[Differentiation of serum albumin from albumin in cerebrospinal fluid, pleura exsudate and edema fluid].
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Cells obtained by tryptic digestion of the surface of intact adult and fetal Fischer 344 rat lungs were plated on glass fragments. Epithelial cell lines were readily established by selecting fragments with 2 to 10 cells 2 days after plating and growing them in F12 K media containing 10% fetal bovine serum (FBS). These cell lines and new lines that can be easily obtained a provide a reliable source of diploid, density-inhibited epithelial cells. These cells of mesothelial origin may serve as models for the study of mesothelial cells in situ.
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The solitary fibrous tumor (SFT) is a very rare and usually benign neoplasm. This tumor is mostly located in the thoracic cavity, but it has also been reported in numerous sites including liver, skin, and meninges. Due to its rarity diagnosis is often difficult. Accordingly, histopathological differentiation is of major importance. Solitary fibrous tumors consistently express CD 34 and react negatively to epithelial markers. This absence of expression of epithelial markers, especially cytokeratin, is also useful to distinguish these rare entities from sarcomatous mesotheliomas. The treatment of choice for solitary fibrous tumors is extensive surgical resection. Up to now there is no evidence that radiation and chemotherapy are effective. The local recurrence or onset of metastases depends on histologic parameters. In cases of benign classification (60-80%), the recurrence rate was only 2% after surgical excision. One-half of the patients with malignant tumors can be cured; the rest develop recurrences and metastases more often. Especially in those cases, emphasis should be placed on continual follow-up examination. We report two cases of a 65- and a 75-year-old male patient with huge intrathoracic solitary fibrous subpleural tumors, discovered incidentally on routine chest X-ray.
The morphological diagnosis of small mesothelial lesions in pleural biopsies is gaining importance in view of more aggressive, multimodal therapeutic options and of medicolegal aspects if a malignant mesothelioma is diagnosed. We present a light microscopically and immunohistochemically based morphological classification for the planning of further clinical follow-up procedures. A reactive mesothelial hyperplasia heals without scars. Mesothelial inclusions in pleuritic scars are common in recurrent pleuritis and must not be confused with an epithelioid component of a desmoplastic mesothelioma. In case of atypical mesothelial proliferations, further diagnostic procedures have to be performed to obtain a clear diagnosis of malignancy. Mesothelioma in situ is the first morphological step in neoplastic mesothelial changes, also with regard to medicolegal aspects for the unambiguous diagnosis of a mesothelioma. Early infiltrative growth is characteristic of so called early mesothelioma. A useful immunohistochemical panel for the differential diagnosis consists of anti-cytokeratin, Ck 5/6, calretinin, EMA and MiB-1, whereas the immunohistochemical detection of telomerase is not helpful.
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This review describes the sonographic morphology of the most important pleural diseases and defines the role of sonography compared with chest radiography and CT in diagnostic work-up of pleural pathology.
The ultrastructural characteristics of the mesothelial intracellular and extracellular lamellar bodies (LB) in norm, and especially in pathological conditions are still unknown. After routine fixation procedure, material from organs in the three serous cavities of Wistar rats, as control group were compared with animals following experimental hemothorax (EH) and experimental peritonitis (EP), using transmission and scanning electron microscopy (TEM, SEM). Different membrane-bound profiles, short strip-like structures and single LB characterize the control group. Five days after EH small groups of LB were observed. Single balloon-like profiles, numerous particles and larger groups of LB with wide varieties in size, form and membrane structure characterize the 8th day after EH. Thin and concentric membranes build single LB the 5th day of EP. Eight days after the same treatment, groups of LB, complex structures with several multilamellar centers, strip-like structures with rough granulo-filamentous material and uninterrupted covering over wide areas were observed. We conclude that constant components in the untreated rats are different membrane profiles, as initial lamellar formations and single typical LB with predominant intracellular position. The preferable sites for exocytosis of LB are the intercellular spaces. The present data demonstrate simultaneous findings of the two main groups of formations by using routine fixation in the control group and in the treated animals. The first represent LB as well as other round profiles, observed by TEM and particles, observed by SEM, which are widespread and probably have a basic role. The second ones are strip-like structures and its SEM-equivalents, i.e. uninterrupted covering. TEM-profiles and their SEM-images show significant organ differences and in some cases lack of correspondence between both electron microscopic techniques in the same treatment. Significant enlargement of the number of LB and the length of the strip-like structures characterize the mesothelium after pathologic conditions. LB with considerable differences in the structure and larger particles over the microvillous border predominate after EH. Strip-like profiles, continuous covering and smaller groups of LB with similar morphology and preferable submesothelial position characterize the mesothelium after EP.
