Pleural fibromas: a clinical review and report of six patients.

Localized pleural fibromas are a definite clinical entity. Their origin is much debated. Though most arise from the mesothelial cell, occasionally some arise from the pleural fibroblast. The former retain the potential to become malignant. Distinguishing between the two origins can aid prognosis after treatment. The characteristic cell is a spindle-shaped fibroblast. Slits or clefts lined by flattened cells are often present in the tumor. Clinically, pleural fibromas are usually asymptomatic, space-occupying lesions. Chest symptoms are nonspecific. Extrathoracic symptoms, especially arthritis, are not uncommon and occur only in the benign variety. Excision is the treatment of choice, but long-term follow-up is essential, for recurrence is not unknown and is often heralded by the region of arthritic symptoms. Recurrences may be benign or malignant, the latter having a poor prognosis, with most patients dying within 2 years. Experience with benign pleural fibromas seen in 6 patients over a 25-year period is presented.