Hybrid video-assisted thoracoscopic resection of a massive mediastinal solitary fibrous tumor: overcoming challenges: a case report.

Abstract

Background: Solitary fibrous tumors are uncommon mesenchymal neoplasms, with an incidence of less than one case per million people annually. This case is notable for its presentation in a young patient and is the first reported instance of a pleural solitary fibrous tumor causing atrial compression. The successful use of a hybrid surgical approach for resection adds to its novelty.

Case presentation: A 34-year-old Palestinian female patient presented with an 8-month history of progressive chest pain, palpitations, and mild shortness of breath. Imaging revealed a large mediastinal mass (14.5 × 12.5 × 6 cm) compressing the heart, particularly the left ventricle. Computed-tomography-guided core biopsy confirmed a solitary fibrous tumor on histopathology. Risk stratification using the Demicco model classified the tumor as low risk, with a mitotic index of 1-2 per 10 high-power fields and < 5% necrosis. The patient underwent a hybrid surgical approach combining video-assisted thoracoscopic surgery with thoracotomy to achieve complete resection. Postoperative recovery was uneventful, with resolution of symptoms and no recurrence at 1-month follow-up.

Conclusions: This case highlights the rarity of large mediastinal solitary fibrous tumors with significant compression of mediastinal structures. It demonstrates the importance of innovative surgical techniques, multidisciplinary care, and long-term surveillance for managing these rare tumors.