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Squamous metaplasia of the pleura with malignant transformation was observed five months after the development of an empyema and bronchopleural fistula in a 58 year old woman with lingular bronchiectasis.
Studies of pleural clearance of calcium tungstate particles were made in the dog. By using scanning electron microscopy and elemental microanalysis, we show that mesothelial cells of the visceral leaflet of the pleura are also involved in the clearance of particles present in the pleural space. The histological study of lung parenchyma shows many macrophages loaded with tungsten particles, and we conclude that this way may be an important pathway for the transmission of pathologic processes from the pleural space to the lung.
3 cases of an unusual presentation of tuberculosis of the pleura which should be differentiated from neoplasm have been described.
This review attempts to provide up to date information on structure/function relationships of the pleura and on the pathology of pleural effusions, pneumothorax, pleural repair, pleural infections, pleural involvement in systemic connective tissue disorders, non-malignant asbestos-induced pleural disease, mesothelioma and other pleural tumours.
The histopathologic findings were compared from 20 mg/kg intrapleural tetracycline hydrochloride (TCN) and three doses of intrapleural minocycline hydrochloride (5, 10, and 20 mg/kg) (MCN) in New Zealand white rabbits. Both TCN and MCN produced an early neutrophilic predominant pleural effusion that became mononuclear over 48 h. There was no difference in pleural fluid accumulation, number of adhesions, or histologically measured visceral and parietal pleural thickness between TCN and MCN (all p = ns). The TCN, 20 mg/kg, produced more visceral pleural plaque than MCN, 5 mg/kg (p < 0.05). Increasing MCN doses resulted in greater pleural fluid neutrophil accumulation. With higher dose MCN, greater mesothelial cell desquamation and fibroblast proliferation was evident compared to the 5 mg/kg dose. The MCN and TCN produce similar histopathologic condition in the rabbit pleura which suggests that MCN should cause a similar clinical response in humans.
Pleuritis or pleural effusion frequently develops in patients with pneumonia or heart failure. Most of these pleural changes regress without intrapleural intervention. The detailed mechanisms of the regression of the pleural changes in humans are not well documented. We studied the parietal pleura of nine patients with lung cancer and two patients with coronary artery disease by scanning electron microscopy (SEM). All patients had neither radiographic nor gross evidence of pleural disease but all had mixed surface alterations by SEM. Focal denudation of mesothelial cells was common. Deeper injuries exposed thick and thin interweaving collagen bundles. Patchy depositions of amorphous or crystallized fibrin covered normal and damaged pleural surfaces, frequently admixed with macrophages, red blood cells, and tissue debris. Reactive mesothelial cells appeared to proliferate over the fibrin. Our findings suggest that subclinical pleural alterations occur often in patients with pulmonary or cardiac diseases and that an intact pleural surface in those patients is restored mainly by the proliferation of reactive mesothelial cells.
Malignant mesothelioma of the pleura occurs primarily in individuals who were exposed to asbestos either in the workplace or home. The incidence of malignant mesothelioma is rising and, reflective of the malignancy's long latency period, is expected to continue to increase into the next century. Current treatment measures, including surgery, radiation therapy, chemotherapy, intrapleural therapy, and combined-modality therapies, have had varying impacts on survival. This paper explores current trends in the treatment of malignant pleural mesothelioma.
This report describes the occurrence of solitary fibrous tumors of the pleura in a mother and her daughter. No other occurrence of this rare tumor in members of the same family has ever been reported.
Antibiotic concentrations in the human lung and pleural tissue were measured following intravenous administration of doxycycline. The average serum levels were 9.3, 7.0 and 3.0 micrograms/ml at 1, 2, and 3 hours; correspondingly, the lung tissue levels were 6.8, 3.5 and 2.3 micrograms/g. The pleural tissue antibiotic concentrations at the same time intervals were 2.5, 1.5, and 1.5 micrograms/g. This suggests that doxycycline is retained well by the lung and the pleura, well above the minimal inhibitory concentration of most of the common bacterial pathogens of the lung, and may be used in the treatment of lung infections caused by susceptible organisms.
A variety of imaging techniques can be used to evaluate the pleura and the pleural space. Standard radiographs are the most common. In this article, however, we review the use of three other imaging techniques: sonography, CT, and MR imaging. Sonography allows easy identification of pleural fluid and loculation and differentiation from pleural masses; CT is best for characterizing location and composition of pleural masses; MR is somewhat limited, but is best for imaging superior sulcus carcinoma.
The CT findings in cases of benign fibrous mesothelioma of the pleura have been described previously, but little attention has been given to a correlation of these findings with the pathologic appearance of the tumors. Accordingly, we analyzed the CT scans in nine proved cases in which pathologic studies were available and compared the pathologic findings with the CT appearance of the tumors. On enhanced CT scans (available in eight patients), the lesions showed significant enhancement in all cases. Pathologic examination showed that the enhancement could be explained by the vascularity of the tumor. Areas of myxoid (n = 7) or cystic (n = 3) degeneration and hemorrhage (n = 3) seen in the pathologic specimens correlated with round or tubular low-attenuation areas on unenhanced and enhanced CT scans. On unenhanced CT scans (n = 3), the tumor density was the same as that of the surrounding musculature. Calcification was seen in one patient. Large lesions showed lobulated borders, but no invasion into the lung parenchyma and chest wall was noted. There was no pleural effusion. Our experience suggests that intense enhancement of the tumors occurs because of the vascularity of the tumors. Areas of low attenuation in the tumors on CT were due to foci of myxoid or cystic degeneration and hemorrhage in the lesion.
