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A 7-month-old infant boy with pleural lipoblastoma is presented. The diagnosis was confirmed by operation. Radiologic findings consisted of a pleura-based mass with well-defined margin. The main differentiation is from liposarcoma, which is extremely rare in children under 3 years of age.
PURPOSE: The aim of the current study was to characterize the MR appearance of solitary fibrous tumor of the pleura (SFTP). METHOD: Twenty-two consecutive patients with histologically confirmed SFTP were retrospectively evaluated with MRI. RESULTS: Tumors demonstrated low signal intensity (n = 18, 82%), iso signal intensity (n = 2, 9%), and high signal intensity (n = 2, 9%) on T1-weighted images. On T2-weighted images, tumors were observed as low signal intensity (n = 10, 45%), high signal intensity (n = 2, 9%), and mixed signal intensity (n = 10, 45%). Solid component in the proliferation of tumor cells corresponded to low signal intensity in 12 tumors (55%) on T2-weighted images. On gadolinium-enhanced T1-weighted images, inhomogeneous enhancement (n = 18, 82%), nodular enhancement (n = 6, 27%), and homogeneous enhancement (n = 4, 18%) were observed. The enhanced lesion within the tumors had dense tumor tissue and dilated microvessels in the pathologic specimen. CONCLUSION: SFTP shows variable appearance and enhancement pattern on MRI according to morphologic tumor heterogeneity.
A patient with malignant mesothelioma of the pleura presented with radiological, endoscopic, and manometric features of achalasia. This is the third such patient who had achalasia along with pleural mesothelioma.
Angiosarcoma is a rare soft tissue sarcoma that usually occurs in deep soft tissues, breast, spleen, liver, and bone. Primary thoracic parietal localization of angiosarcoma is rare and prognosis is poor. In this report, we present the CT and PET features of a patient with pseudomesotheliomatous angiosarcoma of the chest wall and pleura, which, to the best of our knowledge, have not previously been described.
A 38-year-old woman who had a Cope needle biopsy of the pleura was treated for plural tuberculosis on the basis of a positive PPD-S skin test and presence of caseating granulomas in the pleural biopsy. Ten months later she developed a tender, subcutaneous nodule in the area of the previous needle biopsy. Surgical exploration revealed a dumbbell abscess through the chest wall communicating with an area of consolidation in the right middle lobe. En bloc surgical resection of the abscess and peripheral portion of the right middle lobe was curative, although all pathologic and cultural studies of the resected tissue were non-diagnostic.
Extrapulmonary small cell carcinoma is uncommon. Small cell carcinoma of pleural primary origin has not, based on a literature review of the past three decades, been reported. We have reported a case of small cell carcinoma of the pleura, discussed its management and significance, and briefly reviewed the pertinent literature.
Localized fibrous tumor of the pleura is a rare primary pleural neoplasm. The tumors are usually discovered incidentally on routine chest radiography. A change in the lesion's position with respiration and/or posture of the patient indicates a pedunculated pleural lesion. Computed tomography and magnetic resonance imaging reveal the relation of the lesions to adjacent structures. Magnetic resonance imaging is also useful for the characterization of the lesions on the basis of signal features. These tumors usually consist of mature fibrous tissue.
In order to define the histopathological criteria for the diagnosis of malignant neoplasm involving pleura, we studied 11 pleurectomy specimens containing undoubted malignant cells. The most important feature for a diagnosis of malignancy was the pattern of neoplastic infiltration of the fibrous sub-pleural tissue. These criteria were subsequently applied in a re-analysis of 76 pleural needle biopsies with a diagnosis of cancer. The patterns most frequently seen were a multi-pronged growth of at least four clusters of atypical cells in the fibrous sub-pleural tissue, a solid pattern with a large collection of atypical cells and a confluent one where large numbers of small clusters of atypical cells appeared almost fused in the stroma. Less frequently, malignant cells covered the surface of fibromuscular tissue, or were found in an intravascular or intramuscular location, but often associated with any of the three main patterns. Five needle biopsies were considered suspicious and 11, considered benign, contained a prominent mesothelial reaction. The benign control cases showed mesothelial cells mainly in a peripheral growth pattern or as clusters of cells interspersed with fibrin, without any mitotic activity; granulation tissue and lympho-histiocytic infiltrates were more frequently seen in the control group.
