Management of benign variants of mesothelioma

The distinction between benign pleural plaques and malignancy can usually be made by simple radiographic findings. When there is uncertainty, surgical biopsy, preferably by a VATS approach, should be performed. Biopsy should be performed separately from the definitive resection because immunohistochemistry and electron microscopy are usually required to distinguish benign pleural lesions from diffuse malignant pleural mesothelioma. Benign or malignant solitary fibrous tumors, when pedunculated and free of adjacent structures, may be easily treated by VATS surgical excision. Careful evaluation of adjacent structures and the entire pleural cavity is essential to minimize the risk of recurrence. All solitary fibrous tumors, regardless of a benign or malignant histology, must be approached with caution because of the risk of local recurrence. The initial treatment of choice for solitary fibrous tumors or pleural tumors mimicking this lesion is en bloc surgical resection. Patients should be followed closely postoperatively and recurrences managed by extensive surgical resection with or without adjuvant radiation.