CTICasesSolitary Fibrous Tumor of the Pleura
Imaging findings
Chest radiograph demonstrates a large right-sided mass with a well-circumscribed inferior and medial border and a fading superior margin, creating an incomplete border sign (waterfall sign) suggesting an extraparenchymal or pleural-based origin. CT confirms a very large, high-attenuation, heterogeneous solid mass with internal vessels visible and mild adjacent pleural thickening. The mass abuts but is separate from the lung. There may be intercostal artery feeders visible supplying the mass. The tumor was resected via thoracotomy with a portion of lung due to adhesions in a chronic smoker.
Key takeaways
Solitary fibrous tumor (SFT) of the pleura is a rare mesenchymal neoplasm that typically presents as a large, well-circumscribed pleural-based mass on chest radiograph. The incomplete border sign or waterfall sign on radiograph is characteristic of extra-pulmonary masses. On CT, SFT appears as a large heterogeneous solid mass with internal vessels and sometimes feeding intercostal arteries. SFTs are CD34 positive on immunohistochemistry and were formerly called benign mesothelioma — a misnomer since they are neither mesothelial nor always benign. Doege-Potter syndrome (hypoglycemia from IGF-2 production) is a reported paraneoplastic association, though exceedingly rare in practice.
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