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PubMed1999

Comparison of omentum, pleura and diaphragm for tracheal autograft survival in rats.

Pleura, diaphragm, pericardial fat pad, intercostal muscles and omentum can be used to protect and revascularize the bronchial suture line. To compare the efficiency of pleura, diaphragm and omentum, an experimental study was designed. Heterotopic tracheal autotransplantation was performed in 15 rats. Animals were divided into three groups; omentum, diaphragm and pleura. Tracheal Segment Necrosis Scoring System was used for pathologic examinations. Pleural and diaphragmatic groups showed the least necrosis and there was significant statistical difference among these groups and omental group (P < 0.05). Our study showed that pleura and diaphragm could be used as safely as omentum for protection and survival of bronchial suture lines.

Analysis of Variance↗
PubMed2002

Chrysotile and tremolite asbestos fibres in the lungs and parietal pleura of Corsican goats.

BACKGROUND AND AIMS: Environmental exposures to chrysotile and tremolite from the soil cause pleural plaques and mesothelioma in northeast Corsica. Goats grazing in the contaminated areas inhale asbestos fibres. We used this natural animal model to study whether these exposures actually result in increased fibre burdens in the lungs and parietal pleura. METHODS: Ten goats from areas with asbestos outcrops and two from other areas were slaughtered. Fibre content of lung and parietal pleural samples was determined by analytical transmission electron microscopy. RESULTS: Both chrysotile and tremolite fibres were detected. In the exposed goats, the geometric mean concentrations of asbestos fibres longer than 1 microm were 0.27 x 10(6) fibres/g dry lung tissue and 1.8 x 10(6) fibres/g dry pleural tissue. Asbestos fibres were not detected in the lungs of the two control goats. Chrysotile fibres shorter than 5 microm were predominant in the parietal pleura. Tremolite fibres accounted for 78% and 86% of the fibres longer than 5 microm in lung and parietal pleural samples, respectively. CONCLUSIONS: Environmental exposure in northeast Corsica results in detectable chrysotile and tremolite fibre loads in the lung and parietal pleura of adult goats. Tremolite fibres of dimensions with a high carcinogenic potency are detected in the parietal pleura.

Animals↗
PubMed1975

The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura.

Lympatics in the parietal pleura and diaphragm of rabbits and mice formed lacunas, terminal dilatations of lymphatic channels, with cribriform laminas bordering the pleural space at one end and one-way valves on the other end. The laminas consisted of a coarse mesh of connective tissue fibers covered by mesothelial cells at one side and endothelial cells at the other. At the fenestrated portions of the meshwork the basal surfaces of the 2 lining cells were closely apposed and some preformed stomas were found bridging the pleural and lymphatic spaces. No such structures were found in the visceral pleura, but similar cribriform laminas were also present in human parietal pleura at autopsy. Intrapleurally injected carbon particles reached the lacunas faster than similarly injected chicken red blood cells in living rabbits. Carbon particles appeared to pass through the closely apposed lining cells as well as the stomas but not into the intact interstitial structures. These structural and functional findings supported the observation that large particles and cells in the pleural cavity are removed only through the lymphatics and only at specific sites in the parietal pleura.

Animals↗
PubMed2006

Spinal afferent neurons projecting to the rat lung and pleura express acid sensitive channels.

