Cases Of Malignant Pleural Effusion Research Articles

A Case of Malignant Pleural Effusion Complicated by Klebsiella rhinoscleromatis

A Case of Malignant Pleural Effusion Complicated by Klebsiella rhinoscleromatis

A simple and efficient clinical prediction scoring system to identify malignant pleural effusion.

Early diagnosis of malignant pleural effusion (MPE) is of great significance. Current prediction models are not simple enough to be widely used in heavy clinical work. We aimed to develop a simple and efficient clinical prediction scoring system to distinguish MPE from benign pleural effusion (BPE). This retrospective study involved patients with MPE or BPE who were admitted in West China Hospital from December 2010 to September 2016. Patients were divided into training, testing, and validation set. Prediction model was developed from training set and modified to a scoring system. The diagnostic efficacy and clinical benefits of the scoring system were estimated in all three sets. Finally, 598 cases of MPE and 1094 cases of BPE were included. Serum neuron-specific enolase, serum cytokeratin 19 fragment (CYFRA21-1), pleural carcinoembryonic antigen (CEA), and ratio of pleural CEA to serum CEA were selected to establish the prediction models in training set, which were modified to the scoring system with scores of 6, 8, 10, and 9 points, respectively. Patients with scores >12 points have high MPE risk while ⩽12 points have low MPE risk. The scoring system has a high predictive value and good clinical benefits to differentiate MPE from BPE or lung-specific MPE from BPE. This study developed a simple clinical prediction scoring system and was proven to have good clinical benefits, and it may help clinicians to separate MPE from BPE.

CANCER RATIO-BASED DIAGNOSTIC TOOL IN IDENTIFYING MALIGNANT PLEURAL EFFUSION: SENSITIVITY, SPECIFICITY AND CLINICAL INSIGHTS

Background: Malignant pleural effusion (MPE) is a common cause of exudative lymphocytic pleural effusion. Although pleural fluid evaluation is routinely performed, cytology or histopathology remains the gold standard for MPE diagnosis. The cancer ratio (CR), calculated by comparing serum LDH to pleural fluid ADA levels, has shown promise in diagnosing MPE. However, no studies have investigated its utility in the Thai population, which has a high tuberculosis prevalence.
 Objectives: This study aimed to evaluate the diagnostic accuracy of the CR in MPE diagnosis, compare clinical and pleural fluid parameters between MPE and nonMPE cases, determine the appropriate CR cut-off for the Thai population and develop a prediction score for prediagnosing MPE.
 Results: Between July 2021 and December 2022, patients presenting exudative lymphocytic pleural effusion were included in the study. Demographics, symptoms, radiographic findings and pleural fluid parameters were collected and cytology/histopathology served as the reference test. CR performance was assessed using receiver operating characteristic curves, and a prediction score was developed using multivariable logistic regression analysis. Among 122 patients, 46.7% received a diagnosis of MPE. The CR exhibited a sensitivity of 87.7% and specificity of 72.3% (AUC 0.83) with a cut-off level >10. Patients with MPE showed longer symptom duration, lower fever and massive pleural effusion, which were more common in MPE than nonMPE cases. A prediction score incorporating symptom duration, fever history, effusion amount and CR demonstrated superior diagnostic performance for MPE (AUC 0.94) compared with the CR alone.
 Conclusion: The CR can effectively differentiate MPE from nonMPE among patients with exudative lymphocytic pleural effusion. A cut-off level >10 is recommended for diagnosing MPE in the Thai population. Combining clinical, radiologic and CR data may aid in prediagnosing MPE; however, further research is needed for validation.

