Intrapulmonary solitary fibrous tumour: a rare neoplasm of the lung and a challenging pre-operative diagnosis

Abstract

BACKGROUND: Case report of a 78-year-old male who came to our observation for a growing pulmonary mass of the left upper lobe without a pre-operative diagnosis. Post-operative histopathology revealed an intrapulmonary Solitary Fibrous Tumour (SFT) of the lung.

CASE REPORT: The pulmonary lesion was an ovoid mass centrally located in the left upper lobe; it had been known and stable in size for two years; the last Chest Computed Tomography (CT) Scan highlighted a marked increase in maximum diameter (35 versus 22 mm) with contrast enhancement. In view of the growth of the lesion, the patient was referred for surgery after multidisciplinary team evaluation, although a pre-operative diagnosis had not been reached. The patient underwent Video-Assisted Thoracic Surgery (VATS) left upper lobectomy by a biportal approach. The pulmonary nodule consisted of a proliferation of bland-looking spindle cells intermingled with fibrotic stroma and alternating sclerotic and cellular areas. At immunohistochemistry, the spindle cells expressed CD34, bcl2 and CD99. A final diagnosis of intrapulmonary SFT was reached. The 36-month follow-up was negative for relapses.

CONCLUSIONS: Primary intrapulmonary SFTs are extremely rare neoplasms, generally with benign biological behaviour; surgical resection is safe and essential in order to be curative and can be achieved by a minimally invasive approach. Pre-operative diagnosis is challenging, due to aspecific clinical and radiological features.