A rare case of solitary fibrous tumor of the pleura: An unusual presentation

A 69-year-old male presented with rapidly worsening symptoms, including breathlessness, productive cough, and weight loss. Physical examination revealed a deviated trachea and absent breath sounds on auscultation of the left side of the chest. Radiographic imaging revealed a large pleural mass associated with a significant pleural effusion, subtotal lung collapse, and mediastinal shift. Pulmonary function tests showed severe impairment, with a 39% forced expiratory volume in 1 second (FEV1) and 62% diffusing capacity of the lungs for carbon monoxide (DLCO). A positron emission tomography-computed tomography (PET-CT) scan showed mild avidity in the lesion. Definitive management involved a staged approach with initial decompression followed by surgical resection via a left double-space open thoracotomy. Intraoperatively, the tumor was found to occupy three-quarters of the chest cavity. The entire lung was adherent to the chest wall. Histological analysis showed pattern less architecture with high vascularity, hypercellularity, necrosis, elongated nuclei, pale cytoplasm, and high mitotic activity. Immunohistochemical staining was positive for CD34, BCL2, CD99, Ki-67, and STAT6, leading to a diagnosis of solitary fibrous tumor (SFT). The malignant potential could not be determined. The patient was monitored every six months for five years, with an estimated recurrence risk of 20%.