CTICasesHypervascular Parietal Pleural Solitary Fibrous Tumor
Imaging findings
Chest radiograph shows an extrapleural mass in the upper left hemithorax demonstrating an incomplete border sign and obtuse margins with the chest wall, without rib destruction. Contrast-enhanced CT and MRI show extreme hypervascularity, marked heterogeneous enhancement, and a "salt-and-pepper" appearance on T2-weighted MRI, mimicking an intercostal artery aneurysm or a paraganglioma.
Key takeaways
Surgical resection and pathology confirmed a solitary fibrous tumor (formerly hemangiopericytoma) of the parietal pleura, which stained strongly positive for STAT6. While solitary fibrous tumors typically arise from the visceral pleura and are moderately vascular, they can occasionally arise from the parietal pleura and demonstrate profound hypervascularity, mimicking paragangliomas, vascular malformations, or Castleman's disease. STAT6 immunohistochemistry is critical in confirming the diagnosis.
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