SAT564 Metastatic Malignant Pleural Effusion In A Patient With Remote History Of FTC

Abstract Disclosure: D.M. Lee: None. M. Gong: None. C. Czerlanis: None. A. Arif: None. R. Arceo-Mendoza: None. Introduction: Differentiated thyroid follicular epithelial-derived cancers include Papillary (PTC) and Follicular Thyroid Cancer (FTC). FTC is less common, accounting for only 5-15% of all thyroid cancers. It is more common in older patients and spreads via hematogenous route, with distant metastases in 10-15% of patients, commonly in the lungs and bone. We describe an unusual case of a patient with a remote history of FTC who presents with recurrence more than 50 years later in the form of a malignant pleural effusion. Clinical Case: A 79/M with a remote history of FTC that was diagnosed in the 1960s presents with one week of L sided pleuritic chest pain and dyspnea. CXR on admission showed opacification of the L hemidiaphragm. A chest CT confirmed the L sided pleural effusion. Thyroid US showed surgically absent thyroid and a 1.1cm solid nodule in the L surgical bed. PET/CT demonstrated hypermetabolic rim of L pleural effusion with no uptake in the neck. Thoracentesis was done which showed exudative pleural fluid concerning for malignancy. Immunohistochemical stains were positive for TTF-1 and thyroglobulin, consistent with metastatic thyroid cancer. He also underwent L supraclavicular lymph node FNA with findings suspicious for metastatic thyroid cancer with follicular features, with NO nuclear features of PTC. On further history, the patient reports having radiation therapy for acne around age 17 and was then diagnosed with FTC in his 20s. He underwent total thyroidectomy and RAI treatment. He recalls being told that he had a few weeks to live, and an “experimental treatment” was offered at the time, which we suspect was cobalt radiation. The patient unfortunately was eventually lost to endocrine follow up but denies any known recurrence prior to this admission. Upon discharge, an I-123 WBS was performed showing multiple foci in the R neck. Uptake is also noted in bilateral lung base, greater on the left. He was treated with 250 mCi I-131. He is currently doing well overall, asymptomatic, and with stable surveillance imaging. He is on levothyroxine suppression therapy with Tg level on a downward trend. Clinical Lesson/Conclusion: Involvement of pleural fluid by metastatic thyroid cancer though reported, is relatively rare, accounting for only less than 1% in all the patients with malignant pleural effusion. To our knowledge, there are no reported cases of malignant pleural effusions from metastatic FTC presenting remotely so many years after the initial diagnosis. The diagnosis of metastatic thyroid cancer in pleural fluid can be challenging and knowledge of the clinical context, even with remote history dating back 50 years ago just like in our case, and supporting immunohistochemical stains is essential for making the right diagnosis. Presentation Date: Saturday, June 17, 2023

Diagnostic value of pleural effusion Krebs von den Lungen-6 in malignant pleural effusion of patients with non-small cell lung cancer.

The aim of this study was to investigate the diagnostic potential of Krebs von den Lungen-6 (KL-6) in differentiating between malignant pleural effusion (MPE) induced by non-small cell lung cancer (NSCLC) and benign pleural effusion (BPE). We collected 143 pleural effusion samples from August 2018 to March 2021. The samples included 91 cases of MPE and 52 cases of BPE. The KL-6 and other indicators in pleural effusion were detected. The level of pleural effusion KL-6 (pKL-6) in the MPE group was significantly higher than in the BPE group (Mann-Whitney U = 442.500, P = .000). The area under the curve (AUC) of pKL-6/pleural effusion adenosine deaminase (pADA) + pleural effusion carcinoembryonic antigen (pCEA)/pADA (AUC = 0.992) in diagnosing MPE was higher than that of pKL-6 alone (AUC = 0.903), with a sensitivity of 93.26% and specificity of 100%. The measurement of pKL-6 can differentiate NSCLC-induced MPE from BPE. Furthermore, the combined detection of pKL-6/pADA and pCEA/pADA can significantly improve the diagnostic efficiency for distinguishing NSCLC-induced MPE.

