Fact-sheet: Solitary fibrous tumor
Updated on 02/26/2021 at 2:47 PM
View all RADEOS cases associated with this fact-sheet
Definition
Tumor of submesothelial connective tissue, typically benign (80%), mainly affecting the pleura but also occurring extrapleurally.
Cellular, fibrous, and vascular components
Clinical features
Between 50 and 60 years of age
Characteristic signs:
- often asymptomatic
- chest pain/dyspnea
- Low blood glucose Hypoglycemia
- osteoarthropathy
- arthralgia
Radiography
Homogeneous, well-defined, round or oval mass
Adjacent to the pleura or to the fissures
Obtuse pleural angle (70-90%)
Basal predominance
Mobile or change in morphology with positional changes if pedunculated
Ultrasound
Well-defined hypoechoic lesions
CT
Well-defined tissue mass, smooth or lobulated
Pleural origin
Structure and enhancement +/- heterogeneous
Vascular network with a vascular pedicle sometimes visible
Mass effect rather than invasion of adjacent structures
Mobility with positional change
MRI
Hypo/isointense on T1
Hypointense on T2 but variable depending on the nature of the tumor:
- Hyperintense if cellular, necrosis, hemorrhage
- Hypointense if fibrotic
- Signal voids ("flow voids") within intratumoral vessels
Enhancement after injection
Delayed sequence to differentiate necrosis from fibrosis
Vascular intervention
+/- preoperative embolization to reduce hemorrhagic risk
Management
Complete en bloc surgical resection
Classification
Criteria favoring malignancy:
- Size >10 cm
- Heterogeneity
- Necrotic area
- Diffusion restriction
- Pleural effusion
- Mitotic activity
- Hypermetabolism on PET
Definite malignancy: invasion of adjacent structures and secondary localizations
Differential diagnosis
Sarcomas ++