: Surgical resection of benign solitary fibrous tumours is usua lly curative, but local recurrences can occur years after seemingly adequat e surgical treatment. Malignant solitary fibrous rumours generally have a p oor prognosis. Clinical follow-up and radiological follow-up are indicated for both benign and malignant solitary fibrous tumours. (C) 2001 Elsevier S cience B.V. All rights reserved.