Correct!
4. Percutaneous transthoracic fine needle aspiration and core biopsy

Given the peripheral nature of this lesion and the lack of an associated airway, flexible fiberoptic bronchoscopy is not the best method for obtaining a tissue diagnosis for the lesion in this patient. Mediastinoscopy cannot access the inferior thorax caudal to the posterior aspect of the subcarinal space, and the lesion in this patient has no mediastinal extension. Similarly, the lesion does not have contact with, and is not in proximity to, the esophagus, and therefore endoscopic ultrasound would not be a good choice for obtaining a tissue diagnosis in this patient. Video-assisted thoracoscopic surgery would be a useful procedure for obtaining a tissue diagnosis for this patient, but a tissue diagnosis could also be achieved less invasively using percutaneous transthoracic fine needle aspiration and core biopsy; the latter is the best method among those listed for obtaining a diagnosis for this patient.

The patient underwent percutaneous transthoracic fine needle aspiration and core biopsy which showed a bland spindle cell lesion embedded within a myxocollagenous stroma, without nuclear atypia or mitotic activity. Immunoperoxidase staining showed positivity for BCL-2, although CD34 staining was negative. The histopathological features are consistent with solitary fibrous tumor of the pleura.

Diagnosis: Solitary fibrous tumor of the pleura

References

  1. Ginat DT, Bokhari A, Bhatt S, Dogra V. Imaging features of solitary fibrous tumors. AJR Am J Roentgenol. 2011;196(3):487-95. [CrossRef] [PubMed]
  2. Sung SH, Chang JW, Kim J, Lee KS, Han J, Park SI. Solitary fibrous tumors of the pleura: surgical outcome and clinical course. Ann Thorac Surg. 2005;79(1):303-7. [CrossRef] [PubMed]
  3. Truong M, Munden RF, Kemp BL. Localized fibrous tumor of the pleura. AJR Am J Roentgenol. 2000;174(1):42. [CrossRef] [PubMed]
  4. Chick JF, Chauhan NR, Madan R. Solitary fibrous tumors of the thorax: nomenclature, epidemiology, radiologic and pathologic findings, differential diagnoses, and management. AJR Am J Roentgenol. 2013;200(3):W238-W248. [CrossRef] [PubMed]
  5. Bhardwaj H, Lindley S, Bhardwaj B, Carlile PV, Huard DR. Catch me if you can: a wandering solitary fibrous tumor of the pleura. Am J Respir Crit Care Med. 2014; 190(3):e7-9. [CrossRef] [PubMed]
  6. Cardillo G, Lococo F, Carleo F, Martelli M. Solitary fibrous tumors of the pleura. Curr Opin Pulm Med. 2012;18(4):339-46. [CrossRef] [PubMed]
  7. Algın O, Gökalp G, Topal U. Signs in chest imaging. Diagn Interv Radiol. 2011;17(1):18-29. [CrossRef] [PubMed]
  8. Hsu CC, Henry TS, Chung JH, Little BP. The incomplete border sign. J Thorac Imaging. 2014;29(4):W48. [CrossRef] [PubMed]

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