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PubMed1999

Desmoplastic small round cell tumour of the pleura: a case report with further cytogenetic and ultrastructural evidence of 'mesothelioblastemic' origin.

A typical case of desmoplastic small round cell tumour of the pleura in a 25-year-old man is described. In addition to the typical histological and immunohistological findings, the EWS-WT1 fusion product was also observed. Ultrastructurally, some tumour cells displayed intracytoplasmic neolumina, with short microvilli characteristic of submesothelial cells. These findings support the theory of a splanchnopleuric intraembryonic mesodermal, 'mesothelioblastemic' origin, both morphologically and cytogenetically.

Adult↗

PubMed1976

[Follow up study of patients operated on metastases of the lung and pleura (author's transl)].

From 1956 til 1974, 1851 patients have been operated on a malignancy of the lung. 29 of them had a solitary lung metastasis and 2 of them a metastasis of the pleura. Among those, the primary malignancies showed the following frequency: 7 malignancies of the uterus, 7 sarcomas, 4 carcinomas of the breast, 4 carcinomas of the large bowel, 4 malignant goiters, 3 hypernephromas, 1 seminoma and 1 malignancy of the pancreas. The mean survival time was 3.3 years. 25.8% of the patients survived 5 years. Patients with a primary malignancy of the uterus appear to do best. In case of repeated metastases we did not operate upon again.

Adenocarcinoma↗

PubMed1978

[Benign tumors of the lung and pleura (author's transl)].

218 benign tumors of the lung and pleura, 190 of which were operated, are discussed. Little doubt exists about the necessity of operative removal in cases of benign pleuro-pulmonary tumors. Therapeutic management depends on histology, localisation and the extent of growth. The majority of untreated benign tumors have a poor prognosis even if malignant degeneration does not occur. Postoperative prognosis of rehabilitation and resocialization is good.

Adult↗

PubMed2000

Primary myxoid sarcoma of the pleura: 5 years follow-up.

Primary sarcomas of the pleura are rare intrathoracic tumours. We describe a case of a recurring myxoid pleural sarcoma in a 51-year-old male patient with coronary heart disease, who initially was admitted for coronary revascularization surgery. Tumour diagnosis was based on pathological examination of a biopsy after radiological detection of a nodule in the right upper lobe. The nodule was excised. The first recurrence was diagnosed after 15 months. Pleuropneumonectomy was done. Four years after the first excision further tumour masses appeared above the diaphragm and were surgically removed and adjuvant irradiation carried out. A year later the patient is doing well.

Asbestos↗

PubMed2005

Giant solitary fibrous tumor of the pleura.

A 42-year-old woman developed an exceedingly big, solitary fibrous tumor of the pleura (SFTP) that occupied the whole right thorax. She complained of worsening dyspnea as her right lung was completely compressed and the mediastinum was pushed to the left side. A successful resection was performed; after reassembly, the tumor measured 20 cm x 22 cm x 30 cm and weighed 5.2 kg. The squashed right lung reached 60 % re-expansion postoperatively and the patient is in good health at 38 months' follow-up.

Adult↗

PubMed2006

Recurrence and malignant transformation in solitary fibrous tumour of the pleura.

Solitary fibrous tumours of the pleura are mesenchymal neoplasms and recurrence with malignant progression after complete resection rarely occurs. In the case of a 76-year-old patient we found multifocal recurrence with malignant transformation within six months following primary excision. Even though the vast majority of these tumours are benign, complete resection as well as clinical and radiological follow-up are highly recommended because of the potentially adverse biological behaviour and the lack of radical treatment options other than surgery.

Aged↗

PubMed1986

Localized benign mesothelioma of the pleura: case report and review of the literature.

Localized benign mesothelioma of the pleura is a rather uncommon disease with good prognosis after successful tumor extirpation. We present the history of a 66-year-old patient, in whom tumor growth could be observed retrospectively over a period of 6 years. The tumor was extirpated successfully. On the basis of this history and a review of the literature epidemiologic, clinical, radiologic, pathological and prognostic criteria of the tumor are described.

Aged↗

PubMed1990

[Sonography of the lungs and pleura].

