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PubMed2000

A case of multiple synchronous localized fibrous tumor of the pleura.

We report a patient with two synchronous distinct masses in the same hemithorax both of which got the diagnosis of benign localized fibrous tumor of the pleura. The plain chest X-ray was rather obscured due to a large left-sided pleural effusion, but her subsequent computerized chest tomography revealed a heterogeneous hypodense soft tissue mass, which was pleural in origin, sitting on the diaphragm bathed in fluid. At thoracotomy, we detected two distinct masses in the left hemithorax, both arising from the visceral pleura via their vascular pedicles.

Aged↗

PubMed2002

An unusual presentation of solitary fibrous tumour of the pleura: right atrium and inferior vena cava compression.

Solitary fibrous tumours of the pleura are rare and usually present with unpredictable clinical signs. We report a 58-year-old patient presenting with signs of cardiac decompensation and external compression of the right atrium and inferior vena cava by a voluminous solitary fibrous tumour arising from the diaphragmatic pleura. Marked clinical improvement was obtained after excision of the mass with complete disappearance of the cardiac signs.

Chest Pain↗

PubMed1998

Primary angiosarcomas of the chest wall and pleura.

Primary angiosarcomas of the chest wall and pleura are extremely rare and carry a dismal prognosis. Two cases are reported. One patient (case 1), presented with massive recurrent haemothorax, was found to have multifocal angiosarcoma of the pleura, treated with surgical de-bulking, chemical pleurodesis and chemotherapy, achieving control of the bleeding. She died 10 months later from complications related to chemotherapy. A full post-mortem examination confirmed this was a primary pleural angiosarcoma with no evidence of disease elsewhere. Another patient (case 2) with a large solitary angiosarcoma of the chest wall, discovered incidentally on a routine physical examination, was successfully treated with surgical excision and subsequent radical radiotherapy, remaining well 15 years post-operatively.

Adult↗

PubMed1999

Pseudomesotheliomatous carcinoma involving pleura and peritoneum: A clinicopathologic and immunohistochemical study of three cases.

Pseudomesotheliomatous carcinoma is a rare variant of peripheral adenocarcinoma of the lung that can manifest clinical, radiologic, and pathologic features similar to malignant mesothelioma. We present three patients with pseudomesotheliomatous carcinoma of the lung. In one patient the carcinoma extended beyond the thorax and extensively involved the peritoneum, mesentery, omentum, and intestines. All patients experienced weight loss and chest pain. All were white men aged 63, 65, and 67 years. Two were smokers and had shortness of breath, cough, and pleural effusion. One had a history of asbestos exposure. No patient developed dyspnea or hemoptysis. One was successfully treated for prostatic carcinoma 18 months earlier. Radiographically, all tumors were pleura-based. Grossly, the tumors spread extensively over pleural (and in one case peritoneal) surfaces and mimicked malignant mesothelioma. Histologically, all tumors were poorly differentiated and necrotic; two tumors exhibited spindle-cell components and desmoplasia. Mucin production was detectable in none, 10%, and 50% of tumor cells. The percentages of tumor cells immunoreactive for Ber-EP4 were 70%, 100%, and 80%; for Leu MI 0%, 90%, and 50%; for epithelial membrane antigen 80%, 80%, and 100%; for B 72.3%, 0%, 90%, and 20%; for polyclonal carcinoembryonic antigen 0%, 10%, and 10%; and for monoclonal 5%, 0%, and 0%. Of these, Ber-EP4 and B 72.3 rendered the most reliable diagnostic results. The clinical, radiologic, and gross and routine histologic findings were similar to those of a malignant mesothelioma; the final diagnosis could be made based mainly on immunocytochemical results. We have reviewed the English and German literature regarding 65 such tumors and present our experience with three additional cases. We emphasize the application of immunocytochemical studies on pleura-based poorly or undifferentiated malignant tumors of unknown origin.

Aged↗

PubMed2004

[Giant solitary fibrous tumor of the pleura treated by video-assisted surgery: a case report].

Solitary fibrous tumors of the pleura are rare, with unpredictable clinical manifestations. By the time of diagnosis, the size and consistency of the tumor usually preclude the use of minimally invasive surgical techniques. We present a case of a 34-year-old male with a solitary fibrous tumor of the visceral pleura masquerading as a mediastinal tumor. The tumor was removed by video-assisted thoracic surgery.

