LOCALIZED FIBROUS TUMOR OF PLEURA

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LOCALIZED FIBROUS TUMOR OF PLEURA

• GENERAL THRACIC SURGERY
• CHAPTER 64

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Localized fibrous tumor

• Previous name Localized mesothelioma of pleura,
  benign or malignant.
• Scharifker and Kaneko Cell origin of these tumor
  is noncommitted mesenchymal cell present in the
  areolar tissue subjacent to the mesothelial
  lining of the pleura, not from mesothelial cell
  of pleura.
• Malignant variety Localized malignant fibrous
  tumor of the pleura.

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Benign localized fibrous tumor of the pleura

• From visceral pleura.
• On a stalk, project into pleural space.
• May inward growth into lung parenchyma.
• Occasionally within fissure.
• May from mediastinal, diaphragm, costal portion
  of parietal pleura Often malignant.
• Solitary, ovoid round.

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Benign localized fibrous tumor of the pleura

• Histology Fibroblastlike cell and connective
  tissue.
• Lack keratin reactivity and positive CD34
  antigen Differentiates fibrous tumor from
  mesothelioma.
• Table 64-1.

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Benign localized fibrous tumor of the pleura
Clinical feature

• Equal frequency in both sex.
• Common in 5th to 8th decades.
• Half asymptomatic,
• Chronic cough, chest pain, dyspnea. Table 64-2.
• Chest pain Most lesion arise from parietal
  pleura.

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Benign localized fibrous tumor of the pleura
Clinical feature

• Hypertrophic pulmonary osteoarthropathy (20)
  Stiffness of the joint, edema of ankle,
  arthralgia, pain of long bone (especially the
  tibia).
• Gynecomastia.
• Clubbing finger.
• Hypoglycemia (3-4) Tumor production insulin
  like growth factors or somatomedins.
• Galactorrhea.

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Benign localized fibrous tumor of the pleura

• Radiographic features
• Circumscribed mass of varying size.
• Located in the lung periphery.
• Margin sharply defined.
• Movable with change position.

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Benign localized fibrous tumor of the pleura

• Diagnosis
• Fine needle aspiration.
• Biopsy.

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Benign localized fibrous tumor of the pleura
Treatment

• Surgical resection.
• Lesion within parenchyma Lung resection.
• Tumor within fissure Bilobectomy.
• Tumor located in mediastinum, diaphragm, parietal
  pleura Should be excised widely Because of
  associated malignancy.

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Benign localized fibrous tumor of the pleura

• Prognosis Cured by adequate excision.
• Recurrence 2.

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Malignant localized fibrous tumor of the pleura

• Incidence12.
• Gross feature Table 64-3.
• Clinical features 3/4 have symptoms Chest
  pain, cough, dyspnea, fever, osteoarthropathy
  (rarely), hypoglycemia (11).
• Radiographic features Tumor more large, pleural
  effusion (32), rib erosion.

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Malignant localized fibrous tumor of the pleura

• DiagnosisMost until the histologic examination.
• TreatmenWide local excision, pulmonary and
  pleural excision, from parietal pleura should be
  resected with chest wall, post-operative
  radiotherapy and chemotherapy.
• Prognosis45 long term survival, chest wall
  invasion or pleural effuison are poor prognostic
  feature.
• Recurrence Less than 5 years.