Diagnostic value of SHOX2, RASSF1A gene methylation combined with CEA level detection in malignant pleural effusion

AimTo investigate the diagnostic value of combined detection of SHOX2 and RASSF1A gene methylation with carcinoembryonic antigen (CEA) level in diagnosing malignant pleural effusion.MethodsBetween March 2020 and December 2021, we enrolled 68 patients with pleural effusion admitted to the Department of Respiratory and critical care medicine of Foshan Second People's Hospital. The study group included 35 cases of malignant pleural effusion and 33 cases of benign pleural effusion. Methylation of the short homeobox 2 genes (SHOX2) and RAS-related region family 1A gene (RASSF1A) in pleural effusion samples were detected by real-time fluorescence quantitative PCR, and the level of carcinoembryonic antigen (CEA) in pleural effusion samples was detected by immune flow cytometry fluorescence quantitative chemiluminescence.ResultsSHOX2 or RASSF1A gene methylation was detected in 5 cases in the benign pleural effusion group and 25 patients in the malignant pleural effusion group. The positive rate of SHOX2 or RASSF1A gene methylation in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (71.4% vs. 15.2%, P < 0.01). Positive CEA (CEA > 5 ng/m) was detected in 1 case in the benign pleural effusion group and 26 patients in the malignant pleural effusion group. The CEA-positive rate in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (74.3% vs. 3%, P < 0.01). When SHOX2 and RASSF1A gene methylation was combined with CEA detection, 6 cases were positive in the benign pleural effusion group, and 31 patients were positive in the malignant pleural effusion group. The positive rate of combined detection in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (88.6% vs. 18.2%, P < 0.01). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’s index of SHOX2, RASSF1A gene methylation combined with CEA in diagnosing malignant pleural effusion were 88.6%, 81.8%, 85.3%, 83.8%, 87.1% and 0.7 respectively.ConclusionThe combined detection of SHOX2 and RASSF1A gene methylation with CEA level in pleural effusion has a high diagnostic value for malignant pleural effusion.

An Elusive Case of Pleural Effusion

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T- and N-classification, locoregional control and histologic grade. A 61- year-old male, chronic smoker, presented with complaints of grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after eight months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement.

A Discriptive Study on the Efficacy of Doxycycline for Pleurodesis in Malignant Pleural Effusions

Objective: The purpose of this study was to determine the efficacy of Doxycycline for pleurodesis in cases of malignant pleural effusions. Subject and Methods; This was a descriptive case study conducted at Sheikh Zayed Hospital Rahim Yar Khan during the period of May 2021 to November 2021. In this study the diagnosed cases of malignant pleural effusion, irrespective of its type and metastasis in adult age range were included of both genders. The pleural effusion was effectively drained with appropriate chest drain. After complete drainage assessed by X ray chest PA view, 10 capsules of Doxycycline (100 mg) were diluted in 50 ml normal saline and were injected through chest drain and clamped for 24 hours. Paracetamol was given as analgesia. The drain was re opened after 24 hours and were followed by X ray chest to label for any fluid presence. Efficacy was lapelled as yes where there was no fluid on x ray and drain output was less than 50 ml. Results: In this study, there were total 40 cases of malignant pleural effusion of any type. Out of these 22 (62%) were females and 18 (34%) males. The mean age was 52.39±9.13 years. Regarding different types of CA, the most common was CA breast comprising 30 (60%) of the cases followed by lung cancer seen in 15 (30%) of cases. The efficacy of Doxycycline for pleurodesis was observed in 22 (56%) of cases. The efficacy was observed in 12 (72.73%) cases with effusion less than 1 liter with p= 0.01. There was no significant difference in terms of duration of pleural effusion where it was seen in 55% of cases with effusion more than 1 month and 60% of cases with duration less than this with p= 0.83. Conclusion: Doxycycline has shown its efficacy for pleurodesis in almost half of the cases. Keywords: Doxycycline, Pleurodesis, Fever, Pulmonology, Epidemiological