BACKGROUND: The acid sensitive ion channels TRPV1 (transient receptor potential vanilloid receptor-1) and ASIC3 (acid sensing ion channel-3) respond to tissue acidification in the range that occurs during painful conditions such as inflammation and ischemia. Here, we investigated to which extent they are expressed by rat dorsal root ganglion neurons projecting to lung and pleura, respectively. METHODS: The tracer DiI was either injected into the left lung or applied to the costal pleura. Retrogradely labelled dorsal root ganglion neurons were subjected to triple-labelling immunohistochemistry using antisera against TRPV1, ASIC3 and neurofilament 68 (marker for myelinated neurons), and their soma diameter was measured. RESULTS: Whereas 22% of pulmonary spinal afferents contained neither channel-immunoreactivity, at least one is expressed by 97% of pleural afferents. TRPV1+/ASIC3- neurons with probably slow conduction velocity (small soma, neurofilament 68-negative) were significantly more frequent among pleural (35%) than pulmonary afferents (20%). TRPV1+/ASIC3+ neurons amounted to 14 and 10% respectively. TRPV1-/ASIC3+ neurons made up between 44% (lung) and 48% (pleura) of neurons, and half of them presumably conducted in the A-fibre range (larger soma, neurofilament 68-positive). CONCLUSION: Rat pleural and pulmonary spinal afferents express at least two different acid-sensitive channels that make them suitable to monitor tissue acidification. Patterns of co-expression and structural markers define neuronal subgroups that can be inferred to subserve different functions and may initiate specific reflex responses. The higher prevalence of TRPV1+/ASIC3- neurons among pleural afferents probably reflects the high sensitivity of the parietal pleura to painful stimuli.

Acid Sensing Ion Channels↗
PubMed1988

Surface morphology of the human pleura. A scanning electron microscopic study.

The superficial morphology of the pleura has been observed in humans by scanning electron microscopy (SEM). Pleural samples from the visceral, mediastinal, diaphragmatic and costal normal human pleura were observed, and a thorough morphometric study was performed. The most evident feature was the ubiquitous presence of microvilli and micropores. The secretion and absorption activities therefore should not be regarded as accomplished by different topographic zones of the pleura. Discontinuities and clefts were observed at the level of cellular junctions; absorption of high weight molecules and cells from the pleural space may be facilitated at this level, but the structures which were observed in humans may not be considered "stomata," according to the definition of such morphologic units as we give in the present study. Cilia and blebs, described in the experimental animal or in other mesothelia, were not seen in the human pleura.

Humans↗
PubMed1992

Structure and distribution of the lymphatic vessels in the parietal pleura of the monkey as studied by enzyme-histochemistry and by light and electron microscopy.

The entire distribution of lymphatics in whole mount preparations of the Japanese monkey was studied using the enzyme-histochemical technique reported by KATO et al. (1990, 1991). In this staining, the lymphatic endothelium was colored dark brown by its positive 5'-nucleotidase activity, while most blood vessels (especially arterioles) were colored blue due to their positive alkaline phosphatase reaction. The whole mount preparations of the pleura treated enzyme-histochemically clearly indicated the distribution, branching patterns and running courses of lymphatic vessels. They revealed numerous short blind-ending knobs which represented the initial portions of lymphatics. These knobs were seen near the surface of the parietal pleura along its entire extent. In the costal and diaphragmatic pleura, the lymphatics ran parallel to the intercostal muscle fibers, but perpendicular to the tendinous and muscular fibers of the diaphragm; they formed ladders, independent of the courses of blood vessels. In the mediastinal pleura, lymphatic vessels showed a tree-like branching accompanying blood vessels. Under the light microscope, toluidine-blue stained semithin sections revealed the initial part of lymphatics as a small irregularly outlined cavity (7-10 microns in diameter) surrounded by a dense connective tissue. This lymphatic dilation was sometimes located close to a thin mesothelial layer. Such a structure suggesting a "stoma" was seen near the attachment of the muscular diaphragm to the sternum and along the borders of the ribs. Transmission electron microscopy revealed an occasional interruption in the mesothelium. This stoma continued to a submesothelial cavity whose base comprised an attenuated endothelium of an extended lymphatic vessel.

5'-Nucleotidase↗
PubMed2006

Lymphomas involving the pleura: a clinicopathologic study of 34 cases diagnosed by pleural biopsy.