Diagnoses were made by ultrasound in 73 out of 80 cases with unclear thorax x-ray. One case was misinterpreted, no diagnoses were possible in 6 cases. Pleural effusion or opacities reaching the pleura are necessary to perform ultrasound examination. Sonographic findings in pleural or pulmonary changes are discussed and correlated with pathological anatomical findings. Additional information can be obtained by sonography in pleural lesions and in pulmonary lesions masked by pleural effusion. Atelectases can be differentiated from pneumonia, and tumours can be identified in peritumorous pneumonia or atelectases.

Adult↗

PubMed2002

Synovial sarcoma of the pleura: a clinical and pathologic study of three cases.

Synovial sarcomas are rare soft tissue malignancies that most commonly affect the extremities in the vicinity of large joints. These malignancies typically occur in adolescents and young adults between the ages of 15 and 40 years.(1,2) Historically they are believed to originate from primitive pluripotent mesenchyme capable of synovial differentiation. This belief is consistent with the malignancy's origin from sites devoid of normal synovium, such as the pleural cavity. A variety of pleural cavity sarcomas have been described, including liposarcoma,(3) chondrosarcoma,(4) osteosarcoma,(5) and malignant schwannoma.(6) Pleural synovial sarcoma, however, is a much rarer entity. In fact, pleural synovial sarcoma was first described only 6 years ago(7) and has not yet been reported in the surgical literature. Because of its rarity, pleural synovial sarcoma is often mistaken for the histologically similar malignant mesothelioma, the most common of the pleural neoplasms. This is a critical distinction, because synovial sarcoma may be extremely aggressive. Studies in the last 10 years have shown it to be extremely sensitive to ifosfamide-based chemotherapy, and survival of patients with synovial sarcoma has recently increased with chemotherapy, with 5-year survivals now as high as 57%.(8-10) In this report, we describe 3 cases of synovial sarcoma of the pleura. Clinical findings are correlated with pathologic features, including immunohistochemical stains and fluorescence in situ hybridization (FISH) for the identification of the diagnostic chromosomal translocation, t(X;18)(p11.2;q11.2). This delineation of the clinical and pathologic aspects of this rare, newly recognized tumor should increase awareness among the surgical community.

Adult↗

PubMed2003

Extramedullary relapse in the pleura in acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloblastic leukemia with specific clinical, morphologic and genetic features and a good response to all trans retinoic acid (ATRA). However, extramedullary (EM) relapse is an interesting feature of these cases, especially those treated with ATRA. Recently, we have encountered an EM relapse in the pleura in a case with APL receiving an ATRA containing regimen. This case is reported and the relevant literature is reviewed.

Adult↗

PubMed1984

Diffuse malignant mesothelioma of pleura: diagnostic criteria based on an autopsy study.

Sixteen unequivocal, diffuse malignant mesotheliomas ( DMM ) of pleura and eight diffuse pleural tumors simulating DMM , all from autopsied cases, were studied with hematoxylin and eosin, mucicarmine, diastase-periodic acid-Schiff ( DPAS ), colloidal iron, carcinoembryonic antigen, and keratin immunoperoxidase stains. Collagen production by tumor cells when identifiable was diagnostic of DMM and was found not only in sarcomatous and "biphasic" mesotheliomas but also focally in "epithelial" variants. In "epithelial" areas, a constant nuclear/cytoplasmic (N/C) ratio with variable cell size often imparted a distinctive appearance of regularity, and mucin-negative DPAS -negative vacuoles or ground-glass cytoplasmic zones always could be found. Most metastatic carcinomas featured a high N/C ratio; some but not all had mucicarmine-positive or DPAS -positive vacuoles. Stains for carcinoembryonic antigen and keratin did not discriminate between DMM and metastatic carcinoma. Distant metastases were present in 12 of the 16 DMM cases but were clinically occult in 11 cases.

Aged↗

PubMed1992

Extraskeletal myxoid chondrosarcoma of the pleura. Report of a case clinically simulating mesothelioma.