Most patients presenting with malignant mesothelioma of the pleura (MMP) are only suitable for palliative treatment. Radiotherapy has not been shown to improve survival in patients with this disease, but is of use in the palliation of symptoms. In this retrospective review of 111 patients with MMP referred to the Peter MacCallum Cancer Institute, the palliative effect of radiotherapy was analysed. More than half of the patients whose response could be assessed had some symptomatic relief from the radiotherapy treatment. No dose-response relationship could be found.
A case of malignant solitary fibrous tumor (SFT) is reported, occurring in a 61-year-old man with frequent hypoglycemia. Endocrinological analyses showed high serum levels of insulin-like growth factor II (IGF-II) and suppressed secretion of insulin. After the removal of a pleural tumor, which weighed 3150 g, serum IGF-II levels returned to normal and hypoglycemic attacks ceased. The tumor was composed of uniform spindle cells arranged in bundles, and fascicles with varying amounts of collagen and reticulin fibers. Mitotic figures at the rate of 6/10 high-power fields, and frequent foci of necrosis and hemorrhage were seen. Almost all of the tumor cells were immunohistochemically positive for vimentin and CD34. Electron microscopy revealed the immature mesenchymal or myofibroblastic nature of the tumor cells. These findings are consistent with malignant SFT of the pleura. Moreover, the tumor produced IGF-II mRNA as demonstrated by northern blot analysis. Thus, hypoglycemia of this patient was induced by SFT through the production and secretion of IGF-II.
Localized fibrous tumour of pleura is a rare condition. Most follow a benign course and are an incidental finding during routine chest X-ray. A small proportion of these tumours are malignant and have characteristic clinical and histopathological features. This case report is of a 65 year old woman who presented with respiratory symptoms and polyarthropathy, and had a subsequent resection of a massive pleural tumour with features suggestive of malignancy.
OBJECTIVES: To estimate the risk of cancer and death in Swedish insulation workers some years after their exposure to asbestos had stopped. One hypothesis was that the risk of lung cancer would tend to decrease some years after the exposure had ended. METHODS: In a cohort study the cancer morbidity and cause of death was investigated in 248 insulation workers and compared with the corresponding morbidity and mortality in the general population. Due to stringent regulations, exposure to asbestos of all types had almost ended in Sweden in the mid-1970s. Through a questionnaire, surviving insulation workers were asked about their exposure to asbestos and their smoking habits. RESULTS: Between 1970 and 1994 there were 86 deaths compared with the 46.0 expected (standardised incidence ratio (SIR) 1.9; 95% confidence interval (95% CI) 1.5 to 2.3), the increase was mainly due to an increased cancer mortality. The morbidity was increased for lung cancer (11 cases v 2.5 expected (SIR 4.4; 95% CI 2.2 to 7.9)), peritoneal mesothelioma (seven cases; no expected incidence could be calculated as the occurrence is too rare in the general population), cancer in pancreas (five cases v 0.7 expected (SIR 7.1; 95% CI 2.3 to 16.7)). No cases of pleural mesothelioma were found. The risk of lung cancer did not tend to approach that of the general population after the exposure to asbestos decreased. CONCLUSIONS: In the 1980s and the early 1990s, Swedish insulation workers still have a highly increased risk of diseases related to asbestos. The attributable risk for death and cancer was about 50%. The study also confirms the previous finding that mesothelioma in insulation workers seems to be situated in the peritoneum more often than in the pleura.
BACKGROUND: Three cases of diffuse malignant vascular tumours of the pleura are described which mimicked malignant mesothelioma clinically and pathologically (so called "pseudomesothelioma"). All had occupational histories of exposure to asbestos. The relationship of these tumours to mesothelioma and asbestos exposure is discussed. METHODS: To examine the histogenetic relationship between mesothelioma and these three tumours an immunohistochemical analysis of vascular marker (CD31, CD34, and Von Willebrand factor) expression was undertaken in 92 cases of pleural mesothelioma, in addition to these three tumours. Electron microscopic fibre analysis of lung tissue was performed on each of the three cases to assess asbestos fibre content. RESULTS: Diffuse pleural epithelioid haemangioendotheliomas may closely resemble malignant mesothelioma clinically and pathologically but, of the 92 pleural mesotheliomas tested, none showed expression of CD31, CD34, and Von Willebrand factor. Although all three cases had claimed exposure to asbestos, ferruginous bodies typical of asbestos were only seen by light microscopy in case 2, and only in this subject was the asbestos fibre content raised in comparison with the range seen in a non-exposed background population. The latent period in the pleural epithelioid haemangioendotheliomas ranged from 18 to 60 years. CONCLUSIONS: Endothelial differentiation does not appear to occur in mesothelioma and therefore should be clearly separated from it. No definite association between pleural epithelioid haemangioendothelioma and exposure to asbestos can be made from this small series but further investigation is warranted.
