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with a Ki67 proliferation index of 10&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Metastatic fibrous tumor was diagnosed and the chemotherapy committee decided to administer 4 cycles of doxorubicin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The disease progressed with tumor growth&#44; pain&#44; cholestasis&#44; pyloric syndrome&#44; and dyspnea&#46; Subsequently&#44; an incisional biopsy of a lesion on the patient&#39;s forearm revealed the same tumor characteristics&#44; but this time Ki67 proliferation index was 25&#37;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Currently&#44; 2 years after diagnosis&#44; the patient is receiving second-line paclitaxel&#44; with little response&#44; and local radiation therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Intrapulmonary fibrous tumor forms from submesothelial fibroblasts in the pulmonary parenchyma&#44; 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Letter to the Editor
Intrapulmonary Solitary Fibrous Tumors: Benign or Malignant?
Tumor fibroso solitario intrapulmonar: ¿benigno o maligno?
Emiliano Schiavonia,
Corresponding author
schiavoniemiliano@gmail.com

Corresponding author.
, Facundo Alvarez Padillaa, Mario Bustosa,b
a Servicio de Cirugía de Tórax, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina
b Miembro de la Asociación Iberoamericana de Cirugía Torácica (AIACT), Argentina
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        "titulo" => "Tumor fibroso solitario intrapulmonar&#58; &#191;benigno o maligno&#63;"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest computed tomography&#44; showing a 25-mm nodular image in the basal segment of the right lung field&#46; &#40;B&#41; Tomography slice of the abdomen&#44; showing a mass in liver segment V&#44; measuring approximately 30<span class="elsevierStyleHsp" style=""></span>mm&#46; &#40;C&#41; Magnetic resonance image of nodular formation located between the muscle planes of the palm and distal third of the right forearm&#44; 50<span class="elsevierStyleHsp" style=""></span>mm&#215;30<span class="elsevierStyleHsp" style=""></span>mm&#215;20<span class="elsevierStyleHsp" style=""></span>mm&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 59-year-old woman with a pulmonary mass&#44; who presented due to a 3-month history of discomfort in the left hemithorax&#46; Chest computed tomography showed a mass of 67<span class="elsevierStyleHsp" style=""></span>mm&#215;87<span class="elsevierStyleHsp" style=""></span>mm with defined borders&#44; soft-tissue density&#44; and peripheral calcifications&#44; in the lower left lobe&#59; and&#44; in the same lobe&#44; another lesion with the same characteristics&#44; measuring 26<span class="elsevierStyleHsp" style=""></span>mm&#215;39<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Clinical staging was negative&#44; and 15 days after diagnosis a left lower lobectomy was performed with resection extended to the diaphragm&#46; The pathology report revealed 2 tumors&#44; one 80<span class="elsevierStyleHsp" style=""></span>mm&#215;63<span class="elsevierStyleHsp" style=""></span>mm and the other 45<span class="elsevierStyleHsp" style=""></span>mm&#215;34<span class="elsevierStyleHsp" style=""></span>mm&#44; with disease-free margins&#46; Both tumors had the same microscopy report of spindle cell neoplasm with lengthened&#44; hyperchromatic nuclei&#44; and areas of epithelioid cells&#46; Diaphragmatic muscle fibers showed no signs of malignant infiltration&#46; Immunohistochemistry was positive for CD34 and Bcl-2&#44; with Ki67 proliferation index of 2&#37;&#46; Diagnosis was intrapulmonary fibrous tumor with pleural involvement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient remained asymptomatic and disease-free until 16 months after the intervention&#44; when multiple nodules consistent with metastases were detected in the lungs&#44; pleura&#44; liver&#44; bone&#44; and muscles &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A lung biopsy was performed and the pathology findings showed the same microscopic characteristics as the previous lesions&#44; with a Ki67 proliferation index of 10&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Metastatic fibrous tumor was diagnosed and the chemotherapy committee decided to administer 4 cycles of doxorubicin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The disease progressed with tumor growth&#44; pain&#44; cholestasis&#44; pyloric syndrome&#44; and dyspnea&#46; Subsequently&#44; an incisional biopsy of a lesion on the patient&#39;s forearm revealed the same tumor characteristics&#44; but this time Ki67 proliferation index was 25&#37;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Currently&#44; 2 years after diagnosis&#44; the patient is receiving second-line paclitaxel&#44; with little response&#44; and local radiation therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Intrapulmonary fibrous tumor forms from submesothelial fibroblasts in the pulmonary parenchyma&#44; and is very rare&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is a slow growing tumor&#44; with a benign course&#44; and detection is incidental&#46; Even more rare is the malignant form&#44; which we present here&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Radiologically&#44; it is visualized as a nodule with defined borders&#44; with or without internal calcifications&#44; and heterogeneous uptake of intravenous contrast medium&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The histological features are those described above&#44; and it is identical to pleural fibrous tumor&#46; Immunohistochemistry is positive for CD34 antibody in 100&#37; of cases&#44; CD99 antibody in 70&#37; of cases&#44; Bcl-2&#44; SMA and epithelial membrane antigen in 20&#37; of cases&#44; and vimentin in 90&#37; of cases&#59; it is negative for cytokeratins&#44; actin&#44; desmin&#44; and S100 protein&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment of choice is resection with disease-free margins&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Systemic chemotherapy may be administered&#44; but doubts remain as to its usefulness&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Five-year survival is greater than 90&#37; and the rate of recurrence is 1&#46;4&#37; in benign forms and between 9&#37; and 19&#37; in malignant variants&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As demonstrated by our patient&#44; the biological behavior and the unpredictable course of fibrous tumor make long-term follow-up essential&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Schiavoni E&#44; Padilla FA&#44; Bustos M&#46; Tumor fibroso solitario intrapulmonar&#58; &#191;benigno o maligno&#63; Arch Bronconeumol&#46; 2016&#59;52&#58;225&#8211;226&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest computed tomography&#44; showing a 25-mm nodular image in the basal segment of the right lung field&#46; &#40;B&#41; Tomography slice of the abdomen&#44; showing a mass in liver segment V&#44; measuring approximately 30<span class="elsevierStyleHsp" style=""></span>mm&#46; &#40;C&#41; Magnetic resonance image of nodular formation located between the muscle planes of the palm and distal third of the right forearm&#44; 50<span class="elsevierStyleHsp" style=""></span>mm&#215;30<span class="elsevierStyleHsp" style=""></span>mm&#215;20<span class="elsevierStyleHsp" style=""></span>mm&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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