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Desmoplastic reactions secondary to adjuvant chemotherapy and radiation in stage IIIA lung cancer, plus advances in complex tracheobronchial surgery, have rejuvenated an interest for augmenting bronchial stump coverage and suture line reinforcement. We present the techniques and applications of harvesting pleural, azygos vein, pericardial flaps, and fat pad grafts, and intrathoracic transposition of chest wall muscle flaps.
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Water and protein movement across the pulmonary endothelial-visceral pleural membrane of spontaneously breathing anesthetized dogs was analyzed to determine if the protein concentration at the microvascular membrane (Cpro) influences microvascular permeability. The left lung was enclosed in a water-impermeable membrane, creating a visceral pleural space (VPS); fluid and solute fluxes were determined as the filtration or reabsorption of water and protein in the VPS. The plasma protein concentration was experimentally varied by plasmapheresis with saline replacement while the pleural fluid protein concentration was varied by introducing different concentrations of plasma mixed with saline into the VPS. Hydrostatic pressures were maintained within a physiologic range (pulmonary capillary pressure 12.1-16.1 mm Hg). The plasma protein concentration fell as low as 1.98 g/dl, and Cpro, calculated as the mean of the plasma and pleural fluid protein concentrations, ranged from 1.73 to 6.23 g/dl. The relationship between Cpro and the apparent homoporous diffusional permeability for protein (Phs), Phs(cm/sec X 10(-6] = 0.95 Cpro (g/dl) + 2.28, was highly significant (r = 0.87, P less than 0.01). In contrast, the hydraulic conductivity was not affected by a reduction in Cpro to this level (r = 0.21, P greater than 0.4). Although the solute concentration at the endothelial membrane should be considered when evaluating changes in protein permeability, under most experimental conditions the magnitude of this effect will be small.
The amounts of Na+ and Cl- in the right pleural space of anesthetized rabbits were determined 10 and 60 min after a 2 ml hydrothorax with the following solutions: Ringer, Ringer with an inhibitor of the Na(+)-Cl- coupled transport or of the Na+/K+ pump, Ringer with gluconate instead of Cl- or with methylglucamine instead of Na+. During the 10-60 min period: (a) with Ringer Na+ and Cl- decreased (P less than 0.01) along with an iso-osmotic liquid absorption, (b) with disulfonic-stilbene (0.1 mM), amiloride (0.7 mM), acetazolamide (0.1 mM), or ouabain (0.5 mM) Na+ did not change and Cl- decreased less (P less than 0.01) than with Ringer. With gluconate-Ringer or methylglucamine-Ringer the liquid flow reversed: in the former case Cl- and, to a smaller extent, Na+ increased (P less than 0.01); in the latter only Na+ increased (P less than 0.01). These findings suggest: (1) the occurrence of a Na+/H+ and Cl-/HCO3- double exchange on the serosal side and of a Na+/K+ pump on the interstitial side of the pleural mesothelium; (2) a slow efflux from the pleural space of gluconate or methylglucamine relative to the corresponding influx of Cl- or Na+, respectively; this drags liquid into the space by osmotic gradient.
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