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A silent gigantic solitary fibrous tumor of the pleura: case report

DOI: 10.1186/1749-8090-6-122

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Abstract:

Solitary fibrous tumors (SFT) of the pleura are rare intrathoracic neoplasm. Immunohistochemical analysis has confirmed that SFTs originate from mesenchyme underlying the mesothelial layer of the pleura. Although they are usually asymptomatic, larger tumors occupying a large space in the thoracic cavity, present more commonly with symptoms such as dyspnea, chest pain and malaise. Although the tumor was large enough to push the descending aorta and other mediastinal structures to the right, our patient displayed no symptoms other than malaise. We successfully resected the huge tumor via two separate thoracotomies. One year later, the patient is in good health without tumor recurrence.A 57-year-old man was referred to a hospital because of progressive general malaise for a month. His medical history was unremarkable and he had no history of exposure to asbestos. At physical examination, breath sounds were absent on the left lower region. A roentgenogram showed a giant tumor in the left thorax (Figure 1A). The heart appeared to be compressed towards the right side. He had no other chest complaints, such as cough, chest pain, and dyspnea. Computed tomography (CT) revealed a well-circumscribed homogeneous mass, which compressed the descending aorta (Figure 1B). The hematological and biochemical findings were normal. Bronchofiberoscopy showed stenosis of the left lower lobar bronchus from extraluminal compression. Bronchoscopic cytology revealed no abnormal findings and no evidence of bronchitis. CT-guided biopsy demonstrated fibrotic soft tissue without evidence of malignancy but the appearance of the specimen did not have enough diagnostic strength. Spirometry showed the following results: vital capacity, 2.4 L (49% of predicted); forced expiratory volume in a second, 1.7 L (42% of predicted). Results of blood gas analysis were also within normal limits. The patient was referred to our institution for surgical treatment of a suspected SFT.Left posterolateral thoracotomy

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