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Giant hypervascular solitary fibrous tumors of the pleura (SFTPs) present significant challenges due to their size and vascularity and potential involvement of adjacent structures. Careful preoperative planning of the surgical approach is required, depending on the tumor size and location. Furthermore, intraoperative bleeding may significantly complicate surgical procedures in patients with hypervascular tumors. Herein, we report a case of a giant hypervascular SFTP with a pulmonary artery shunt that was successfully managed by thoracoscopic excision after preoperative embolization of the vascular supplies. A 60-year-old woman underwent computed tomography during a medical check-up. A mass measuring 12.6 cm in diameter was detected in the right thoracic cavity, which was extensively attached to the diaphragm. Magnetic resonance imaging revealed a slightly high signal on T1-weighted images and an extremely high signal on short-TI inversion recovery images. Four-dimensional computed tomography revealed that the right inferior phrenic artery was an arterial supply, and a branch of the middle lobar artery was contrasted as a draining vessel, forming a shunt. Angiography-guided embolization was performed to reduce vascularity, followed by an echo-guided percutaneous biopsy to confirm SFTP. The patient underwent three-port video-assisted thoracoscopic surgery. Intraoperatively, the cranial side of the tumor was found to be contiguous with the right middle lobe, requiring resection of the lobe together with the tumor. The caudal side exhibited abundant vascularity and was carefully dissected due to its proximity tothe diaphragm. Intraoperative frozen section diagnosis of the resected tumor revealed histological features suggestive of SFTP, consistent with the preoperative diagnosis, and no tumor cells were observed at either the right middle lobe or diaphragmatic margins, indicating a cranio-caudal R0 resection. The patient's postoperative course was uneventful, and no recurrence was observed after two years. Preoperative imaging demonstrated a hypervascular tumor in broad contact with the diaphragm, and the vascular pedicle was not clearly visualized due to compression by the tumor. Multiple feeding arteries were suspected; therefore, preoperative arterial embolization was performed to minimize intraoperative bleeding. A multidisciplinary strategy enabled safe and minimally invasive resection.
Takada et al. (Wed,) studied this question.