1/138. 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.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
2/138. Granulocyte colony stimulating factor-producing diffuse malignant mesothelioma of pleura.We report the rare case of a 61-year-old man with a diffuse malignant mesothelioma of mixed subtype which produced granulocyte colony-stimulating factor (G-CSF). The white blood cell (WBC) was elevated to 85,100/mm3 without any evidence of infection, and the G-CSF level in the pleural effusion was also increased at 13,200 pg/ml. The lobes of the lung were encased in a tumor. Histopathologically, the tumor cells were of a polymorphous morphology with an epithelial and sarcomatoid mixed pattern. immunohistochemistry showed that the tumor cells were positive for vimentin, cytokeratin, epithelial membrane antigen, thrombomodulin, and G-CSF, and negative for carcinoembryonic antigen (CEA), CD34, and surfactant apoprotein-A.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
3/138. Preoperative work-up of a solitary diaphragmatic mass in a patient with right shoulder pain: a case for diagnosis.A patient presented with right shoulder pain. Imaging studies revealed an apparently solitary soft tissue pleural lesion, accompanied by a very small pleural effusion. On medical thoracoscopy, a diffuse malignant pleural mesothelioma was found. thoracoscopy proved to play an essential part in the diagnostic work-up, avoiding a futile thoracotomy for a presumed solitary soft tissue tumour.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
4/138. Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma.Intrapleural catheters are useful in the palliative treatment of malignant effusions. Complications are infrequent and of little importance. We report a case of subcutaneous implantation metastasis along the course of intrapleural catheter, which had been placed under sonographic guidance in a patient with pleural mesothelioma. After drainage of the effusion, cisplatin plus cytarabine was administered via the chest tube, achieving complete remission of the pleural effusion. Subcutaneous metastasis became evident 3 months later and was the only sign of disease progression for 2 months. The seeding of cancer cells was probably caused by a small leakage of fluid around the chest tube that occurred during the placement procedure as a result of the increased intrapleural pressure caused by the large quantity of fluid that had accumulated in the pleural space.- - - - - - - - - - ranking = 0.34978165041578keywords = effusion (Clic here for more details about this article) |
5/138. Unilateral absence of lung perfusion on pulmonary scintigraphy secondary to lung cancer with extensive pleural metastases from lung cancer.A man with a 20-year history of smoking who underwent Tc-99m MAA Pulmonary perfusion imaging, which showed virtually absent perfusion of the right lung and fairly normal perfusion of the left lung. Eighteen days after the study, the patient died; at autopsy poorly differentiated carcinoma of the right lung was confirmed, which included extensive thickened pleura and plaques deposits and compression of the right lung; 200 ml of bloody pleural effusion was also found on the right side. The unilateral absence of lung perfusion on Tc-99m MAA pulmonary scintigraphy might reflect the autopsy findings of the right lung and pleura.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
6/138. Presence of human herpesvirus 8 dna sequences in renal transplantation-associated pleural Kaposi sarcoma.OBJECTIVE: To describe one case of symptomatic skin and pleural Kaposi sarcoma (KS) associated with kidney transplantation. diagnosis was supported by morphologic study and human herpesvirus 8 (HHV-8) detection in both tissues. Pulmonary involvement was not present. DESIGN: The presence of HHV-8 dna sequences was proved using polymerase chain reaction (PCR), Southern blot hybridization, and in situ hybridization. SETTING: Human herpesvirus 8 is found in most KS from patients with and without the acquired immunodeficiency syndrome. Clinically significant pulmonary infiltration by KS is diagnosed uncommonly antemortem, and pleural disease is exceptional. PATIENT: A 49-year-old man who had renal transplant with immunosuppressive therapy (tacrolimus and prednisone) and developed a cutaneous KS. A pleural effusion appeared without pulmonary involvement. Both lesions disappeared when immunosuppressive drugs were suspended. Later, the pleural effusion and the cutaneous lesions reappeared. Pleural biopsy specimens showed KS infiltration. OUTCOME: The patient refused treatment and was lost to follow-up. RESULTS: The skin and pleural biopsies showed a proliferation of spindle-shaped cells positive for CD34. The HHV-8 sequences were detected by nested PCR. No amplification was detected in uninvolved skin from the patient or in peripheral blood mononuclear cells from 10 healthy individuals used as controls. The Southern blot hybridization confirmed these results. CONCLUSIONS: To our knowledge, this is the first report of HHV-8 in symptomatic pleural KS, which was probably associated with immunosuppression after kidney transplantation. The demonstration of HHV-8 dna in biopsy material in the appropriate cells could be diagnostic when the morphologic setting is consistent with KS.- - - - - - - - - - ranking = 2keywords = pleural effusion, effusion (Clic here for more details about this article) |
