CTICasesRecurrent Malignant Solitary Fibrous Tumor of the Pleura
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Imaging findings
Initial chest X-ray showed a markedly elevated right hemidiaphragm. CT revealed a large, circumscribed, heterogeneous, pleural-based mass in the right hemithorax, depressing the diaphragm but maintaining a fat plane. The mass contained areas of calcification. A small ipsilateral pleural effusion and a solitary lung nodule were also present. PET CT showed heterogeneous FDG uptake in the mass with no uptake in the contralateral lung nodule. Post-resection, follow-up CT demonstrated recurrent right pleural-based nodules, now with bone destruction and extension through the ribs, as well as additional pulmonary nodules.
Key takeaways
Solitary fibrous tumors of the pleura (SFTP) can be malignant, presenting as large, heterogeneous, circumscribed pleural masses that may calcify and mimic an elevated hemidiaphragm. Malignant SFTPs have a high propensity for local recurrence and aggressive behavior, including invasion into adjacent structures like bone, and distant metastasis, even after surgical resection. Careful follow-up is crucial for patients with malignant SFTPs due to this high recurrence risk.
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