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

Abstract

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.

Keywords

• Solitary fibrous tumors
• SFTs
• Mediastinal tumors