CTICasesMalignant Fibrous Tumor of the Pleura (Mediastinal Origin)
Imaging findings
A very large, firm-appearing mass is seen in the posterior mediastinum, originating from the posterior part of the mediastinum and extending posteriorly, accompanied by a pleural effusion. The mass shows some calcification and causes minimal mass effect on adjacent airways. Biopsy initially suggested small cell carcinoma, but after radiological consultation, immunohistochemical stains (including CD34) were strongly positive for fibrous tumor of the pleura, and gene rearrangement for synovial sarcoma was negative. Pathology revealed small, uniform cells, a fair mitotic rate, and necrosis.
Key takeaways
Fibrous tumors of the pleura, often large, can arise from atypical locations such as the mediastinal pleura, mimicking a mediastinal mass. Radiological findings combined with immunohistochemistry are crucial for differentiating them from other malignancies like small cell carcinoma or synovial sarcoma. Malignant forms can show high mitotic rates and necrosis. Surgical resection can be extensive due to adherence to surrounding structures.
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