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J Thorac Cardiovasc Surg 1995;109:1246-1248
© 1995 Mosby, Inc.
BRIEF COMMUNICATIONS |
Saitama, Japan
Solitary fibrous tumors, which mostly arise from the pleura, are not common, and lesions growing from the epicardium are extremely rare. We present a case of an epicardial solitary fibrous tumor that was found as an enlarged mediastinal shadow in a chest roentgenogram and was resected after 21/2 years' observation.
A 50-year-old woman was referred to the National Defense Medical College Hospital in November 1990 with a suspected ventricular aneurysm. Ultrasonic echocardiography revealed that it was a solid mass attached to the right ventricle with a stalk. Surgical resection was recommended to the patient, but she refused because of no subjective symptoms. She was thus followed up in the outpatient clinic.
About 21/2 years later, the patient was admitted to our hospital because of dyspnea and palpitation in the right lateral decubitus position. A chest roentgenogram demonstrated enlargement of the mass after the 2 1/2 years of follow-up (Fig. 1). The computed tomographic scan and the magnetic resonance image revealed that the lesion grew in the pericardial cavity and was contiguous with the right ventricular wall.
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The lesion was an encapsulated tumor 12.5 x 10.5 x 8.0 cm in size and 530 gm in weight (Fig. 2). Histologically, the tumor consisted of spindle-shaped and multiangle tumor cells with admixture of different cell types. In the hypercellular areas, the tumor cells and intercellular collagen fibers proliferated without obvious structure, which corresponded to the so-called "patternless" arrangement described as a feature of solitary fibrous tumor 
3 (Fig. 3). High vascularity with a hemangiopericytoma-like pattern was also observed. Irregularity of the nuclear shape was conspicuous and mitotic figures were relatively frequent (2 to 5 per 10 high-power fields). In the hypocellular areas, hyalinization and mucinous degeneration of intercellular collagen was prominent. Immunohistochemically, the tumor cells were positive for vimentin and negative for cytokeratin, actin, and s-100 protein. These gross and microscopic findings were compatible with those of solitary fibrous tumor.
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Solitary fibrous tumor, which has also been known as localized fibrous mesothelioma, was first classified as a pleural neoplasm by Klemperer and Rabin 1 in 1931. Although solitary fibrous tumors most commonly arise from the pleura, several have recently been reported to arise in extrapleural sites such as the upper respiratory tract and other serosal cavities. 2,3 Among them, lesions that arise from the epicardium are so rare that we could find no reported case in reviewing the literature. Three such lesions arising from the pericardium and growing in the pericardial cavity have been reported so far. 3-5
Most solitary fibrous tumors are cured by surgical excision but some may be lethal because of extensive intrathoracic growth, unresectable recurrences, and metastatic diffusion. 2-5 We consider that surgical resection is the best treatment for solitary fibrous tumors if they are resectable. Tumors must be resected with a margin free of tumor cells. Epicardial solitary fibrous tumors may arise in the vicinity of the coronary artery, as in our case. In such cases it is important to repair the defect on the ventricular wall to avoid damage to the coronary artery.
Footnotes
From the Department of Surgery IIa and the Department of Laboratory Medicine,b The National Defense Medical College, Saitama, Japan. 
J THORAC CARDIOVASC SURG 1995;109:1246-8
References
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