Ann Thorac Surg 2006;81:2316
© 2006 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Localized Fibrous Mesothelioma: An Extremely Rare Benign Pleural Tumor
Christophoros Kotoulas, MD
a
,
*
,
Maria Fotinou, MD
b
,
Emily Tsaroucha, MD
b
,
Marios Konstantinou, MD
b
,
Achilles Lioulias, MD
b
a General Military Hospital of Athens, Athens, Greece
b Chest Diseases Hospital of Athens, Athens, Greece
* Address correspondence to Dr Kotoulas, 82 Grasmere Rd, Gatley, Cheadle, SK8 4RS, UK (Email: chrkotoulas{at}hol.gr).
A 43-year-old white housewife presented with nonproductive cough and fever. No asbestos exposure was documented. Physical examination and blood tests were normal. Chest roentgenogram showed a left loculated pleural effusion. Computed tomographic scan revealed a lunate, mixed-density, mass-like lesion pleural-based (Fig 1).
An exploratory thoracotomy was performed and a 10 x 8 x 5 cm yellowish, fibro-adipose, pedunculated mass was resected from the parietal pleura (Fig 2). There was neither chest wall nor pulmonary invasion nor mediastinal adenopathy.
Histology showed the tumor to consist of intermixed mature adipose and fibrous tissue with no cellular atypia or mitotic activity. A few invaginations lined by a single row of mostly flattened mesothelial cells crisscrossed the tumor. Immunohistochemistry showed these cells to stain with anti-cytokeratins and mesothelioma (HBME-1) antibodies, whereas mesenchymal cells stained for vimentin. A diagnosis of localized fibrous mesothelioma was rendered (Fig 3).
The patient is alive and well 4 years postoperatively, without any clinical or radiologic sign of recurrence.
Most benign variety tumors as compared with malignant tumors tend to be small in size and are more often in a typical location. On the other hand malignant tumors may show an increased cellularity, cellular pleomorphism, and high mitotic counts. The use of the HBME-1 clone cannot differentiate between benign and malignant epithelial mesothelioma. Finally, most of the patients with benign localized fibrous tumors of the pleura are cured by adequate resection of the lesion.
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M. A Regal, A. M Al Rubaish, Y. F Al Ghoneimy, and R. I Hammad
Solitary Benign Fibrous Tumors of the Pleura
Asian Cardiovasc Thorac Ann,
April 1, 2008;
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139 - 142.
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