Solitary fibrous tumors of the pleura: not always a benign entity
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(A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Nunes, J. Maia, J.P. Ferreira, J. Neves, I. Marques" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "S." "apellidos" => "Nunes" ] 1 => array:2 [ "Iniciales" => "J." "apellidos" => "Maia" ] 2 => array:2 [ "Iniciales" => "J.P." "apellidos" => "Ferreira" ] 3 => array:2 [ "Iniciales" => "J." "apellidos" => "Neves" ] 4 => array:2 [ "Iniciales" => "I." "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915933115?idApp=UINPBA00004E" "url" => "/08732159/0000002100000002/v0_201604141148/X0873215915933115/v0_201604141148/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Solitary fibrous tumors of the pleura: not always a benign entity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "105" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.M. Nascimento, T. Gomes, A. Fernandes, A. Afonso" "autores" => array:4 [ 0 => array:4 [ "Iniciales" => "L.M." "apellidos" => "Nascimento" "email" => array:1 [ 0 => "lu_maria_nascimento@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "T." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "A." "apellidos" => "Fernandes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "A." "apellidos" => "Afonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Department of Pulmonology, Centro Hospitalar de Trás-os-Montes e Alto, Vila Real, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. lu_maria_nascimento@hotmail.com" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n02-90393312fig1.jpg" "Alto" => 1636 "Ancho" => 1447 "Tamanyo" => 709967 ] ] "descripcion" => array:1 [ "en" => "(A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm." ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Solitary fibrous tumor of the pleura (SFTP) is a rare tumor originating in mesenchymal cells; it represents less than 5% of all pleural tumors.<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> It is generally benign but 10–30% of SFTP are malignant.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">We report the case of a 61 year-old man, with a past history of bronchiectasis and severe restrictive ventilatory defect due to thoracic scoliosis (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a> A), who came to the pulmonology outpatients department with complaints of asthenia over the last year. He was an occasional pipe smoker and the physical examination showed marked thoracic deformity which limited chest expansion. A chest X-ray showed a large retrosternal opacity (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>B) and the chest computed tomography (CT) confirmed the presence of a retrosternal lobulated mass, 10.2 cm × 3.7 cm, in the right hemithorax (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>C and D). A percutaneous CT-guided biopsy was carried out and the histology showed evidence of mesenchymal neoplasm without necrosis, significant pleomorphism or mitotic figures. The tumor cell population stained diffusely for CD 34, vimentin, <span class="elsevierStyleItalic">bcl-2</span> and CD 99 and negative for S-100. Ki-67 was <5%. Although a benign SFTP was diagnosed based on the histology, a right thoracotomy was performed for diagnosis and treatment. A pedunculated tumoural mass was complete resected with segmental resection of the right upper lobe. Immunohistochemistry showed positivity for CD-34 and <span class="elsevierStyleItalic">bcl-2</span> confirming SFTP. The pathological examination revealed multiple mitotic figures (12 mitoses per 10 high-power fields), mild pleomorphism, hypercellularity, focal hemorrhage and several areas of necrosis and the resection margins were tumor-free. According to these features the tumor was classified as malignant. The post-operative period was uneventful and the patient was discharged home. The patient is now in the third month after surgery without any sign of local recurrence or metastization.</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n02-90393312fig1.jpg" alt="(A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm."></img></p><p class="elsevierStylePara">Figure 1. (A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm.</p><p class="elsevierStylePara">SFTP is a rare tumor with generally an indolent course and good prognosis with a 10-year survival rate up to 98%.<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> It occurs mainly in individuals in their sixth or seventh decades of life without gender bias. There is no association with tobacco, asbestos or other exposures. More than 50% of the patients are asymptomatic<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and the tumor is frequently an incidental finding on a routine chest X-ray. When symptomatic, the patients usually present non-specific respiratory symptoms such as dyspnea, cough and chest pain, and more rarely systemic symptoms. Occasionally, SFTP can manifest as paraneoplastic syndromes, such as hypertrophic pulmonary osteoarthropathy (Pierre Marie-Bamberger syndrome) and refractory hypoglycemia (Doege-Potter syndrome). The frequency of these syndromes increases with tumor size.</p><p class="elsevierStylePara">Malignant SFTP is uncommon and its incidence varies from 7% to 60%. It rarely arises from a pre-existing SFTP undergoing malignant transformation. The role of percutaneous CT-guided biopsy is not yet established because its diagnostic accuracy is low<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> and it can underestimate the degree of malignancy given the size and histological heterogeneity of these tumors. Therefore, a pre-surgical diagnosis should not affect the decision to perform surgery for benign and malignant SFTP. According to the world Health Organization Classification for soft tissue tumors, the malignant SFTP is diagnosed if one or more of the following histologic features are present: hypercellularity, pleomorphism, tumor necrosis, more than 4 mitoses per ten high-power fields and infiltrative margins. Immunohistochemistry may be useful in differentiating the SFTP from mesotheliomas and intrapleural sarcomas. Generally SFTP is vimentin, CD34, CD99 and <span class="elsevierStyleItalic">bcl</span>-2 positive and cytokeratin negative.