Giant pleural fibrous tumor: a case report

Pleural fibrous tumor (PFT) is an infrequent and indolent pleural tumor, and most patients remain asymptomatic for years. The diagnosis is usually incidental and in large-size cases, representing a major surgical challenge. They may be associated to paraneoplastic syndromes such as refractory hypoglycemia or Doege-Potter syndrome. The present case is a 50-year-old female who came with dyspnea, chronic cough and constitutional syndrome. The CT scan showed a large intrathoracic mass of 20×18×17 cm 3 which compressed the right lower and middle lobes (RLL and RML). At the time of the operation, the approach was right lateral thoracotomy extended to the chondrocostal region. During the resection, the tumor was accidentally opened and at that time the patient showed hypoglycemic levels. It is not often a long size PFT with hypoglycemia at the moment of operation without previous diagnosis. PFT is usually asymptomatic and is diagnosed incidentally in half of the cases. Tumor resection is the treatment of choice, which also leads to the cure of paraneoplastic syndrome. For tumors larger than 5 cm, thoracotomy is preferred, and both the tumor and its implant pedicle must be resected with safety margins.