We have carried out sequential prospective studies of treatment with surgery alone, chemotherapy, and radiotherapy in malignant mesothelioma of the pleura. The survival of treated patients was contrasted with that of 64 contemporary untreated patients whose clinical condition at presentation was comparable with that of the treated patients. Non-radical surgery alone (28 patients) was of palliative benefit, particularly for the control of recurrent pleural effusions, and may have prolonged survival in one patient with localised malignant mesothelioma. Chemotherapy with doxorubicin, vincristine, and cyclophosphamide (12 patients, with preceding surgery in eight) was without objective benefit. Megavoltage radiotherapy by an off axis beam rotational technique (12 patients, with preceding surgery in eight) abolished pain and dyspnoea and may have prolonged survival in one patient and terminated recurrent pleural effusions in three, but it was of no value in the other patients. There was no significant difference in survival between treatment groups or between treated and untreated patients, and no difference when mesotheliomas of epithelial, sarcomatous, and mixed cell types were examined separately. Treatment of this disease appeared to fail because of the unresponsiveness of the tumour to existing forms of treatment and the advanced stage of the disease at clinical presentation.
106 pleural effusions or pleural opacities suggesting fluid were evaluated in a prospective study by B-mode real-life sonography and radiography. 41 cases were first investigated by means of ultrasound, 65 by the conventional erect roentgenogram. The correct diagnosis of pleural fluid was made by ultrasound in 95.3% and by radiologic examination in 86.8% of the cases. Radiography failed to distinguish between pleural effusion and solid pleural thickening in 7.5%, sonography in 1.9% of the cases. In 8 patients with normal roentgenograms, small epidiaphragmal pleural effusions were detected by means of ultrasound. In diagnosis of pleural effusion, sonography was found to be superior to the conventional radiologic technique both in sensitivity and in diagnosing the consistency. The value of the ultrasonic method both in establishing the quality of intrathoracic masses adjacent to the pleura and in sonographically guided needle puncture is emphasized.
Over 160 cases of pleura carcinosis were treated systematically by local intrapleural instillation of Iscador, and the results were documented by cytomorphological examination of the punctate. The results show that, under these conditions, Iscador has two distinct activities, i.e. cytotoxic activity and immunostimulating activity.
OBJECTIVE: To ascertain the cytologic characteristics of solitary fibrous tumors of the pleura (SFTPs) on smear preparations. STUDY DESIGN: Fine needle aspiration cytology (FNAC) was initially attempted preoperatively in five cases, but the specimens were inappropriate for interpretation because only a few tumor cells were obtained. Therefore, scratch smears made at the time of operation were used. Papanicolaou and immunocytochemical staining was performed in all 10 cases, 2 of which were malignant. RESULTS: As expected, cellular tumors yielded more cells. The cytologic appearance was variable, showing spindle/bipolar, dendritic/stellate and intermediate cells. Atypical cells reminiscent of sarcoma were also present in cellular, benign tumors. Highly atypical epithelioid cells were obtained in two malignant cases. Immunocytochemically, the tumor cells were positive for CD34 and vimentin and negative for cytokeratin, regardless of histologic differences and cell shape. CONCLUSION: It seems difficult to diagnose SFTPs with certainty by FNAC, partly because the cell morphology of SFTPs resembles a wide variety of heterogeneous groups of spindle cell tumors and partly because only a few tumor cells were available in the FNAC specimens in the present study. However, a cytologic diagnosis of SFTP is possible if cytologic preparations yield CD34-positive cells with spindle/bipolar or dendritic/stellate morphology.
A 52 year old man developed an extraskeletal mesenchymal chondrosarcoma (ESMC) arising from the pleura. Clinically, the tumour mimicked a mesothelioma. Fine needle biopsy was consistent with the diagnosis of sarcomatoid mesothelioma. Histological examination of multiple tumour samples, supported by immunohistochemical characterization, made it possible to correctly diagnose extraskeletal mesenchymal chondrosarcoma.