Images in Cardiothoracic Medicine and Surgery
Solitary fibrous tumor as a cause of chronic cough
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(5) 602–603 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313519806 aan.sagepub.com
Kyung Hwa Kim, Jong Hun Kim and Ja Hong Kuh
A 64-year-old man who was a nonsmoker, presented with nonproductive cough for more than 3 months and an abnormal radiologic finding (Figure 1a). His complete blood count, liver and respiratory function tests were within normal limits. On bronchoscopy, the mucosa appeared normal. Contrast-enhanced computed tomography showed a well-circumscribed hypervascular heterogeneous mass in the right lower lobe, adherent to the diaphragm peripherally (Figure 1b). An ultrasound-guided transthoracic biopsy was nondiagnostic. The patient underwent exploration by thoracotomy with a video-assisted thoracoscopic view that showed a large pyramid-shaped pleural-based mass with smooth well-circumscribed encapsulation and a prominently vascularized stalk to the right lower lung (Figure 2a, 2b). The mass was resected with concomitant wedge resection of lung parenchyma at the base of the vascularized stalk. There was no evidence of penetration of the tumor through the visceral pleura or communication with neighboring structures. The diaphragmatic surface of the mass was firmer than the other sides of the pyramidal shape. Microscopically, there were spindle or epithelial cells with a hemangiopericytoma-like vascular pattern (Figure 2c). Mitotic activity was present (3 mitoses per high-power field). These findings indicated a solitary fibrous tumor, probably derived from the visceral pleura. The postoperative course was uneventful, and the patient was doing well without mass recurrence or cough after 2 years.
Department of Thoracic and Cardiovascular Surgery, Research Institute of Clinical Medicine of Chonbuk National University Hospital, Jeonju-si, Republic of Korea
Figure 1. (a) Chest radiograph showing an abnormal mass lesion in the right hemithorax (arrow). (b) Computed tomography revealing a well-circumscribed hypervascular mass adjacent to the posterobasal segment of the right lower lobe.
Corresponding author: Ja Hong Kuh, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Research Institute of Clinical Medicine of Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-Ro, Geumam-dong, Deokjin-gu, Jeonju 561-180, Republic of Korea. Email: [email protected]
Downloaded from aan.sagepub.com at UNIV CALIFORNIA SAN DIEGO on November 14, 2015
Kim et al.
603
Figure 2. (a) At operation, the smooth glistening encapsulated surface of the mass (star) was well visualized adjacent to the visceral pleura, with a prominently vascularized stalk (arrow). (b) The resected specimen was a pyramid-shaped mass (10 7 11 cm) with the concomitantly resected wedge of lung parenchyma at the base of the stalk. (c) The tumor exhibited a patternless architecture with hemangiopericytoma-like branching blood vessels. Immunohistochemically, the tumor cells were positive for CD34 and CD99.
Funding Acknowledgment The authors thank Kyu Yeoun Jang (Department of Pathology, Chonbuk National University Hospital) for his contribution to the pathological diagnosis.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at UNIV CALIFORNIA SAN DIEGO on November 14, 2015
Solitary fibrous tumor as a cause of chronic cough
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(5) 602–603 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313519806 aan.sagepub.com
Kyung Hwa Kim, Jong Hun Kim and Ja Hong Kuh
A 64-year-old man who was a nonsmoker, presented with nonproductive cough for more than 3 months and an abnormal radiologic finding (Figure 1a). His complete blood count, liver and respiratory function tests were within normal limits. On bronchoscopy, the mucosa appeared normal. Contrast-enhanced computed tomography showed a well-circumscribed hypervascular heterogeneous mass in the right lower lobe, adherent to the diaphragm peripherally (Figure 1b). An ultrasound-guided transthoracic biopsy was nondiagnostic. The patient underwent exploration by thoracotomy with a video-assisted thoracoscopic view that showed a large pyramid-shaped pleural-based mass with smooth well-circumscribed encapsulation and a prominently vascularized stalk to the right lower lung (Figure 2a, 2b). The mass was resected with concomitant wedge resection of lung parenchyma at the base of the vascularized stalk. There was no evidence of penetration of the tumor through the visceral pleura or communication with neighboring structures. The diaphragmatic surface of the mass was firmer than the other sides of the pyramidal shape. Microscopically, there were spindle or epithelial cells with a hemangiopericytoma-like vascular pattern (Figure 2c). Mitotic activity was present (3 mitoses per high-power field). These findings indicated a solitary fibrous tumor, probably derived from the visceral pleura. The postoperative course was uneventful, and the patient was doing well without mass recurrence or cough after 2 years.
Department of Thoracic and Cardiovascular Surgery, Research Institute of Clinical Medicine of Chonbuk National University Hospital, Jeonju-si, Republic of Korea
Figure 1. (a) Chest radiograph showing an abnormal mass lesion in the right hemithorax (arrow). (b) Computed tomography revealing a well-circumscribed hypervascular mass adjacent to the posterobasal segment of the right lower lobe.
Corresponding author: Ja Hong Kuh, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Research Institute of Clinical Medicine of Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-Ro, Geumam-dong, Deokjin-gu, Jeonju 561-180, Republic of Korea. Email: [email protected]
Downloaded from aan.sagepub.com at UNIV CALIFORNIA SAN DIEGO on November 14, 2015
Kim et al.
603
Figure 2. (a) At operation, the smooth glistening encapsulated surface of the mass (star) was well visualized adjacent to the visceral pleura, with a prominently vascularized stalk (arrow). (b) The resected specimen was a pyramid-shaped mass (10 7 11 cm) with the concomitantly resected wedge of lung parenchyma at the base of the stalk. (c) The tumor exhibited a patternless architecture with hemangiopericytoma-like branching blood vessels. Immunohistochemically, the tumor cells were positive for CD34 and CD99.
Funding Acknowledgment The authors thank Kyu Yeoun Jang (Department of Pathology, Chonbuk National University Hospital) for his contribution to the pathological diagnosis.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at UNIV CALIFORNIA SAN DIEGO on November 14, 2015
