Pleural fibroma

Pleural fibromas (PF), also known as solitary fibrous tumours of the pleura (SFTP), are a rare benign pleural-based tumour that accounts for <5% of all tumours involving the pleura.

Usually presents in the  6th to 7th decades. There is no recognised gender predilection.

Usually asymptomatic and discovered as an incidental finding on a routine chest radiograph 3. Of those who are symptomatic, clinical presentation can be with either a cough, chest pain or shortness of breath. 

Associations

Asbestos exposure is not an association.

They are composed of irregularly arranged fascicles comprising of spindle cells with collagen separation. Thought to originate from submesoepithelial mesenchymal cells. Approximately 80% of pleural fibromas arise from the visceral pleura. Myxoid or cystic degeneration can occur. 

Location

There may be a predilection towards the mid to lower zones of the chest. In ~80% of cases, they arise from visceral pleura, with the remainder arising from the parietal pleura.

Variants
Plain radiograph

Presents as a pleural based mass. Tends to be relatively circumscribed and can sometimes be lobulated. It often forms an obtuse angle with the chest wall. Tumours may grow to a large size. Pedunculated lesions can change position and appearance with respiration or with a change in position (on serial radiographs). 

Calcification, rib destruction, and pleural effusions are typically not associated features

CT

Tends to have soft tissue attenuation on unenhanced scans and show relatively homogenous intense background enhancement on contrast-enhanced scans (from rich vascularization). Non-enhancing areas may be present corresponding to necrosis, myxoid degeneration, or haemorrhage within the tumour. A pedicular attachment may also be seen.

MRI

Due to the fibrous component, signal characteristics tend to be

  • T1: typically low to intermediate signal
  • T2: typically low signal overall (thought to be due to high cellularity and abundant collagen); areas of necrosis and myxoid degeneration can have high signal

MR may also show necrotic, haemorrhagic and cystic components in better detail if these entities are present. 

The majority of tumours tend to be benign and slow growing. Malignant tumours are extremely uncommon but have been reported. Surgical resection is the treatment of choice 5-6.  There can be recurrence in a small proportion (~15%) of cases.

Considerations for extremely well-defined lesions include:

If not extremely well defined broader, considerations include:

Also, consider the differential for a single pleural mass.

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Article Information

rID: 9690
System: Chest
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Solitary fibrous tumour of the pleura
  • Solitary fibrous tumour of pleura
  • Benign fibrous mesothelioma of pleura
  • Localised fibrous tumour of pleura
  • Localized benign fibrous tumor of pleura
  • Pleural fibromyxoma
  • Localised fibrous tumour of pleura (LFTP)
  • Localized fibrous tumor of pleura
  • Solitary fibrous tumour of the pleura (SFTP)
  • Pleural fibromas

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