Aunque no es facil discernir el grado de atipias o la presencia de mitosis, me inclino por un Fibroma pleural submesotelial

TUMOR FIBROSO SOLITÁRIO DA PLEURA

Me parece un tumor fibroso solitario de la pleura. Realizaría cd-34.

Solitary fibrous tumor of the pleura.

CD34 and Bcl-2 must be positive and cytokeratin negative.

Benign appearance both clinical and microscopic supports,

Localized fibrous tumor of pleura/Pleural fibroma.

Proliferación mesenquimal fusocelular compatible con tumor fibroso solitario. Coincido en solicitar bcl2, cd 34 y actina musculo específica.

I think it could be a Solitary fibrous tumor of the pleura.

I'm not completely sure about the histological benign appearance of the lesion.

Is there a necrotic area depicted in Fig. 3 and mitotic figures in Fig. 4?

Besides markers such as CD34 and Bcl-2 it perhaps could be helpful to search for other features, such as p53 expression and assess the proliferative rate.

Clelia Miracco

Department of Human Pathology and Oncology

Siena

Italy

Solitary fibrous tumor of pleura

Estimados Dr. Stephen Berns e demais colegas do foro

Embora eu considere o diagnóstico de tumor fibroso solitário uma boa hipótese, acho que, em algumas imagens, a celularidade que se observa é grande demais. Alguns focos são praticamente sólidos. Na figura 2 observei o que parece ser material mucinoso no interior de alguns agregados celulares.

Minha primeira hipótese diagnóstica é de um SARCOMA SINOVIAL PLEURAL. Acrescentaria EMA e queratina ao painel imunoistoquímico que, certamente, deverá incluir o CD34.

Abraços a todos

Romualdo

Caruaru - Brasil

Solitary fibrous tumor of pleura.

Cari saluti a tutti

Vincenzo Polizzi

Acrescentaria ao diagnóstico diferencial Fasciite nodular.

Grato

Tumor fibroso solitário.

Hospital Geral de Bonsucesso

Rio de Janeiro Brasil

CARACTERÍSTICAS CITOLÓGICAS BENIGNAS. TUMOR FIBROSOS SOLITARIO DE LA PLEURA

Vejo uma neoplasia de células fusiformes, raras delas com discreta anaplasia. A avaliação de mitoses é difícil nestas imagens, mas acho que há algumas.

A minha principal hipótese diagnóstica como muitos colegas já falaram é um tumor fibroso solitário pleural, porém não dá para afastar outras neoplasias de células fusiformes.

Tumor fibroso solitario

Ciao a tutti da Milano

I am not sure that this is a solitary fibrous tumor of the pleura because of the high cellularity in some microscopic fields, the lack of at least focal hemangiopericytoma-like pattern, the presence of necrosis, the presence of abundant newly formed small vessels. In addition, the clinical history of the patient is important (previous excision of a soft tissue tumor?) as well the radiologic features of the lesion (size of the lesion? is it an infiltrative growth? is there any involvement of the lung?). The hypothesis of pleuropulmonary synovial sarcoma is interesting but this latter is supposed to be a mitotically active tumor. In conclusion, I wish to add another hypothesis: spindle-cell hemangioendothelioma.

TUMOR FIBROSO MALIGNO SOLITARIO DE LA PLEURA

England et al5 reviewed 223 cases of localized fibrous tumor of the pleura and developed histologic criteria to separate malignantlesions from their benign counter-parts.Criteria for malignancy include high cellularity, high mitotic rate (more than 4 mitoses per 10high-power fields), pleomorphism,hemorrhage, and necrosis. Our case exhibited malignant histologic features including areas of high cellularity, mitoses,cellular pleomorphism,and focal necrosis.

Histologic differential diagnoses of pleural-based malignant spindle cell tumors include malignant localized fibrous tumor, spindle cell carcinoma,Sarcomatoid malignant mesothelioma, and various sarcomas. Immunohisto-chemical studies are usually helpful in separating these entities.

Localized fibrous tumors of thepleura are negative for keratin and are frequently reactive for CD34.Both spindle cell carcinomas and sarcomatoid malignant mesotheliomas are positive for keratin.Additionally, malignant mesothe-liomas may also be positive for mesothelial marker calretinin.Sarcomas are typically negative for both keratin and CD34, although positive staining for either markermay occur in rare cases.

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Urschel JD,Brooks JS,Werness BA,etal. Metachronous benign solitary fibroustumours of the pleura (localized “mesothe-liomas”): a case report. Can J Surg. 1998;41:467-469.

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Carter D, Otis CN. Three types ofspindle cell tumors of the pleura: fibroma,sarcoma, and sarcomatoid mesothelioma.Am J Surg Pathol. 1988;12:747-753.

Crotty TB, Myers JL, Katzenstein AL,et al. Localized malignant mesothelioma: aclinicopathologic and flow cytometricstudy. Am J Surg Pathol. 1994;18:357-363.

Ali SZ,Hoon V,Hoda S,et al. Solitaryfibrous tumor: a cytologic-histologic studywith clinical, radiologic, and immunohisto-chemical correlations. Cancer. 1997;81:116-121.

Attanoos RL,Dojcinov SD,Webb R,etal. Anti-mesothelial markers in sarcomatoidmesothelioma and other spindle cell neo-plasms. Histopathology. 2000;37:224-231.

Fisher C. Synovial sarcoma. AnnDiagn Pathol. 1998;2:401-421.