CONTEXT: Pleural involvement by lymphoma is relatively common. However, there are very few clinicopathologic studies reported in the literature of lymphomas involving the pleura. OBJECTIVE: To characterize the clinicopathologic features of lymphomas involving the pleura. DESIGN: We reviewed the clinicopathologic features of 34 patients with lymphoma involving the pleura proven by biopsy and classified these neoplasms using the World Health Organization classification. RESULTS: There were 22 men and 12 women, with an average age of 62 years (range, 22-82 years). Nine (26.5%) patients had pleural involvement as the only site of disease, 22 (64.7%) had other sites of involvement, and 3 (8.8%) had inadequate staging data. Eighteen (56.2%) of 32 patients with adequate clinical data had a history of lymphoma (including 3 patients with pleural involvement as the only disease site). In 29 (85.3%) cases, a specific diagnosis according to the World Health Organization classification could be made: 17 (58.6%) diffuse large B-cell lymphoma, 5 (17.2%) follicular lymphoma (including a case with areas of diffuse large B-cell lymphoma), 2 (6.9%) small lymphocytic lymphomas/chronic lymphocytic leukemia, 2 (6.9%) precursor T-cell lymphoblastic lymphoma/leukemia, 1 (3.4%) mantle cell lymphoma, 1 (3.4%) posttransplant lymphoproliferative disorder, and 1 (3.4%) classical Hodgkin lymphoma. The other 5 cases were B-cell lymphomas that could not be further classified. Cytologic examination of pleural fluid was performed in 15 cases and was positive for lymphoma in 8 (53.3%) cases. CONCLUSIONS: Most patients with lymphoma involving the pleura have simultaneous evidence of systemic involvement. The most frequent type is diffuse large B-cell lymphoma, followed by follicular lymphoma. Cytologic examination can have negative results in patients with pleural involvement by lymphoma.

Adult↗
PubMed1976

[Peculiar capillary convolution of the parietal pleura. III. Electron microscopy studies].

By means of electron microscopy and ultrahistochemical research it has been attempted to detail the structure and explain the function of the pleural tufts of the parietal pleura present in the ventral mediastinum of dogs. This led to the discovery that the varions forms present for the surface-enlarging pleura protusions in actuality exhibit corresponding morphological characteristics. As a special formation of the serous lamina of parietal pleura, they are covered by an occasionally incomplete mesothel unit. The parenchyma of these organs is compinsed of a macrophage-rich outer border zone and of a vessel-canying central zone. The experimental in vivo application of cationized ferritin in the pleura-space clearly indicated a high resorptive metabolism of the mesothel and of the pluripotential mesenchym cells. The higher incidence of lymphoplasmatic cell-forms in the proximity of the central vessels along with leucocytic cell infiltrations fulfill an immunocellular and phagocytic function. The structure of the cell population of the pleural tufts partaking on the resorption of matter out of the pleural space has been discussed in detail. The in vivo application of a cationized ferritin solution for the purpose of studying these resorptive processes has been critically judged.

Animals↗
PubMed1992

Surgery and the management of peripheral lung tumors adherent to the parietal pleura.

Among 37 patients with peripheral T3 lung lesions, preoperative clinical and imaging evidence was suggestive of T3 disease in 28 and of T2 disease in nine. Intraoperatively, the T2 designation was changed to T3 on the basis of adherence of the tumor to the parietal pleura. All had mediastinoscopy followed by resection and complete lymph node dissection. There were 17 lobectomies and 20 pneumonectomies. The chest wall was resected in continuity with the lung in 21 patients, and in 16 only an extrapleural resection was done. Follow-up was completed in all patients (range 2 to 14 years, median 7 years). The 5-year actuarial survival rate for all patients was 30%. As expected, the presence of lymph node metastasis affected the 5-year actuarial survival rate: N0 = 41%; N1 = 29%, and N2 = 0%. Histologic examination of the resected specimen confirmed a T3 lesion in 30 patients. The tumor was removed completely in 100% of patients whose chest wall was resected in continuity with the lung but in only 31% in whom an extrapleural resection was done. In the absence of lymph node metastasis, the 5-year survival rate of patients after en bloc resection of the chest wall was 50% compared with 33% for those with extrapleural resection (p less than 0.05). The finding of a peripheral lung tumor adherent to the parietal pleura indicates, in most instances, extension through the parietal pleura. When tumor is firmly adherent to the parietal pleura, an en bloc resection of the chest wall rather than an extrapleural dissection should be performed. This assures complete tumor removal and improves the probability of long-term survival.

