A case of solitry fibrous tumor originating in the chest wall for which transcutaneous arterial embolization worked out preoperatively

Abstract

A 51-year-old man complained of common cold like symptoms. A chest X-ray film showed a mass lesion (13cm in diameter) in the right thorax, and a chest CT and a MRI film suggested that the tumor was a blood-rich chest wall tumor. Many feeding vessels were shown. A diagnosis of solitary fibrous tumor was established by CT guided needle biopsy, but then right pleural effusion increased with progression of anemia. To reduce operative blood loss, transcutaneous arterial embolization was performed on the day before the operation. Right 7th to 11th intercostal arteries were proved to be feeders by aortography, and embolized. After thoracotomy, bloody effusion retained was about 1000ml and a huge tumor was found to be abhered to the chest wall over 4 vertebrae and 5 intercostal spaces. So we abandoned extensive chest wall resection. The tumor was removed extrapleurally. Many fragile tumor vessels were shivered carefully. The Gross appearance showed the tumor had whitish capsules. We confirmed by frozen section that the resected margin was free from tumor invasion, so we stopped additional chest wall resection. The pathological diagnosis was a solitary fibrous tumor showing a pericytic vascular pattern in large parts. Immunohistochemical analysis showed it to be marginally malignant, so radiation therapy was administered to the chest wall. There is no sign of recurrence. We conclude that preoperative TAE is effective to safely resect huge SFTPs, which are diagnosed in the chest wall and blood-rich.