Presentation
Pleuritic chest pain.
Patient Data
Very large left lower lobe soft tissue density mass with vascularity, few sparse peripheral calcifications, and a broad abutment of the pleura medially, posteriorly and at the dome. Small left pleural effusion. Remainder of the pleura is unremarkable with no pleural nodularity. No right pleural effusion.
Posterior left upper lobe plate atelectasis. Near complete compression of the basal left lower lobe with hyperinflation of the superior segment.
The patient underwent an image-guided core biopsy.
HISTOPATHOLOGY
MACROSCOPIC: Lung/pleural vesicle BX– 3 cores of cream tissue measuring up to 16 mm in length.
MICROSCOPIC: Sections taken show on morphological and immunohistochemical examination features consistent with a solitary fibrous tumor. A mildly cellular proliferation of bland spindle cells is identified embedded within fibrous connective tissue. The spindle cell nuclei show no cytological atypia or mitotic activity. On immunohistochemical examination, the spindle cells show diffuse positive staining for CD34 and focal positive nuclear staining for STAT6 with negative staining for the broad spectrum cytokeratin AE1/AE3 and for the mesothelial marker Calretinin
DIAGNOSIS: Visceral pleura mass: Features are identified on morphological and immunohistochemical examination consistent with a solitary fibrous tumor.
Case Discussion
Solitary fibrous tumors of the thorax are rare causes of a pleural-based mass. These large tumor was not suspected clinically with the patient presenting with a possible pulmonary embolus.
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