Carcinoma, Non-Small-Cell Lung↗
PubMed1987

[Practical recommendations for examining the pulmonary pleura of fetuses and newborn infants using contact microscopy].

It has been found that the pleura visceralis of fetuses and neonates is consistently involved in inflammatory processes occurring in pneumonias caused by Gram-negative organisms (Citrobacter sp., Escherichia coli, Klebsiella sp., Serratia marcescens) and may display signs of infection when the pneumonia is not yet apparent. This property of the pleura as a filtration membrane may help the pathologist in the early diagnosis of infectious disorders in neonates. Recommendations are given on the excision of pulmonary pleura and the staining of its preparations for contact microscopy whereby these can be examined during or shortly after the autopsy. Morphologic features of the infections caused by the indicated organisms are detailed. Citrobacter infections, for example, show a preponderance of macrophage responses, Klebsiella-caused lesions are characterized by involvement of the lymphatic bed, while those due to S. marcescens have hemolysis in the lung tissue and pleura as their main feature.

Bacterial Infections↗
PubMed1978

[Morphology of the microcirculatory bed of the lungs and visceral pleura in liver cirrhosis].

Morphological examinations of the microcirculatory bed of the lungs and pulmonary pleura in 30 fatal cases of cirrhosis of the liver revealed generalized involvement of the blood and lymph vessels. Most significant changes were found in venular and lymphomicrocirculatory parts of the pulmonary pleura as a manifestation of compensatory-adaptative processes directed at retention of the hemodynamic homeostasis of the pulmonary circulation. In the author's opinion, the most important factors causing reactions of the microcirculatory bed of the pulmonary pleura include venous hypervolemia of the pulmonary circulation followed by hypoxia. It is suggested that changes in the vessels of the microcirculatory bed of the lungs and pulmonary pleura in patients with cirrhosis of the liver are an important part of the compensatory-adaptative mechanisms; their disorders cause the development of the right ventricle insufficiency.

Adult↗
PubMed1981

Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature.

Three-hundred-sixty cases of solitary fibrous tumor of the pleura from the literature are analyzed, and eight new cases are described. Of patients reported on prior to 1972, 72% had symptoms due to the tumor at the time of diagnosis, but only 54% of patients reported on since then were symptomatic. This probably reflects earlier diagnosis as a result of increased use of chest radiographs in asymptomatic populations. Cough, chest pain, dyspnea, and/or pulmonary osteoarthropathy are each found in at least one-third of patients who have symptoms. Approximately 80% of solitary fibrous tumors of the pleura originate in the visceral and 20% in the parietal pleura. In the literature and in this experience these tumors are on the whole circumscribed. The range in size from 1-36 cm with a mean of 6 cm. Many are pedunculated on pleural-based pedicles that contain hypertrophic arteries and veins. Histologic examination of the tumor usually discloses cellular areas alternating with hyalinized and/or necrotic areas. Spindle-shaped cells typically have minimal nuclear pleomorphism and rare or absent mitoses. Numerous thin-walled vessels constitute an additional feature of large tumors. Electron microscopical examination reveals features of both fibroblasts and mesothelial cells. Solitary fibrous tumors behave in a benign fashion in 88% of cases after surgical resection. In 12% of the cases the tumor is responsible for the patient's death because of its extensive intrathoracic growth, by virtue of either late diagnosis or unresectable recurrence. No single histologic feature allows a definite prognosis. The best indicator of a good prognosis is the presence of a pedicle supporting the tumor. Also favorable in circumscription of the tumor without invasion of lung, mediastinum, or chest wall. Nuclear pleomorphism and a high mitotic rate are seen in larger tumors but do not necessarily indicate a poor prognosis if the tumor is circumscribed. Solitary fibrous tumors of the pleura are not associated with asbestos.

