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J Thorac Cardiovasc Surg 1996;111:1292-1293
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Intrapulmonary benign fibrous tumor of the pleura

Alessandro Brunelli, MD, Armando Sabbatini, MD, Giovanbattista Catalini, MD, Aroldo Fianchini, MD

Department of Thoracic Surgery
University of Ancona Medical School
Ancona, Italy

To the Editor:

We read with great interest the communication of Aufiero and associatesGo 1 in the August 1995 issue of the Journal concerning intrapulmonary benign fibrous tumor of the pleura.

We recently admitted to our institution a 38-year-old woman with a large mass in the left lung, which had been discovered accidentally on a chest roentgenogram obtained for a motor vehicle accident. A chest computed tomographic scan revealed two distinct lesions, one related to the apical parietal pleura (Fig. 1) and the other involving diffusely the upper lobe of the left lung with compression of the left main pulmonary artery (Fig. 2). A review of her past roentgenograms showed the apical extrapulmonary lesion but no signs of parenchymal involvement at least 8 years before admission. A left pneumonectomy was necessary inasmuch as the left main pulmonary artery appeared involved by the tumor and its nature could not be determined by the intraoperative histologic examination. The mass arising from the apical parietal pleura, which did not involve the lung, was excised as well. Grossly, both lesions appeared circumscribed with a smooth surface, and a cut section revealed dense, whorled fibrous tissue. The intrapulmonary mass did not reach the visceral pleura. Histologic study of both tumors disclosed proliferation of spindle cells with a very low mitotic rate of less of 1 mitosis per 10 high-power fields and a scattered storiform pattern. The spindle cells were separated by abundant collagen. The pulmonary artery was found to be compressed but not infiltrated. Immunohistochemically, both tumors were positive for vimentin and negative for actin and cytokeratin. A diagnosis of benign fibrous tumor of the pleura was made. The specimens were sent for review to a pathologist at another institution, who confirmed the diagnosis.



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  		Fig. 1. Chest computed tomographic scan showing the extrapulmonary apical mass on the left side. R, Right; P, posterior; L, left.

 


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  		Fig. 2. Chest computed tomographic scan at a lower level revealing the tumor of the left upper lobe with involvement of the left pulmonary artery. R, Right; P, posterior; L, left.

 
Intrapulmonary benign fibrous tumors of the pleura have rarely been described,Go Go 1,2 and none of the above was associated with a second distinct extrapulmonary lesion. Whether the multiple metachronous neoplasms in our case were due to the exposure to hypothetical predisposing risk factors creating a favorable environment for a multifocal growth, to the propagation by contiguity, or by blood-borne metastases, indicating an aggressive biologic behavior despite the benign histologic pattern, remain merely speculative.

The atypical localization (from the parietal pleura, intralobar, inverted growth into the parenchyma) and the large size, which have been associated more frequently with malignancy,Go 3 warrant an aggressive attitude toward this tumor, regardless of the histologic findings. Therefore, we recommend excisional biopsy and radical resection in all the cases of intrapulmonary fibrous tumors of the pleura, concurring with the conclusions of Aufiero and associates.Go 1

References

  1. Aufiero TX, McGary SA, Campbell DB, Philips PP. Intrapulmonary benign fibrous tumor of the pleura. J Thorac Cardiovasc Surg 1995;110:549-51.[Free Full Text]
  2. Yousem SA, Flynn SD. Intrapulmonary localized fibrous tumor: intraparenchymal so-called localized fibrous mesothelioma. Am J Clin Pathol 1988;89:365-9.[Medline]
  3. England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura: a clinico-pathologic review of 223 cases. Am J Surg Pathol 1989;13:640-58.[Medline]



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I. Tastepe, A. Alper, H. E. Ozaydin, L. Memis, and G. Cetin
A case of multiple synchronous localized fibrous tumor of the pleura
Eur. J. Cardiothorac. Surg., October 1, 2000; 18(4): 491 - 494.
[Abstract] [Full Text] [PDF]

This Article
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