Pleural fibrous tumors

Pleural fibrous tumors

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Most of pleural tumors are metastatic. Primary tumors of the pleura can be divided as diffuse or localized. Diffuse malignant mesothelioma is frequently associated with asbestosis and a negative prognosis. Mesothelioma is located is called localized fibrous tumor of the pleura, less frequent and not related to exposure to asbestos.
Pleural fibrous tumors can be malignant or benign. Rare tumor is invasive or cause local recurrence after resection. Early diagnosis is important because the tumor is potentially resectable tumor despite the large size. In some cases resection can be repeated to treat recurrence.
The etiology of these tumors is unknown. There are no association with smoking or exposure to asbestos. Although some studies indicate the origin of mesothelial tumors, malignant mesothelioma are different. Most patients are asymptomatic and the lesion is discovered incidentally on radiography. When is this symptoms are usually related to local mass effect or associated paraneoplazic phenomenon. Symptomatic patients may report dyspnea, cough or vague chest or shoulder pain.
Paraneoplazice manifestations have been reported for these tumors, including pulmonary hypertrophic osteoartropatia and hypoglycemia. The fibrous tumors of the pleura are usually discovered at chest radiography. CT scan and MRI may suggest the diagnosis. However, histopathologic examination is indicated for definitive diagnosis. Transthoracic needle biopsy in the evaluation is performed as part of the patient with a pleural mass.
In almost all cases the treatment of choice is surgical resection. The surgeon has to save as much lung parenchyma and obtain negative tumor margins. An open thoracotomy is necessary to remove large masses. Sessile masses of visceral pleura require major resections such as lobectomy or less pneumectomie. More rarely sessile tumors appear as formations that develop in the parietal pleura or chest wall, diaphragm or mediastinum. These tumors are prone to recurrence and require wide resection of a portion of the thorax.
Pathogenesis: Macroscopic tumors present as diffuse or localized lesions. Diffuse pleural mesothelioma tumors known as mesothelial cells in pleural diffuse, have a high degree of malignancy and are often associated with exposure to asbestos. Localized tumors, less frequently, pleural solitary fibrous tumors are known to arise from mesenchymal cells in the tissue adjacent to the mesothelial layer. Typically these tumors develop from the pleural space, but have been reported and other sites such as meninges, epiglottis, salivary galndele, oral cavity, pharynx, thyroid, breast, kidney, peritoneal cavity.
Macroscopically: Benign tumors present as a solitary mass lobular, encapsulated, solid, attached to the pleura by a well vascularized pedicle or a broad base covered with a shiny smooth capsule. The section finds a uniform or nodular, solid, pale gray, with areas ranging from soft cyst and areas of necrosis and hemorrhage. The tumor varies in diameter from 1 cm to 39 cm, with an average of 6-8 cm. can appear anywhere on the surface of intrathoracic pleura, most commonly in the visceral pleura. Intrascizural lesions may occur, rarely intrapulmonar. Rarely arise in the parietal pelura more likely to be malignant is higher in these cases. In most cases, a solitary tumor, the presence of multiple lesions is extremely rare.