</p><p class="elsevierStylePara">Complete resection of tumor is the treatment of choice, the only demonstrated effective treatment and the most important prognostic factor.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> The choice of surgical approach (video-assisted thoracoscopic surgery (VATS) and standard thoracotomy) is essentially based on tumor size and the difficulty of removal. The role of adjuvant radio and chemotherapy in malignant SFTP remains unclear since there is no systematic assessment due to the rarity of the tumor. Despite this, there are some reports showing good response to adjuvant radiotherapy in tumors with incomplete resection.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Recurrence rates for completely resected malignant SFTP range from 14% to 63%<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> in pedunculated and sessile tumors, respectively, and occur mainly in the first 24 months after surgery. Despite a complete resection, malignant SFTP can have a poor prognosis with a 5-year rate survival of 45,5%.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> Recurrent tumors should be resected and combined chemotherapy with temozolomide and bevacizumab can be considered in locally advanced, recurrent or unresectable malignant SFTP.<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">We report a case of a malignant SFTP, a rare pleural tumor that although completely resected and potentially with good prognosis, should have long-term follow-up due to the high risk of local and metastatic recurrence.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. lu_maria_nascimento@hotmail.com</p>" "pdfFichero" => "320v21n02a90393312pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n02-90393312fig1.jpg" "Alto" => 1636 "Ancho" => 1447 "Tamanyo" => 709967 ] ] "descripcion" => array:1 [ "en" => "(A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "(A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib8" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Localized fibrous tumours of the pleura: clinical and surgical evaluation. 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| 2023 April | 65 | 17 | 82 |
| 2023 March | 84 | 21 | 105 |
| 2023 February | 71 | 23 | 94 |
| 2023 January | 42 | 19 | 61 |
| 2022 December | 70 | 18 | 88 |
| 2022 November | 89 | 42 | 131 |
| 2022 October | 74 | 37 | 111 |
| 2022 September | 50 | 34 | 84 |
| 2022 August | 68 | 30 | 98 |
| 2022 July | 67 | 53 | 120 |
| 2022 June | 49 | 35 | 84 |
| 2022 May | 64 | 42 | 106 |
| 2022 April | 46 | 31 | 77 |
| 2022 March | 58 | 44 | 102 |
| 2022 February | 54 | 46 | 100 |
| 2022 January | 58 | 28 | 86 |
| 2021 December | 63 | 39 | 102 |
| 2021 November | 53 | 45 | 98 |
| 2021 October | 66 | 44 | 110 |
| 2021 September | 64 | 39 | 103 |
| 2021 August | 84 | 35 | 119 |
| 2021 July | 74 | 20 | 94 |
| 2021 June | 57 | 29 | 86 |
| 2021 May | 91 | 31 | 122 |
| 2021 April | 239 | 96 | 335 |
| 2021 March | 127 | 43 | 170 |
| 2021 February | 116 | 24 | 140 |
| 2021 January | 93 | 21 | 114 |
| 2020 December | 88 | 19 | 107 |
| 2020 November | 91 | 37 | 128 |
| 2020 October | 74 | 23 | 97 |
| 2020 September | 68 | 31 | 99 |
| 2020 August | 111 | 25 | 136 |
| 2020 July | 113 | 25 | 138 |
| 2020 June | 82 | 29 | 111 |
| 2020 May | 96 | 14 | 110 |
| 2020 April | 72 | 12 | 84 |
| 2020 March | 67 | 12 | 79 |
| 2020 February | 79 | 23 | 102 |
| 2020 January | 95 | 22 | 117 |
| 2019 December | 100 | 26 | 126 |
| 2019 November | 82 | 14 | 96 |
| 2019 October | 84 | 18 | 102 |
| 2019 September | 117 | 31 | 148 |
| 2019 August | 173 | 27 | 200 |
| 2019 July | 177 | 28 | 205 |
| 2019 June | 138 | 22 | 160 |
| 2019 May | 162 | 33 | 195 |
| 2019 April | 143 | 26 | 169 |
| 2019 March | 194 | 16 | 210 |
| 2019 February | 131 | 8 | 139 |
| 2019 January | 153 | 28 | 181 |
| 2018 December | 57 | 10 | 67 |
| 2018 November | 13 | 1 | 14 |
| 2018 October | 18 | 11 | 29 |
| 2018 September | 23 | 8 | 31 |
| 2018 August | 50 | 30 | 80 |
| 2018 July | 39 | 20 | 59 |
| 2018 June | 34 | 14 | 48 |
| 2018 May | 47 | 15 | 62 |
| 2018 April | 49 | 17 | 66 |
| 2018 March | 47 | 13 | 60 |
| 2018 February | 11 | 10 | 21 |
| 2018 January | 16 | 11 | 27 |
| 2017 December | 24 | 15 | 39 |
| 2017 November | 21 | 15 | 36 |
| 2017 October | 16 | 14 | 30 |
| 2017 September | 16 | 6 | 22 |
| 2017 August | 30 | 13 | 43 |
| 2017 July | 21 | 10 | 31 |
| 2017 June | 28 | 10 | 38 |
| 2017 May | 33 | 11 | 44 |
| 2017 April | 21 | 3 | 24 |
| 2017 March | 24 | 4 | 28 |
| 2017 February | 16 | 3 | 19 |
| 2017 January | 10 | 4 | 14 |
| 2016 December | 11 | 5 | 16 |
| 2016 November | 8 | 6 | 14 |
| 2016 October | 5 | 2 | 7 |
| 2016 September | 3 | 2 | 5 |
| 2016 August | 4 | 7 | 11 |
| 2016 July | 7 | 9 | 16 |
| 2016 June | 0 | 2 | 2 |
| 2016 May | 1 | 5 | 6 |
| 2016 April | 30 | 2 | 32 |
| 2016 March | 37 | 15 | 52 |
| 2016 February | 35 | 25 | 60 |
| 2016 January | 30 | 18 | 48 |
| 2015 December | 36 | 18 | 54 |
| 2015 November | 30 | 15 | 45 |
| 2015 October | 36 | 17 | 53 |
| 2015 September | 39 | 10 | 49 |
| 2015 August | 34 | 12 | 46 |
| 2015 July | 37 | 3 | 40 |
| 2015 June | 88 | 13 | 101 |
| 2015 May | 40 | 18 | 58 |
| 2015 April | 113 | 66 | 179 |
| 2015 March | 100 | 62 | 162 |
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