A primary extraskeletal myxoid chondrosarcoma of the pleura that clinically mimicked a malignant mesothelioma in a 66-year-old man with a history of asbestos exposure is described. Although exceedingly rare in this location, the characteristic histologic features, immunohistochemical reactivities, and ultrastructural features support the diagnosis of extraskeletal myxoid chondrosarcoma. Many ferruginous (asbestos) bodies consistent with the exposure history were found in the lung tissue sections and confirmed by energy-dispersive spectrometry. This case demonstrates an unusual pleural primary neoplasm associated with asbestos.

Aged↗

PubMed1994

Expression of CD34 by solitary fibrous tumors of the pleura, mediastinum, and lung.

Solitary fibrous tumors are rare neoplasms that most commonly involve the pleura, mediastinum, and lung. Because they lack distinctive histologic features, immunologic staining has frequently been employed to exclude other neoplasms in the differential diagnosis. Their reported phenotype to date is generally negative, notably for muscle-type actins, desmin, keratin, and S-100 protein. Although this testing is of some help, it does not serve to distinguish all processes in the differential diagnosis, and when it does, it places too great an emphasis on a negative finding to make a diagnosis. We report here that CD34 monoclonal antibodies reacted with 11 of 14 solitary fibrous tumors in paraffin sections. Thus, they provide a positive marker that distinguishes the solitary fibrous tumor from most elements in the differential diagnosis.

Adult↗

PubMed1996

Adenomatoid tumors of the pleura.

We report two cases of small pleural nodules showing the distinctive histologic appearance of adenomatoid tumor. Both lesions were discovered incidentally during surgery in patients undergoing lung resection for unrelated intrapulmonary masses: lung carcinoma in one case and histoplasmosis in the other. The tumors were composed of a focal proliferation of epithelioid cells forming vacuoles and tubular spaces in a fibrous stroma, as seen in adenomatoid tumors from other sites. The differential diagnosis in both cases included metastatic signet ring cell carcinoma. The mesothelial nature of the lesions was supported by immunohistochemical and ultrastructural evidence. The tumor cells in both cases were positive for cytokeratin but negative for carcinoembryonic antigen and LeuM1. One case was also negative for BER-EP4, B72.3, CD34, and Factor VIII. Electron microscopy in this case demonstrated well-developed basal laminae, desmosomes, and numerous slender microvilli along the luminal surfaces of the tumor cells. Adenomatoid tumors are regarded as a benign variant of mesothelioma. Despite the abundance of mesothelial cells in the pleura, adenomatoid tumors are apparently extremely rare in this location. Separation from malignant lesions such as adenocarcinoma and epithelioid hemangioendothelioma is important.

Adenomatoid Tumor↗

PubMed1998

Value of cytokeratin 5/6 immunostaining in distinguishing epithelial mesothelioma of the pleura from lung adenocarcinoma.

The immunohistochemical diagnosis of mesothelioma is commonly made by using a battery of antibodies that reacts with lung adenocarcinomas but not with epithelial mesotheliomas. Only recently have markers that are often expressed in mesotheliomas but not in adenocarcinomas been recognized. Some of these markers, however, require frozen tissue sections, whereas others are not commercially available, or their value remains controversial. In a recent publication, it was suggested that immunostaining for cytokeratin 5/6 could assist in distinguishing epithelial mesothelioma from lung adenocarcinoma. To determine the practical value of cytokeratin 5/6 immunostaining in the diagnosis of mesothelioma, 40 formalin-fixed, paraffin-embedded epithelial pleural mesotheliomas, 30 pulmonary adenocarcinomas, 93 nonpulmonary adenocarcinomas, 15 squamous carcinomas of the lung, 5 large cell undifferentiated carcinomas of the lung, and 12 metastatic transitional cell carcinomas to the lung were stained with the same antibody, which was obtained from a commercial source. Cytokeratin 5/6 reactivity was observed in all 40 mesotheliomas, but there was none in any of the 30 pulmonary adenocarcinomas. Focal or weak reactivity was observed in 14 of 93 nonpulmonary adenocarcinomas (10 of 30 ovarian, 2 of 10 endometrial, 1 of 18 breast, I of 7 thyroid, 0 of 10 kidney, 0 of 10 colonic, and 0 of 8 prostatic). All 15 squamous carcinomas of the lung, 6 of 12 transitional cell carcinomas metastatic to the lung, and 3 of 5 large cell undifferentiated carcinomas of the lung expressed cytokeratin 5/6. It is concluded that cytokeratin 5/6 immunostaining is not only useful in separating epithelial pleural mesotheliomas from pulmonary adenocarcinomas but also can assist in distinguishing epithelial mesotheliomas from nonpulmonary adenocarcinomas metastatic to the pleura.