Adult↗

PubMed2004

Localized fibrous tumors of the pleura: experience with 7 recent cases.

OBJECTIVE: Localized fibrous tumors of the pleura are rare. We report 7 cases and review the literature in order to define the range of clinical characteristics of these tumors, treatment options, and prognosis. METHODS: A retrospective review of 7 cases treated between 1997 and 2003, focusing on clinical presentation, diagnostic tests, and treatment. The tumor was removed surgically in all cases, by thoracotomy in 6 cases and by video-assisted thoracoscopic surgery in 1 patient. RESULTS: All patients recovered fully after surgery, with no postoperative complications. One patient experienced recurrence twice, 33 and 67 months after the initial resection. All are alive at the time of writing, after a mean follow up period of 19 months (range 1 month to 5 years and 10 months). CONCLUSIONS: The treatment of choice for a fibrous tumor of the pleura is full resection and follow-up to detect possible late recurrence.

Adult↗

PubMed1992

The presence of scatter factor in patients with metastatic spread to the pleura.

Pleural effusion fluid obtained from eleven patients with metastatic spread to the pleura was screened for the ability to cause the dispersal--'scattering'--of MDCK colonies in vitro. Four of these samples proved to be positive using this assay. Of these two had titres high enough to warrant further purification on a cation exchange Mono S column. Active material from both lung samples, eluted at the same positions as factor from cultured human lung fibroblasts (MRC-5) and human placenta but in a slightly different position to murine scatter factor. In both cases the semi-purified active agent was identified as hepatocyte growth factor/scatter factor (HGF/SF) using an ELISA detection system specific for human HGF/SF. This is the first report identifying the presence of significant amounts of HGF/SF in the pleura of patients where malignant spread has occurred.

Animals↗

PubMed2003

Matrix metalloproteinases 2 and 9 (gelatinases A and B) expression in malignant mesothelioma and benign pleura.

Matrix metalloproteinases (MMPs), in particular the gelatinases (MMP-2 and -9), play a significant role in tumour invasion and angiogenesis. The expression and activities of MMPs have not been characterised in malignant mesothelioma (MM) tumour samples. In a prospective study, gelatinase activity was evaluated in homogenised supernatants of snap frozen MM (n=35), inflamed pleura (IP, n=12) and uninflammed pleura (UP, n=14) tissue specimens by semiquantitative gelatin zymography. Matrix metalloproteinases were correlated with clinicopathological factors and with survival using Kaplan-Meier and Cox proportional hazard models. In MM, pro- and active MMP-2 levels were significantly greater than for MMP-9 (P=0.006, P<0.001). Active MMP-2 was significantly greater in MM than in UP (P=0.04). MMP-2 activity was equivalent between IP and MM, but both pro- and active MMP-9 activities were greater in IP (P=0.02, P=0.009). While there were trends towards poor survival with increasing total and pro-MMP-2 activity (P=0.08) in univariate analysis, they were both independent poor prognostic factors in multivariate analysis in conjunction with weight loss (pro-MMP-2 P=0.03, total MMP-2 P=0.04). Total and pro-MMP-2 also contributed to the Cancer and Leukemia Group B prognostic groups. MMP-9 activities were not prognostic. Matrix metalloproteinases, and in particular MMP-2, the most abundant gelatinase, may play an important role in MM tumour growth and metastasis. Agents that reduce MMP synthesis and/or activity may have a role to play in the management of MM.

Adult↗

PubMed2001

Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura.

AIMS: To determine the value of immunohistochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy we optimized a double panel of MOC-31 and HBME-1 and compared the results with others from the literature. METHODS AND RESULTS: A multi-antibody panel was applied to biopsy samples from 44 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura. We used monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber-EP4, carcinoembryonic antigen (CEA), tumour-associated glycoprotein (B72.3), LeuM1, vimentin, desmin, epithelial related antigen (MOC-31) and mesothelial cell (HBME-1). Positivity for MOC-31 and Ber-EP4 was found to have the highest nosologic sensitivity (94.1% and 84.6%, respectively) and specificity (86.3% both antibodies) for carcinoma. Positive staining for HBME-1 and vimentin had the highest sensitivity (90.9% and 100%, respectively) and specificity (91.3% and 60%, respectively) for mesothelioma. A two-marker antibody panel with HBME-1 and MOC-31 was the most efficient for the distinction between carcinoma and malignant pleural mesothelioma. CONCLUSION: A combination of MOC-31 (an anti- epithelial marker) and HBME-1 (an anti-mesothelial marker) has a diagnostic efficiency of 76.1% for the distinction between carcinoma and mesothelioma in pleura.