Pleural Biopsy in Evaluation of Malignant Pleural Effusion- A Review

Malignant pleural effusion (MPE) is one of the common presentation of many carcinoma including lung, breast and lymphomas. It is very important to make an etiological diagnosis of the MPE cases without any delay as treatment depends on its cause. Cytopathological examination of fluid for malignant cells is the easiest and most sensitive method for detecting malignant pleural effusion (MPE). Despite cytology being a sensitive test, many patients remain undiagnosed, then there is a need of histopathological examination of pleura. Invasive procedures like Closed pleura biopsy (CPB) or thoracoscopy was recommended. CPB was earlier considered an investigation of choice in cases of undiagnosed pleural effusion with good efficacy Since the emergence of medical thoracoscopy (MT), use of CPB in the diagnosis of cytology negative MPE is gradually declining. However, due to the high cost and challenges associated with the surgery, thoracoscopy is only used in a restricted number of cases. CPB is less reliable than cytopathological testing of fluid or MT in determining MPE. Yet, it is a simple procedure with little procedure -related complication. The purpose of this article is to assess the clinical presentation and approach to MPE, as well as the role of CPB in diagnosing MPE and to investigate the benefits and drawbacks of CPB.”

A Case of Malignant Pleural Effusion with Carcinoma en Cuirasse Drained with Foley Catheter and Underwater Sealed Bottle

Abstract Managing malignant pleural effusion coexisting with a carcinoma en cuirasse (CEC) is challenging, especially with pleural effusion, which is to be evacuated with a chest tube that should be anchored to the skin of the chest using a nonabsorbable suture. A 47-year-old female patient presented to the surgical outpatient clinic with complaints of a week’s history of worsening breathlessness and intermittent dry cough. Two years before this complaint, she had a biopsy of an ulcerating right breast mass which revealed a triple-positive invasive ductal carcinoma. She received neoadjuvant chemotherapy and subsequently had a mastectomy that was followed by radiation to the chest wall and adjuvant chemotherapy. The general examination revealed a middle age woman who was dyspneic, with the chest showing a mastectomy scar and evidence of CECs. A diagnosis of right massive pleural effusion was made, which was completely drained by a Foley catheter followed by chemical pleurodesis. This is the first report of the coexistent of this condition, for which a patient would need urgent intervention. Instead of using a chest that would have required anchoring it on the infiltrated chest skin, an improvised urinary catheter desirable as self-retention could be achieved by inflation of the balloon.

Role of liquid-based cytology and cell block study of pleural fluid in the evaluation of cases of malignant Pleural effusion with special reference to immunohistochemistry

Introduction: Lung cancer is the most common primary tumor associated with malignant pleuraleffusion (MPE). In this study, we aim to use cell remnants for cell block preparation after performingliquid-based cytology (LBC) of effusion fluid. Immunohistochemistry was helpful to evaluate thosecases having diagnostic dilemmas in LBC and cell block. Method: It was a cross-sectional,prospective, single institution-based study, conducted in the department of Pathology incollaboration with the Department of Respiratory Medicine IPGMER &amp; SSKM Hospital, from January2018 to June 2019 in the institution. Result: Most of the study population were in between the agegroup of 51 to 60 years with male predominance and with fever and cough being the predominantsymptoms. Liquid-based cytology was positive for malignancy in 58% of cases and suspicious ofmalignancy in 22% of cases of malignant pleural effusion and it had 95.35% sensitivity, 58.82%specificity in diagnosing malignant pleural effusion.LBC was done followed by cell block preparationsare studied further by Immunohistochemistry. Discussion: Morphological features were betteridentified by the cell block method when compared to LBC. Multiple sections can be obtained forspecial stain or IHC study which bridges the gap between cytology and histology.

Management of Malignant Pleural Effusion (MPE) in a Tertiary Hospital in a low-income-country: Challenges and Prospects

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa.Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects.Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the data from the hospital record’s department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities.Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer.Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges.

Thoracoscopy and talc poudrage compared with intercostal drainage and talc slurry infusion to manage malignant pleural effusion: the TAPPS RCT.

