Correct!

4. Solitary fibrous tumor of the pleura

Neurogenic tumor is unlikely based on the discussion above. Furthermore, patients with neurogenic tumors often frequently experience intense pain when the lesion undergoes needle biopsy, even with liberal use of local anesthetic, which did not occur in this case. While metastatic sarcoma could show “spindle cells” on transthoracic needle biopsy,  the diagnosis of sarcoma for this lesion unlikely in the absence of a known sarcoma elsewhere, particularly in the absence of features of widespread metastatic disease. Percutaneous transthoracic needle biopsies are highly accurate for the diagnosis of primary lung malignancy, particularly when the lesion is as large as the mass in the present case and the needle is well-placed. Therefore, if this lesion represented a primary bronchogenic malignancy, a transthoracic needle biopsy result would be very unlikely to show results consisting of “spindle cells.” Given the appearance of the lesion [extensive chest wall contact, without overtly aggressive features], and the tissue sampling results showing “spindle cells,” solitary fibrous tumor of the pleura is the best choice among those provided.

The patient subsequently underwent surgical resection of the lesion, which established the diagnosis of a benign solitary fibrous tumor of the pleura.

Diagnosis: Solitary fibrous tumor of the pleura (also known as localized fibrous tumor of the pleura).

Which of the following regarding solitary fibrous tumor of the pleura is false?

  1. Solitary fibrous tumor of pleura more commonly exhibits benign, rather than malignant, behavior
  2. Solitary fibrous tumor of the pleura is rarely associated with hypoglycemia
  3. Solitary fibrous tumor of the pleura typically arises from the visceral pleural surface
  4. Solitary fibrous tumor of the pleura is associated with asbestos exposure
  5. Solitary fibrous tumors may occur in sites other than the pleura, such as the mediastinum, liver, kidney, and pericardium