Adenocarcinoma↗

PubMed2003

Pyothorax-associated angiosarcoma of the pleura with metastasis to the brain.

Pleural angiosarcoma is an extremely rare, highly malignant neoplasm. Chronic tuberculous pyothorax is one of the etiological factors associated with the development of pleural angiosarcoma. This report details a case of pleural angiosarcoma in a 70-year-old woman with a history of tuberculous pyothorax. Coagulated blood surrounded by thickened pleura in the right thorax and hematoma-like multiple metastases in the brain were noted on autopsy. The pleural lesion was presumed to be the primary site. Microscopic examination revealed rudimentary channels lined by plump neoplastic cells in the coagulated blood of the pleura and the brain. These neoplastic cells stained positive for endothelial markers. A literature review of English language journals revealed this to be the first patient described in detail who developed cerebral metastasis secondary to pleural angiosarcoma.

Brain Neoplasms↗

PubMed1995

[High-resolution magnetic resonance tomography (HR-MRT) of the pleura and thoracic wall: normal findings and pathological changes].

AIM: To determine the value of high-resolution MRI in pleural and chest wall diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillary region were examined with contrast enhanced high-resolution T1-weighted MRI images using a surface coil. MATERIAL AND METHODS: Normal anatomy was evaluated in 5 healthy volunteers and a normal specimen of the thoracic wall, and correlation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall in 36 patients underwent HR-MRI, and visual comparison of MRI and CT was done retrospectively. RESULTS: Especially sagittal T1-weighted HR-MRI images allowed accurate delineation of the peripleural fat layer (PFL) and the innermost intercostal muscle (IIM), which served as landmarks of the intact inner chest wall. PFL and IIM were well delineated in 3/4 patients with tuberculous pleuritis, and in all 7 patients with non-specific pleuritis, as opposed to impairment of the PFL and/or the IIM, which was detected in 15/18 malignancies as a pattern of malignant chest wall involvement. In one case of tuberculous pleural empyema with edema of the inner chest wall HR-MRI produced false positive diagnosis of malignant disease. CONCLUSION: HR-MRI images improved non-invasive evaluation of pleural and chest wall diseases, and allowed for differentiation of benign and malignant changes.

Adult↗

PubMed1978

Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases.

Exposure to asbestos may occur in any of a large number of occupations, and the latent period from exposure to appearance of clinical or roentgenologic evidence of related disease of the lung or pleura, or both, may be more than 20 years. A complete occupational history is therefore of paramount importance in the detection of asbestos-related diseases. Illustrative cases highlight the features of benign and malignant diseases of the lung and pleura for which a causal relationship to asbestos exposure is probable or established.

Aged↗

PubMed1979

Comparison of the diagnostic values of biopsies of the pleura and cytologic evaluation of pleural fluids.

Results of a comparison of the diagnostic efficacy of percutaneous needle biopsy of the parietal pleura with that of cytologic examination of pleural fluid sediment obtained concurrently from 166 patients with benign or cancerous pleural disorders are reported. Of 44 patients with confirmatory evidence of cancer involving the pleural surfaces, 43 had positive cytologic findings, whereas pleural biopsies were diagnostic in only 16 cases. Of a total of 122 patients with benign pleural diseases, cytology provided the diagnosis in two cases of eosinophilic pleurisy, and pleural biopsy contributed the diagnosis in four of ten cases of tuberculosis. The data indicate that percutaneous needle biopsy of the parietal pleura is less efficacious in the diagnosis of malignant pleural disease than is cytologic evaluation of the fluid sediment, whereas in the diagnosis of tuberculous pleurisy, pleural biopsy proved superior.

Adult↗

PubMed1990

The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy.