There are around 40,000 new cases of malignant pleural effusion in the UK each year. Insertion of talc slurry via a chest tube is the current standard treatment in the UK. However, some centres prefer local anaesthetic thoracoscopy and talc poudrage. There is no consensus as to which approach is most effective. This trial tested the hypothesis that thoracoscopy and talc poudrage increases the proportion of patients with successful pleurodesis at 3 months post procedure, compared with chest drain insertion and talc slurry. This was a multicentre, open-label, randomised controlled trial with embedded economic evaluation. Follow-up took place at 1, 3 and 6 months. This trial was set in 17 NHS hospitals in the UK. A total of 330 adults with a confirmed diagnosis of malignant pleural effusion needing pleurodesis and fit to undergo thoracoscopy under local anaesthetic were included. Those adults needing a tissue diagnosis or with evidence of lung entrapment were excluded. Allocation took place following minimisation with a random component, performed by a web-based, centralised computer system. Participants in the control arm were treated with a bedside chest drain insertion and 4 g of talc slurry. In the intervention arm, participants underwent local anaesthetic thoracoscopy with 4 g of talc poudrage. The primary outcome measure was pleurodesis failure at 90 days post randomisation. Secondary outcome measures included mortality and patient-reported symptoms. A cost-utility analysis was also performed. A total of 166 and 164 patients were allocated to poudrage and slurry, respectively. Participants were well matched at baseline. For the primary outcome, no significant difference in pleurodesis failure was observed between the treatment groups at 90 days, with rates of 36 out of 161 (22%) and 38 out of 159 (24%) noted in the poudrage and slurry groups, respectively (odds ratio 0.91, 95% confidence interval 0.54 to 1.55; p = 0.74). No differences (or trends towards difference) were noted in adverse events or any of the secondary outcomes at any time point, including pleurodesis failure at 180 days [poudrage 46/161 (29%), slurry 44/159 (28%), odds ratio 1.05, 95% confidence interval 0.63 to 1.73; p = 0.86], mean number of nights in hospital over 90 days [poudrage 12 nights (standard deviation 13 nights), slurry 11 nights (standard deviation 10 nights); p = 0.35] and all-cause mortality at 180 days [poudrage 66/166 (40%), slurry 68/164 (42%); p = 0.70]. At £20,000 per quality-adjusted life-year gained, poudrage would have a 0.36 probability of being cost-effective compared with slurry. Entry criteria specified that patients must be sufficiently fit to undergo thoracoscopy, which may make the results less applicable to those patients presenting with a greater degree of frailty. Furthermore, the trial was conducted on an open-label basis, which may have influenced the results of patient-reported measures. The TAPPS (evaluating the efficacy of Thoracoscopy And talc Poudrage versus Pleurodesis using talc Slurry) trial has robustly demonstrated that there is no additional clinical effectiveness or cost-effectiveness benefit in performing talc poudrage at thoracoscopy over bedside chest drain and talc slurry for the management of malignant pleural effusion. Current Controlled Trials ISRCTN47845793. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 26. See the NIHR Journals Library website for further project information.

Comparison of Talc Pleurodesis versus Bleomycin in Malignant Pleural Effusion

Back ground: Malignant pleural effusion can cause significant morbidity to terminal patients. Drainage and control pleural effusion can provide great palliation and improve the quality of life of these patients. The purpose of this study was to evaluate which agent, bleomycin or talc pouring for pleurodesis is superior in terms of effectiveness, safety and cost.&#x0D; Methods: It is a prospective randomized clinical trial from January 2013 to December 2014. A series of 38 patients entered in this trial. Inclusion criteria was diagnosed case of malignant pleural effusion either by fluid cytology or by pleural biopsy. Exclusion criteria was trapped lung, loculated effusions and life expectancy &lt;1 month. Five grams of talc in 50ml of normal saline or 1 unit per kg body weight of bleomycin mixed in 50 ml of normal saline, was administered via chest tube thoracostomy after minimum drainage &lt;100 ml daily in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiography 1 month after pleurodesis.&#x0D; Results: Treatment success was achieved in 16 out of 18 patients (89%) in talc slurring group versus 14 out of 20 patients (70%) in the bleomycin group (p=0.154). Fever, pain and hypersensitivity were the side effects of pleurodesis.&#x0D; Conclusions: These results reflect that talc use was more effective than bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instate of bleomycin can result in significant cost effective.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 42-48

Identification and diagnostic value of pleural fluid periostin and serum periostin of malignant pleural effusions in patients with non-small-cell lung cancer.