Adult↗
PubMed1984

Ultrastructural observations on the histogenesis of localized fibrous tumours of the pleura (benign mesothelioma).

Five localized fibrous tumours of the pleura (benign mesothelioma) were studied ultrastructurally in order to elucidate their histogenesis. The histological subtypes of this benign fibrous lesion of the visceral pleura, i.e. the cellular, the collagenous, and the hyaline, were separately analysed. The tumours are composed of undifferentiated mesenchymal cells, intermediate and differentiated fibroblasts as well as collagenous interstitial tissue. The varying distribution of these cell elements account for the various histological subtypes. Morphological similarities between the mesenchymal tumour cells and the superficial mesothelial cells, which are always separated from the true tumour tissue by an intact basement membrane, were not observed. The different cellular elements can be regarded as parts of a continuous spectrum of cytodifferentiation, in which the mature fibroblasts are derived via intermediate forms from the undifferentiated cells. It is concluded that the localized fibrous tumours of the pleura arise from immature mesenchymal stem cells, which seems to be normally found in the submesothelial layer of the visceral pleura.

Female↗
PubMed2004

Multiple calcifying fibrous tumors of the pleura.

Calcifying fibrous tumor (CFT) is a rare lesion characterized histologically by hypocellular hyalinized collagenous tissue with psammomatous and/or dystrophic calcifications and patchy lymphoplasmacytic infiltrates. CFT usually occurs in the somatic soft tissue of children and young adults but is rarely found in the pleura. We describe here an unusual case of multiple small CFTs in the right mediastinal pleura of a 54-year-old man who had a history of renal cell carcinoma. Suspecting pulmonary and pleural metastases, we performed wedge resection of the right middle lobe and local excision of two nodules in the right pleura. Light microscopy revealed metastatic lesions of renal cell carcinoma in the resected wedge. The pleural nodules were well circumscribed and composed of hypocellular, dense, hyalinized, collagenous tissue with scant lymphoplasmacytic infiltration and characteristic psammoma bodies. Immunohistochemical staining revealed that most spindle cells were positive for vimentin, CD34 and factor XIIIa, and negative for epithelial membrane antigen, keratin, smooth-muscle actin, desmin, S-100 protein and anaplastic lymphoma kinase. We made a histological diagnosis of CFT of the pleura, and the patient remains well 6 months after the wedge resection.

Calcinosis↗
PubMed2002

Synovial sarcoma arising from the pleura: a case report with ultrastructural and immunohistological studies.

Synovial sarcoma commonly occurs in the para-articular regions of the extremities, and rarely in the pleura. We report a 46-year-old woman with primary synovial sarcoma of the pleura. She was admitted with a complaint of left-sided chest pain and exertional dyspnea. She had previously undergone two operations for pleural neoplasm, at the ages of 33 and 36 years. A computed tomography scan revealed an expanded mass in the left thoracic cavity, involving the surrounding tissue. Macroscopic findings demonstrated a 25 x 25 x 15-cm grayish-white mass with hemorrhage beneath the pleura. Both epithelial and spindle cells were observed microscopically. Ultrastructural microscopy of the epithelioid cells demonstrated short, blunt microvilli on the luminal surface, and desmosomes between the neoplastic cells. Immunohistochemically, the tumor cells of the epithelial component were positive for embryonal membrane antigen (EMA), carcinoembryonic antigen (CEA), human mesothelial cells (HBME)-1, and cytokeratin, and the spindle cells were positive for vimentin. These findings led us to a diagnosis of primary synovial sarcoma of the pleura. She had no evidence of recurrence or metastasis after the third operation.

Diagnosis, Differential↗
PubMed2006

Benign localized fibrous tumour of the pleura: CT features with histopathological correlations.

