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Surgical treatment of a massive solitary fibrous tumor of the pleura associated with symptomatic hypoglycaemia

Georgi Mladenov, Djuliana Stoilova, Yasen Georgiev, Nikolai Tsvetkov, Daniel Bulyashki

Abstract

Introduction: Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating from the pleu­ra. SFT is sometimes linked to hypoglycaemia due to the production of Insulin-like growth factor 2 by the tumor. This is known as the Doege-Potter syndrome.

Materials and methods: Presented is a case of a 39-year-old male first admitted to endocrinology for clarification of hypoglycaemia who was later transferred to thoracic surgery due to the finding of a large mass and pleural effusion in the thoracic cavity. Shortness of breath and a persisting cough were also present complaints. The patient underwent a computed tomography (CT) scan and was diag­nosed with a large tumor taking up ¾ of the chest cavity along with a massive hemorrhagic right pleu­ral effusion. The SFT exerted pressure on the structures of the mediastinum: heart and large blood vessels; all of which were shifted left. A CT assisted Tru-Cut biopsy was performed to determine the histology of the mass. It was concluded that the tumor was a benign SFT. Benign SFTs, in comparison to malignant SFTs, make up about 78% to 88% of all diagnosed SFTs. A Positron-emission tomogra­phy scan performed on the whole body came back negative for pathological cell activity. It was also determined that the right lung was shifted cranially by the formation but limited-in-size ventilated parenchyma remained.

Results: To remove the tumor an embolization of the nutritive vessels and an en bloc resection of the tumor, pericardium and right lung was performed. The patient`s postoperative course was unevent­ful and his hypoglycaemic symptoms resolved just after the operation.

Conclusions: SFTs are uncommon findings in pulmonary pathology, especially these associated with paraneoplastic hypoglycaemia. Surgical resection is the cornerstone of their treatment leading to im­mediate improvement of the symptoms and usually without recurrence.


Keywords

solitary fibrous tumor; paraneoplastic hypoglycaemia




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4635

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