Cardinale Luciano, Dalpiaz Giorgia, Pulzato Ilaria, Ardissone Francesco
Department of Radiology, University of Turin, and Department of Clinical and Biological Sciences, San Luigi Hospital, Orbassano, Turin, Italy.
Department of Radiology, Bellaria Hospital, Bologna, Italy.
Lung India. 2018 Mar-Apr;35(2):121-126. doi: 10.4103/lungindia.lungindia_375_17.
Solitary fibrous tumor of the pleura (SFTP) arising from the mediastinal pleura may be confused with primary mediastinal tumors. We studied the computerized tomographic (CT) findings of patients with SFTP that could suggest a diagnosis of SFTP.
At our hospital from January 1995 to June 2012, 39 patients with histologically confirmed SFTP were surgically treated; seven of them abutting the mediastinal pleura. The study group included seven patients aged between 53 and 81 years. Baseline CT scans were retrospectively reviewed to identify radiological findings suggestive of SFTP including: (1) smooth and sharply delineated contours; (2) obtuse, acute, or tapering angles between the lesion and the mediastinum depending on the size; (3) homogeneous soft-tissue attenuation; (4) "geographic pattern" due to the contemporary presence of large vessels, necrosis, and calcifications; (5) displacement of the lung parenchyma; (6) presence of a cleavage plane; and (7) absence of lymphadenopathy or pleural methastasis.
All tumors formed acute angles with the pleura. Six out of the seven presented smoothly tapering margins, three had a "geographic pattern" of attenuation and displaced the anterior junction line; one showed an outside junction line development. Four cases had a clear pleural origin.
The possibility of SFTP should be taken into account when a mass abuts the mediastinum projecting inside the thoracic cavity in the presence of an intense and "geographical pattern" of enhancement without lymphoadenopathy or pleural metastasis. These findings assume greater significance in the presence of discrepancy between the size of the lesion and the clinical presentation.
起源于纵隔胸膜的胸膜孤立性纤维瘤（SFTP）可能与原发性纵隔肿瘤相混淆。我们研究了SFTP患者的计算机断层扫描（CT）表现，这些表现有助于提示SFTP的诊断。
1995年1月至2012年6月期间，我院对39例经组织学确诊的SFTP患者进行了手术治疗；其中7例紧邻纵隔胸膜。研究组包括7例年龄在53至81岁之间的患者。对基线CT扫描进行回顾性分析，以确定提示SFTP的影像学表现，包括：（1）轮廓光滑且界限清晰；（2）根据病变大小，病变与纵隔之间的角度为钝角、锐角或逐渐变细；（3）均匀的软组织密度；（4）由于同时存在大血管、坏死和钙化而形成的“地图样表现”；（5）肺实质移位；（6）存在分隔平面；（7）无淋巴结肿大或胸膜转移。
所有肿瘤与胸膜形成锐角。7例中有6例边缘呈平滑逐渐变细，3例有密度“地图样表现”并使前交界线移位；1例显示外侧交界线形成。4例有明确的胸膜起源。
当肿块紧邻纵隔并向胸腔内突出，同时存在强化的“地图样表现”且无淋巴结肿大或胸膜转移时，应考虑SFTP的可能性。当病变大小与临床表现不符时，这些表现具有更大的意义。
