2024年 · 第104卷第30期

The patient, a 55-year-old female, went to Weifang Second People's Hospital for "chest tightness and right chest pain for 5 days". Physical examination showed that the right lower lung was percussed with turbidity and the right lung was breathing with low sound. Enhanced chest CT showed that the right pleura occupied space, about 88 mm ×90 mm in size, with uneven density, and low-density shadows (Figure 1). Enhanced scan showed obvious enhancement, low-density without enhancement, compression of surrounding tissue, right pleural effusion, incomplete dilation of the right lung (Figure 2), and bone destruction adjacent to the right sixth rib. Color ultrasound showed right pleural effusion of 3.5 cm. Pleural effusion biochemistry suggests exudate. Pathology of pleural tumor biopsy showed that tumor cells were diffusely distributed and abundant in tumor tissue, with spindle-shaped tumor cells, irregular nucleus, deep staining, occasional nuclear division, and not obvious necrosis; Immunohistochemistry: Calcium binding protein antibody (-), WT-1 (-), vimentin (+), desmin (-), insulin-like growth factor II mRNA binding protein 3 (-), signal transduction and transcription activator 6 (+), CD34 (+), B lymphoblastoma-2 gene (+), Ki-67 5%, S-100 (-), diagnosis: consistent with undetermined malignant potential or low-grade malignant spindle cell tumor-solitary fibrous tumor. Clinical diagnosis of solitary fibrous tumor of the pleura (SFTP). SFTP is a tumor originating from dendritic stromal cells in pleural submesothelial tissue. Most of them are benign or borderline, and 10% ~20% are malignant. Common clinical symptoms include cough, chest pain, dyspnea, fever, weight loss, etc. The chest CT findings have certain characteristics. The lesions are mostly single, mostly enveloped, and the boundaries are clear. The malignant signs are unclear boundaries, partial necrosis, and invasion of adjacent tissues. The density of smaller lesions is more uniform, and the mucocystic changes can be seen in larger lesions. The enhanced scan shows "map-like" enhancement, intratumoral staphyloid vessels and peritumoral vascular pedicles.