Solitary Fibrous Tumor Of The Pleura:Clinical Report Of 15 Cases

Objective:Report 15 cases of patients who had accepted surgery due to the Solitary fibrous tumor of the pleura and integrated analyze some previous literatures.The contents of the study covers the origination of the SFTP,clinical manifestations,imaging features,pathology and immunohistochemical result of neoplasia,surgical approach and prognosis.In order to explore the clinical pathological characteristics,the effect of the surgery and give an aid to improve the level of diagnosis and treatment of SFTP.Methods:Retrospectively analyze 15 cases of patients with localized fibrous tumor of the pleura in Shandong provincial hospital during 2003-2016.The analysis includes the medical history,physical examination,diagnosis,radiologic characteristics of SFTP,the method of surgery(VATS,sternotomy,minithoracotomy and thoracotomy),the pathological characteristics of the disease and the prognosis.Results:In 15 patients,6men and 9 women,ages from 41 to 69 years old,average age(53.1 + 7.8),the median age is 51,8 cases are asymptomatic,1 case has HPO,1 case has DPS,Thoracic CT Scan discovered that 8 cases’ tumor were on the left side,7 cases right;9 cases accepted preoperative needle biopsy(7 under the guide of CT or MRI and 2 under the guide of Fiberoptic Bronchoscopic Procedure),but only 6 ceases got exact diagnosis.2 cases of tumor(13%)accepted VATS resection,3 cases(20%)accepted minithoracotomy,9 cases(60%)accepted standard complete resection thoracotomy and 1 case(7%)accepted sternotomy.The tumor diameter varies from 2-24 cm.Postoperative pathological results:malignant in 2 cases and 13 cases were benign.Immunohistochemistry showed that all patients for CD34,vimentin positive and cytokeratin negative.Follow-up time ranged from 6 to 60 months.To the end of the research project,all patients were alive and no distant metastasis cases were found.Conclusion:SFTP is a rare disease,it only accounts about 5%of the pleura neoplasms.About 80%are benign and 20%are malignant,More than half of the cases are asymptomatic,Along with the increase of the tumor size,compressed symptoms will appear,such as cough,chest pain and dyspnea.Paraneoplastic syndrome is relatively rare.The incidence of HPO and DPS are 25%and 5%respectively.SFTP don’t have typical imaging features.X-ray,CT and MRI can’t diagnose it exactly.Needle biopsy has a low specificity.It’s usually difficult to get definite diagnosis preoperatively.The diagnosis relies mainly on the postoperative pathological and immunohistochemical analysis.Surgery is the main treatment method.Benign or small tumor can accept VATs.VATs has obvious advantages compared with standard thoractomy,it has less surgical trauma,less postoperative complications and faster recovery.Some tumors invade lung tissue or chest wall.To ensure the integrity of the tumor resected and to prevent the local recurrence,it’s need to remove part of the lung and chest wall.Surgery cut edge is required to be negative.Complete resection leads to a better prognosis,long-term follow-up is required after the surgery.Patients should accept CT examination every six months in the first 2 years after surgery and then once a year after 2 years.After complete resection,the prognosis of benign SFTP is good,recurrence of mSFTP without pedicel is more than 60%,mSFTP with pedicel is over 10%.So strict follow-up is required.