Adenocarcinoma↗

PubMed2004

Well-differentiated papillary mesothelioma of the pleura: a series of 24 cases.

Well-differentiated papillary mesothelioma (WDPM) of the pleura represents a distinct mesothelial tumor presenting with unilateral pleural effusion and superficial spreading of stout papillary formations with myxoid cores, lined by bland, flattened, or epithelioid cells, without or with limited invasion of the submesothelial layer. The majority of cases have been reported in the peritoneum in women of reproductive age with no history of asbestos exposure and also in the tunica vaginalis of men. We report 24 cases of pleural WDPM and compared their histologic, epidemiologic, and clinical features with those of classic mesothelioma. Men and women were equally affected, with a mean age of 60 years. Half of the patients had a history of occupational asbestos exposure. In 11 patients with a minimal follow-up period of 24 months, the survival ranged from 36 to 180 months with an average of 74 months as compared with 9.89 months for 1248 paired patients with diffuse malignant mesothelioma. Ten-year survival was 30.8%. We conclude that WDPM is a rare and unusual mesothelial tumor, characterized by a lack of deep invasion and associated with an indolent clinical course and long survival. For these reasons, WDPM is best considered as a specific clinico-pathologic entity distinct from conventional diffuse malignant mesothelioma.

Adult↗

PubMed1993

Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations.

OBJECTIVE: This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura. SUMMARY BACKGROUND DATA: No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 80 years. METHODS: A retrospective study was done comparing the effectiveness, indications, complications, and limitations of TS and VATS done for four categories of pleural disease: 1) pleural fluid problems, 2) diffuse lung disease, 3) lung masses, and 4) pneumothorax. The TS period was 1981-1990. The VATS period was 1991-1992. RESULTS: Eighty-nine consecutive TS cases and 64 consecutive VATS cases were reviewed. TS for resolution of pleural fluid problem was successful in 29 of 34 patients (85%), and VATS was successful in 18 of 20 (90%). Diffuse lung disease was diagnosed by TS using a cup biopsy on end-stage patients in respiratory failure. Since 1991 the diagnosis has been made with VATS using stapled wedge excisions on ambulatory patients. Surgical mortality decreased from 33% (10 of 30) to 9% (1 of 11) and the postoperative stay from 16.6 +/- 2.4 days to 8.2 +/- 2.2 days. Lung masses were diagnosed entirely by incisional biopsies using TS. Diagnosis was made in 83% and postoperative stay was 5.3 +/- 1.0 day. VATS allowed excisional biopsies permitting diagnosis in 100% with a postoperative stay of 3.0 +/- 0.2 days (p = 0.05). However, 20% required conversion to thoracotomy to locate the subpleural mass. TS was performed for spontaneous pneumothorax in only 26% (5 of 19) of the total pneumothorax cases, whereas, VATS was used for spontaneous pneumothorax in 67% (12 of 18). CONCLUSION: VATS has continued the effectiveness of TS for treating pleural fluid problems, has resulted in earlier surgical diagnostic intervention in diffuse lung disease and earlier therapeutic intervention in primary pneumothorax states, and has markedly expanded the safety, efficacy and indications for lung mass biopsy.

Adolescent↗

PubMed1994

Neoplasms of the mediastinum, chest wall, and pleura.

Although primary malignant diseases of the mediastinum, chest wall, and pleura are rare, the interest in investigational activity in mesothelioma and thymoma has increased because of new technologies such as magnetic resonance imaging, monoclonal antibody testing, thoracoscopy, and genetic engineering. Improvement in treatment outcome among patients with mesothelioma has been slow, due in part to the rarity of the disease and in part to resistance to treatment. Groupwide or intergroup studies are needed to assess the biology and treatment of these disorders. Advanced malignant thymoma has been shown to be sensitive to chemotherapy. Active studies to define the optimal treatment regimen continue.

Germinoma↗