BackgroundLimited data are available for the diagnostic value, and the diagnostic sensitivity and specificity of pleural fluid periostin (pPOSTN) and serum periostin (sPOSTN) in malignant pleural effusion (MPE) caused by non–small‐cell lung cancer (NSCLC).MethodsWe collected 84 pleural effusion samples, including 44 cases of MPE caused by NSCLC and 40 cases of benign pleural effusions (BPEs) from August 2018 to January 2019. The pPOSTN, sPOSTN, pleural fluid lactate dehydrogenase (pLDH), pleural effusion adenosine deaminase (pADA), pleural effusion total protein (pTP), pleural fluid glucose (pGLU), pleural effusion leukocyte count (pWBC), pleural effusion red cell count (pRBC), pleural effusion carbohydrate antigen 199 (pCA199), pleural fluid carbohydrate antigen 125 (pCA125), pleural effusion ferritin (pFer), serum total protein (sTP), and serum C‐reactive protein (sCRP) were tested, and the obtained data were analyzed by statistical software.ResultsCompared to the BPE group, the pPOSTN level in the MPE group was observably lower, while the levels of sPOSTN, sPOSTN/pADA, pCA199/pADA, and pCA199/pPOSTN increased. The receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) (=0.844, 0.847, 0.841) of sPOSTN/pADA, pCA199/pADA, and pCA199/pPOSTN (cutoff = 11.86, 0.244, 0.015) was observably higher than other indicators for the diagnosis of MPE caused by NSCLC. Thus, the combined detection of pPOSTN, pCA125/pPOSTN, and pCA125/sCRP suggested that the AUC, sensitivity, and specificity was 0.912%, 95.45%, and 77.50% at the cutoff 0.317 and diagnostic performance was higher than sPOSTN/pADA or pCA199/pADA or pCA199/pPOSTN.ConclusionCombined detection of sPOSTN/pADA, pCA199/pADA, and pCA199/pPOSTN can be used as a good indicator for MPE caused by NSCLC.

Application value of paraffin-embedded section of cell block in differential diagnosis of benign or malignant pleural and peritoneal effusion

Objective To investigate the value of paraffin-embedded section of cell block in the diagnosis of benign or malignant pleural and peritoneal effusion. Methods 105 patients suspected with malignant pleural and peritoneal effusion admitted into tour hospital from November, 2015 to December, 2017 were selected as the research objects. The specimens of pleural and peritoneal effusion of all the patients were collected. And these specimens were given paraffin-embedded section of cell block, cell smear, and exfoliative cell pathological examination. The results of exfoliative cell pathological examination were taken as the gold standard. The positive rates of malignant pleural and peritoneal effusion diagnosed by paraffin-embedded section of cell block and cell smear were evaluated. The diagnostic value of the two methods was compared. Results Among the 50 pleural effusion specimens, the results of exfoliative cell pathological examination showed that there were 36 cases of malignant pleural effusion. Among the 55 peritoneal effusion specimens, the results of exfoliative cell pathological examination showed that there were 42 cases of malignant peritoneal effusion. The positive detection rate of pleural effusion diagnosed by paraffin-embedded section of cell block (80.56%) was higher than that diagnosed by cell smear (58.33%), with a statistical difference (P<0.05). The positive detection rate of peritoneal effusion diagnosed by paraffin-embedded section of cell block (85.71%) was higher than that diagnosed by cell smear (64.29%), with a statistical difference (P<0.05). The sensitivity, specificity, and accuracy of paraffin-embedded section of cell block in the diagnosis of malignant pleural and peritoneal effusion were higher than those of cell smear, with statistical differences (all P<0.05). Conclusions Paraffin-embedded section of cell block in the differential diagnosis of benign or malignant pleural and peritoneal effusion has high sensitivity and specificity, and can increase the diagnostic accuracy and provide an important basis for clinical diagnosis and treatment of the disease. Key words: Pleural effusion; Paraffin-embedded section of cell block; Cell smear; Exfoliative cell pathological examination