7/138. Human herpes virus-8 associated primary effusion lymphoma of the pleural cavity in hiv-negative elderly men.Human herpes virus-8 (HHV-8)-associated primary effusion lymphoma (PEL) is an unusual lymphoma confined to the body cavities, which primarily affects human immunodeficiency virus (hiv)-positive men at high risk for Kaposi's sarcoma (KS). We describe two hiv-negative elderly Italian men, who developed pleural HHV-8-positive PEL in association with other diseases (systemic hypertension, colonic carcinoma, chronic obstructive airways disease, dilated cardiomyopathy), but without KS. Thoracic computed tomography revealed unilateral pleural effusion and pleural thickening. Thoracentesis disclosed large lymphoma cells, with no T- or B-cell associated antigens, clonal rearrangement of the immunoglobulin heavy chain gene and the presence of HHV-8 but not Epstein-Barr virus deoxyribonucleic acid sequences. Our cases differ from most pleural effusion lymphomas, in that they are non-acquired immunodeficiency syndrome-related. This highlights the possible human herpes virus-8-associated primary effusion lymphoma risk among elderly human immunodeficiency virus-negative patients, particularly Italians, in whom human herpes virus-8 seroprevalence rates and incidence of classic Kaposi's sarcoma are high.- - - - - - - - - - ranking = 2.6995633008316keywords = pleural effusion, effusion (Clic here for more details about this article) |
8/138. Malignant epithelioid vascular tumors of the pleura: report of a series and literature review.Primary malignant vascular tumors of the pleura are rare. The significance and difficulty of distinction between pleural epithelioid hemangioendothelioma (EHE) and angiosarcoma have not yet been addressed. A new series of pleural angiosarcoma is reported, and the relevant literature is reviewed. Five cases were identified from files of the authors' institutions and personal consultation cases (J.J.B.). Twenty-six cases of primary malignant vascular tumors of the pleura were identified in the literature. In a total of 31 cases, 22 were from the West and 9 from japan. patients were 22 to 79 years old (average, 57), and the male/female ratio was 9:1. Prior chronic pyothorax was identified only in cases reported from japan. history of exposure to radiation or asbestos was noted in a few Western cases. The most common presentation was pleural thickening and effusion. Almost all of the patients died of disease shortly after diagnosis. A spectrum of histology ranging from characteristic high-grade epithelioid to relatively low-grade EHE-like features was observed in our cases and can be found in previous reports. Most cases showed variable spotty cytokeratin immunoreactivity. Endothelial markers (factor 8, CD34, or CD31) were invariably positive. Pleural angiosarcomas are often epithelioid and can be easily mistaken for mesothelioma or carcinoma clinically and histologically. awareness of this rare tumor should prompt the use of endothelial markers when faced with a questionable mesothelioma. When cytokeratin is negative, or focal with strong vimentin reactivity, a vascular tumor should be suspected and confirmed with vascular markers. Because of their invariably aggressive behavior, all epithelioid vascular tumors of the pleura should be considered highly malignant regardless of the presence of EHE-like histological features.- - - - - - - - - - ranking = 0.11659388347193keywords = effusion (Clic here for more details about this article) |
9/138. diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report.BACKGROUND: Clinically documented distant metastases are rare in mesothelioma and tend to occur late in the course of the disease, well after the diagnosis has been made. In this instance, diagnosis was not made until a metastatic deposit was identified microscopically in the enlarged lymph node. CASE: A 65-year-old male with no definite history of occupational asbestos exposure presented with chest pain, pleural effusion and supraclavicular lymphadenopathy. Cytologic examination of material obtained by fine needle aspiration from his cervical lymph node revealed malignant mesothelioma. This was confirmed on histology. CONCLUSION: This was a particularly rare presentation and, as far as we are aware, was the first case in which mesothelioma was diagnosed by fine needle aspiration of a cervical lymph node. It serves to remind the pathologist that when confronted with a lymph node involved by tumor, the possibility of mesothelioma should be included in the differential diagnosis. The case also demonstrates the usefulness of fine needle aspiration in the diagnosis of metastatic tumor.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
10/138. Long term survival of a patient with malignant pleural mesothelioma as a late complication of radiotherapy for Hodgkin's disease treated with 90yttrium-silicate.A case of malignant pleural mesothelioma (PM) 24 years after thoracic radiotherapy for Hodgkin's disease is presented. As primary treatment and to relieve symptoms of dyspnea secondary to pleural effusion a thoracic drain was installed, followed by intracavitary radiation therapy with 90yttrium-silicate. Minor complaints of fever and a dry cough as a side-effect of this treatment were effectively treated with prednisone during 2 weeks. The patient remains in a good clinical condition now 6 years after diagnosis. Considering the few therapeutic options the use of 90yttrium-silicate intrapleural installation could be propagated as a safe and effective antitumour treatment for a selected group of patients with malignant PM.- - - - - - - - - - ranking = 1keywords = pleural effusion, effusion (Clic here for more details about this article) |
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