Thirty-eight patients with malignant mesothelioma of the pleura were seen at Peter MacCallum Cancer Institute between 1981 and 1985. In 35 patients presenting with disease confined to one hemithorax, the following treatments were given: radical surgery, 13 patients: radical radiotherapy, 12 patients; palliative radiotherapy, 20 patients; chemotherapy, 9 patients; observation only, 2 patients. Median survival from time of diagnosis for all 38 patients was 9 months, with an estimated 2-year survival rate of 16%. Treatment did not significantly affect survival, although there was an indication that patients having radical surgery did better (median survival 17 months) than those who did not (median survival 9 months) (p = 0.13). Fifteen patients were given radiotherapy with radical intent but only 12 completed treatment (50 Gy). The median survival of the 12 patients completing radiotherapy was 17 months, with an estimated 2-year survival rate of 17%. Two patient deaths were attributable to radical radiotherapy (one radiation hepatitis, one radiation myelopathy). Twenty-one patients received 31 courses of palliative radiotherapy for various symptoms, predominantly pain. The results were assessable for 26 courses, with 17 (65%) being at least partly successful. In conclusion, radiotherapy appears to be ineffective in prolonging survival in malignant mesothelioma of the pleura, but has a useful role in palliation.

Adult↗

PubMed1995

Desmoplastic small round cell tumor of the pleura.

Three cases of desmoplastic small round cell tumor (DSRCT) with multiphenotypic differentiation, primary in the pleura, are presented. This is a previously unrecognized site for this tumor type. Two patients were male and one female aged 29, 24, and 17 years. All presented with chest pain and were found to have pleural-based tumors associated with pleural effusion. Abdominal involvement was not present in any of the cases. Histologically, the tumor showed the characteristic features of intra-abdominal DSRCT, including angulated nests of small cells embedded in a vascular fibroblastic stroma, focal rhabdoid phenotype, and areas of central necrosis. The neoplastic cells showed evidence of epithelial, mesenchymal, and neural differentiation with characteristic dot-like positivity for vimentin and desmin topographically corresponding to perinuclear aggregates of intermediate filaments identified on electron microscopy in one case. Two patients died of disease 2 years and 15 months after presentation, respectively, and one patient is alive with disease 18 months after presentation. The histogenesis of DSRCT is unknown. Most previously reported cases involved the peritoneum or tunica vaginalis, suggesting a histogenetic relationship to the mesothelium. The occurrence of these tumors in the pleura lends further support to this theory.

Adolescent↗

PubMed1990

Malignancies metastatic to the pleura.

In patients over 50 years of age, neoplasms of the pleura are probably the second most common cause of a pleural effusion after congestive heart failure. Lung cancer, breast cancer, lymphoma, ovarian carcinoma, and stomach cancer are the leading causes of malignant pleural disease, and adenocarcinoma is the most common cell type. This review discusses in detail the etiology and incidence, pathogenesis, clinical manifestations, diagnosis, prognosis, and treatment of neoplasms that involve the pleura with special reference to malignant and paramalignant pleural effusions.

Humans↗

PubMed1996

Malignant mesenchymoma of the pleura.

Malignant mesenchymomas are uncommon tumors of soft tissues. Three such tumors involving the pleura have been reported in the literature. We report a case of malignant mesenchymoma of the pleura that had liposarcomatous, rhabdomyosarcomatous, chondrosarcomatous, and osteosarcomatous elements.

Adipose Tissue↗

PubMed2000

Localized (solitary) fibrous tumor of the pleura.

Clinical, light microscopic, ultrastructural, and immunocytochemical features of localized fibrous tumor of the pleura are reviewed. The differential diagnosis of the benign tumors can be uncomplicated, but atypical variants and malignant forms require the exclusion of other tumors included in the broad array of spindle cell neoplasms that can arise in or extend to a serosal surface. Electron microscopy is useful, but immunostaining procedures offer more extensive and reliable help in reaching the correct diagnosis. Tumors histologically similar to localized fibrous tumor of the pleura have been described in a number of extraserosal locations. Some localized fibrous tumors may be true fibromas, whereas the typical pleural tumor appears to arise from the subserosal mesenchymal cell and is composed of CD34-positive cells which are more primitive in their morphology than mature fibroblasts.

Adolescent↗