Morphological characterization and molecular profiling of malignant pericardial effusion in patients with pulmonary adenocarcinoma.

Malignant pericardial effusions (MPCEs) is a common complication observed in advanced pulmonary adenocarcinoma. In such cases, investigating molecular alterations can have significant therapeutic implication in determining anticancer drugs. The objective was to evaluate the significance of cell block technique in the diagnosis of MPCE and further investigate the morphological and molecular profiles of MPCE in patients with pulmonary adenocarcinoma. Cytopathological and molecular profiles of 19 MPCE cases in patients with pulmonary adenocarcinoma were retrospectively analyzed. The control group consisted of 14 malignant pleural effusion (MPE) cases in patients with pulmonary adenocarcinoma. Anaplastic lymphoma kinase (ALK) and tyrosine-protein kinase Met (C-MET) expression was evaluated by fluorescence in situ hybridization (FISH). Epithelial growth factor receptor (EGFR) and K-Ras (KRAS) mutations were detected by ARMS real-time polymerase chain reaction (RT-PCR). Associations between MPCE and MPE were analyzed using Fisher's exact test. MPCE was found to have micropapillary and solid pattern predominant with mucin secretion compared to acinar patterns, as seen in MPE. Seventeen MPCE cases (89.5%) and all MPE cases (100%) underwent molecular analysis. Mutations in EGFR and KRAS, ALK rearrangement, and C-MET amplification were observed in MPCE and MPE with statistical differences. Additionally, two MPCE cases demonstrated EGFR T790M mutation and multiple insertions at L858. MPCE shows micropapillary and solid cytological patterns predominant with mucin secretion. MPCE are suitable to analyze oncogenic mutations and to develop targeted therapy for patients with pulmonary adenocarcinoma. Further molecular investigations may reveal novel molecular alterations.

Useful Application of Immunostaining to Malignant Pleural Effusion among Lao People in Vientiane Capital, Lao PDR

Background:Pathology and laboratory medicine (PALM) services are limited in low-resource countries, such as Lao PDR. Patients with malignant pleural effusion (MPE) are not properly diagnosed and treated in these situations. The purpose of this study is to confirm the usefulness of immunocytochemistry in MPE to identify the histological type and probable primary site of cancer of MPE and to discuss its usefulness in low-resource countries, such as Laos.Methods:We retrospectively reviewed glass slides of pleural effusion sent to the Department of Pathology at the University of Health Sciences from the central hospitals for cytological screening from January 2012 to December 2016. The cytological review, cell transfer and immunocytochemical staining were performed at Tokyo Medical and Dental University. Among 81 cases of MPE from Laos, 66 cases of malignant tumors that contained enough tumor cells were included in this study, and the slides were screened with 14 primary antibodies to classify the histological type and identify the probable primary site of carcinoma.Results:Among the 66 cases, 34 cases (52%) were of female patients, and 32 cases (48%) were of male patients. The patients’ ages ranged from 28 to 88 years with an average of 58 years. The immunocytochemical study identified 32 cases (49%) of primary lung adenocarcinoma, two cases (3%) of malignant mesothelioma, one case (1.5%) of breast/gynecological carcinoma, one case (1.5%) of T cell lymphoma, and one case (1.5%) of B cell lymphoma. Twenty-nine cases (43.5%) were classified as carcinoma not otherwise specified. Pulmonary small cell carcinoma/squamous cell carcinoma and metastatic colon, prostate, and liver carcinoma were not identified among the cases.Conclusions:Immunocytochemistry is a useful ancillary method in MPE diagnostics. This method could be applied in the pathological laboratories in low- or middle-resource countries, such as Laos.