AIM: To assess the CT features of benign localized fibrous tumour of the pleura, with histopathological correlations. MATERIALS AND METHODS: CT and histopathological findings of 18 patients with surgically resected benign localized fibrous tumour of the pleura were retrospectively assessed. RESULTS: Tumours were pleura or fissure based, semilunar, lentiform or oval in shape, classified according to their homogeneous, slightly heterogeneous or heterogeneous enhancement pattern. Of the 18 tumours, 5 (28%) demonstrated > or = 55 HU increment or higher attenuation than muscles on contrast-enhanced CT, and histopathologically showed a haemangiopericytoma-like pattern with rich vascularity. CONCLUSION: CT analysis of the shape of a mass and the enhancement pattern can be helpful in the diagnosis of benign localized fibrous tumour of the pleura.

Adult↗
PubMed2003

Localized fibrous tumors of the pleura: clinical and surgical evaluation.

BACKGROUND: Localized fibrous tumors of the pleura, which are considered to originate from submesothelial connective tissue, are rare. The purpose of this study was to investigate the clinical features of these tumors and to determine the optimal treatment and follow-up. METHODS: The records of 10 consecutive patients with localized fibrous tumors of the pleura operated on at the Ataturk Center for Chest Diseases and Thoracic Surgery between 1995 and 2001 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all of the patients. Pneumonectomy was required in 1 patient because of a giant intraparenchymal localized fibrous tumor of the pleura. Additional partial chest wall resections were done in 2 patients. RESULTS: The size of excised tumors ranged from 10 x 8 x 4 cm to 30 x 25 x 20 cm. Malignant transformation was seen in 1 patient 22 months after resection of a benign tumor. Four cases were pathologically considered to be malignant. All patients except 1 are alive (follow-up 16 to 57 months after resection). CONCLUSIONS: Although localized fibrous tumors of the pleura are considered histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients.

Adult↗
PubMed2002

Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome.

OBJECTIVE: The aim of this paper is to study clinical characteristics, surgical treatment and outcome of patients with solitary fibrous tumor of the pleura operated in our institutions in a 20-year period. METHODS: Clinical records of all patients operated for solitary fibrous tumors of the pleura between 1981 and 2000 were reviewed retrospectively. Tumors were classified as malignant in the presence of at least one of the following criteria: (1) high mitotic activity; (2) high cellularity with crowding and overlapping of nuclei; (3) presence of necrosis; (4) pleomorphism; otherwise they were considered as benign. RESULTS: Sixty patients (mean age 55 years) were operated in this period. None had asbestos exposure. Symptoms were present in 31 cases. Surgical approaches included thoracotomy (n=53), video-assisted thoracoscopy (n=6), and median sternotomy (n=1). Tumors originated from visceral pleura in 48 cases, from parietal, mediastinal or diaphragmatic pleura in seven, two and three cases, respectively; their mean diameter was 8.5 cm. Tumors could be resected with their implantation basis in 49 patients. In the remaining 11, extended resections were performed, including lung parenchyma (lobectomy, n=4, pneumonectomy, n=2), osteomuscular chest wall structures (n=2), diaphragm (n=2), and pericardium (n=1). Two postoperative deaths (due to myocardial infarction and pulmonary embolism, respectively) occurred. Tumors were pathologically benign in 38 cases and malignant in 22 cases. Mean follow-up was 88 months. Resection was complete in all the patients with benign tumors and no recurrence occurred. Resection was considered as complete in 21/22 malignant tumors. Local recurrence was observed in two cases. Both could be successfully managed by iterative exeresis (no extended resection had been initially performed). Metastatic disease (responsible for patient's death) was observed following the only incomplete resection. Actuarial 5- and 10-year survival rates were 97% for benign tumors and 89% for malignant ones. CONCLUSIONS: Surgical resection provided cure in all the patients with benign tumors. As insufficiency of exeresis is associated with all recurrences in malignant tumors, completeness of resection is in our experience the best prognostic factor in these forms.

Adult↗