OBJECTIVE: The purpose of our study was to describe the clinical and radiologic features of epithelioid hemangioendothelioma of the pleura. CONCLUSION: Pleural epithelioid hemangioendothelioma is an uncommon malignancy that typically affects older men, who present with chest pain and dyspnea. This lesion manifests on chest radiographs and CT scans with unilateral pleural fluid and nodular pleural thickening and appears similar to diffuse pleural carcinomatosis or mesothelioma.
The effects of acid-induced injury to the full thickness of the ovine pleura were studied using light, scanning, and transmission electron microscopy. Thirty minutes after injury, the mesothelial layer had disappeared and necrosis extended down to the subjacent alveolar walls. This was followed by an exudative phase, with edema of the pleural interstitium and subjacent alveoli, together with a marked congestion of alveolar capillaries that peaked at 2 days. Subsequently, the edema and congestion subsided and proliferation of fibroblasts and histiocytes was seen in the pleural interstitium. The subjacent alveoli were considerably distorted by interstitial thickening and alveolar type II cell proliferation. Unlike other studies in the peritoneum, no evidence for a diffuse recolonization of the mesothelial surface was found. Our work indicates that the damaged surface is rapidly covered by a layer of fibrin. Cells from the wound edges became plump and their processes projected toward the denuded region, indicating a process of centripetal healing, with migration of cells in irregular wedges to recolonize the surface.
Post mortem studies of rat lungs showed that application of fibrin sealant augments the tensile strength of the lung/visceral pleura by approximately 100 mmHg, thus impeding air leakage.
BACKGROUND: Localized fibrous tumors of the pleura (LFTPs) are uncommon thoracic neoplasms with variable malignant potential that were previously classified as benign presentation of mesothelioma. We investigate the clinical presentation, recurrence patterns, and long-term survival of patients undergoing curative resection of LFTPs. PATIENTS AND METHODS: Thirty-four patients underwent resection of LFTPs in the present study. There were 20 women and 14 men with a median age of 59 years (range, 35-81 years). The malignant potential of the tumor was estimated through histologic assessment of the degree of cellularity, mitotic activity, and nuclear pleomorphism. Patients' clinical outcomes were correlated to pathologic findings. RESULTS: Seventeen patients (50%) were symptomatic, and 7 tumors (21%) were considered malignant by histologic characteristics. Ipsilateral pleural recurrence remote to the original tumor site occurred in 6 of these patients with malignant microscopic characteristics at a mean of 9 months after resection. Repeated resection was accomplished in 3 of these patients (range, 3-8 repeat operations). There have been no recurrences among the other 27 patients with benign histologic features, and 31 patients remain alive at a median follow-up of 34.5 months. CONCLUSION: Histologic characteristics are helpful in estimating the risk of recurrence among patients with LFTPs. Close surveillance is recommended for patients with malignant histologic characteristics. Local recurrence is common without evidence of systemic spread among such patients. Surgical resection is definitive therapy; however, patients with tumors with histologic atypia require close postoperative observation because of the frequency of locoregional recurrence.
OBJECTIVE: To evaluate the diagnostic performance of transthoracic sonography of the lung in view of an acute suspicion of pulmonary embolism. METHODS: The diagnosis of pulmonary embolism was made within 48 hours of admission with the use of a validated strategy that combined a lung scan, lower limb sonography, helical computed tomography, and pulmonary angiography in 74 consecutive patients. All patients had a 3-month follow-up. Transthoracic sonography of the lung and pleura was performed in a blinded fashion by investigators unaware of the diagnostic process. It was interpreted as suggestive or not suggestive of pulmonary embolism on the basis of previously published descriptions. The results were kept apart from the patient files until the end of the study. RESULTS: Pulmonary embolism was confirmed in 31 (42%) of the 74 patients. None of the patients classified as pulmonary embolism-negative had a thromboembolic event during the 3-month follow-up. The diagnostic performance of transthoracic sonography was as follows: sensitivity, 71% (95% confidence interval, 52%-85%); specificity, 77% (95% confidence interval, 61%-88%); positive predictive value, 69% (95% confidence interval, 50%-83%); and negative predictive value, 79% (95% confidence interval, 63%-89%). The finding of an isolated pleural infarction was significantly more frequent in pulmonary embolism-positive patients compared with pulmonary embolism-negative patients (P = .0001). CONCLUSIONS: The results from this study suggest that transthoracic sonography of the lung does not fulfill satisfactory performance criteria in view of a clinical suspicion of pulmonary embolism.
Seven cases of solitary fibrous tumours of the pleura are here reported, formerly named benign fibrous mesotheliomas. Histologically, these tumours are formed by fusiform cells with a minimal cellular pleomorphism and absence of mitosis. These tumours cause scarce symptoms which are usually diagnosed as a casual finding when a chest X-ray is performed on account of other cause. Treatment should be surgical, with removal of all tumoral mass, thus avoiding its growth and the possibility of the reported degeneration towards malignancy.
In chronic nonspecific diseases of the lungs lesions of the microcirculatory system of the visceral pleura are of generalized character. The most marked changes were observed in postcapillary and venular links of the microhemocirculation. A pronounced hypertrophy of the venular department and rearrangement of the postcapillary network were noted. The microcirculatory lymphatic system was found to be considerably developed. Along with the functioning lymphatic network there were seen emptying sclerosing lymphatic vessels. The changes in vascular terminals revealed were directly dependent upon the duration of the disease, character of expansion of the process in the lungs, degree of cardiopulmonary incompetence. Moreover, disorders of rheological properties of the blood and permeability of vessels were observed, these disorders being particularly pronounced in exacerbation of chronic pneumonia and cor pulmonale insufficiency of II-III degree. It may be assumed that changes in the microcirculation system in chronic nonspecific lung diseases may represent both an important link in the compensatory mechanisms at early stages of the disease and also a cause of deep irreversible metabolic disturbances in persisting and progressing process in the lungs.