LOW YIELD OF CYTOLOGY FOR DIAGNOSIS OF MALIGNANT PLEURAL EFFUSION RELATED TO SQUAMOUS CELL LUNG CANCER

SESSION TITLE: Lung Cancer SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Malignant pleural effusion (MPE) is an ominous development of metastatic cancer that portends a dire prognosis. Some effusions are challenging to diagnose with pleural fluid cytology alone and necessitate pleural biopsy. The aim of this study was to assess the yield of pleural fluid cytology for diagnosis of malignancy secondary to metastatic squamous cell lung cancer as compared to bronchogenic adenocarcinoma. METHODS: We performed a retrospective review of patients with non-small cell lung cancer (NSCLC) who developed pleural effusions to evaluate the diagnostic yield of pleural fluid cytology from serial thoracentesis and pleural biopsy. With institutional review board approval (IRB Pro00091556) we identified MPE cases by reviewing referrals for tunneled pleural catheter placement or pleuroscopy in addition to screening cytopathology reports. RESULTS: Among 36 NSCLC patients with MPE, the initial diagnostic sensitivity of first thoracentesis to diagnose MPE was 66.7%, which improved to 71.4% with second thoracentesis, and 88.2% with pleural biopsy. Yield of pleural fluid cytology for diagnosis of malignancy was 11.1% vs. 85.2 % for squamous cell vs. adenocarcinoma (chi-square test p-value <0.0001). The diagnostic yield of pleural biopsy via pleuroscopy for squamous cell vs. adenocarcinoma was 66.7% vs. 92.9% (chi-square test p-value =0.52). 94.1% of all malignant effusions from NSCLC were classified as exudative by Light’s criteria. CONCLUSIONS: Yield of pleural fluid cytology for diagnosis of metastatic squamous cell lung cancer is low compared to bronchogenic adenocarcinoma. CLINICAL IMPLICATIONS: Clinicians should be aware of the low diagnostic sensitivity of pleural fluid cytology in patients with squamous cell lung cancer. These patients should be referred for pleural biopsy to confirm the diagnosis of an exudative effusion even when pleural fluid cytology is unrevealing. DISCLOSURES: Advisory Committee Member relationship with Leica Biosystems Please note: $5001 - $20000 Added 03/02/2018 by Rajesh Dash, source=Web Response, value=Travel Board Member relationship with College of American Pathologists Please note: $5001 - $20000 Added 03/02/2018 by Rajesh Dash, source=Web Response, value=Travel No relevant relationships by Kevin Davidson, source=Web Response No relevant relationships by Kamran Mahmood, source=Web Response

The current aetiology of malignant pleural effusion in the Western Cape Province, South Africa.

Malignant pleural effusion (MPE) represents a very common cause of pleural exudates, and is one of the most challenging pleural disorders to manage. This could be attributed to the paucity of high-quality experimental evidence, and inconsistent practice worldwide. South Africa (SA) currently has no data regarding the aetiology of MPE. To identify the most common malignancies causing MPE in a population served by a large tertiary hospital in SA, and specifically the relative contribution of mesothelioma. A secondary objective was to evaluate the efficacy of chemical pleurodesis in a subset of patients. We retrospectively included all known cases of MPE evaluated at our institution over a 3-year period with a tissue diagnosis of MPE. The most common causes of MPE in a total of 274 patients were lung cancer (n=174, 63.5%), breast cancer (n=32, 11.7%), unknown primary (n=22, 11.7%) and mesothelioma (n=27, 9.9%). Talc pleurodesis was performed in 81 of 194 patients (41.8%) referred to our division, and was radiologically successful in 22 of 25 (88.0%) followed up to 3 months. The main cause of MPE in our setting was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE in this population.