Cases Of Malignant Pleural Effusion Research Articles

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

Background. 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. Objectives. 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. Methods. We retrospectively included all known cases of MPE evaluated at our institution over a 3-year period with a tissue diagnosis of MPE. Results. 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. Conclusions. 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.

Pleural Ultrasound Elastography: A Novel Technique for the Differential Diagnosis of Malignant Pleural Effusion

Introduction: Traditional thoracic ultrasound (TUS) is often the initial tool used to help diagnose malignant pleural effusion (MPE). Ultrasound elastography (UE), a new technique, has been used to differentiate malignant disease from benign disease by evaluating tissue hardness. However, no studies evaluating the efficacy of UE in diagnosing MPE are available. We assessed the diagnostic value of UE for diagnosing MPE prospectively. Methods: All 244 enrolled patients were divided into a development set and a validation set in chronological order. TUS and UE were performed to diagnose MPE. The cut-off elasticity values (the mean and maximal values) were established using a receiver operating characteristic (ROC) curve constructed from continuous data of the patients in the development set. The diagnostic performance of UE was compared with that of TUS in the validation set. Results: In development set, the mean elasticity value (47·25 kPa) was the optimal cut-off. In the validation set, pleural UE had a sensitivity of 83·64%, a specificity of 90·67%, a positive predictive value (PPV) of 86·79%, and a negative predictive value (NPV) of 88·31% for distinguishing MPE from benign pleural effusion. The sensitivity of UE was significantly higher (p=0·006) than that of TUS (sensitivity of 60·00%, specificity of 93·33%, PPV of 86·84%, and NPV of 76·09%). Pleural UE detected 91·11% (41/45) of MPE cases from among false-negative cases as determined by TUS in all patients. Conclusion: Pleural UE is a good technique compared with TUS for differentiating MPE from benign pleural disease, especially in high tuberculosis burden countries. Funding Statement: The authors state: No funding source was involved. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: This study was approved by the Institutional Ethical Review Board of the First Hospital of China Medical University, and written informed consent was obtained from all patients.

Expression Profile of Three Splicing Factors in Pleural Cells Based on the Underlying Etiology and Its Clinical Values in Patients with Pleural Effusion

Splicing factors (SFs) are involved in oncogenesis or immune modulation, the common underlying processes giving rise to pleural effusion (PE). The expression profiles of three SFs (HNRNPA1, SRSF1, and SRSF3) and their clinical values have never been assessed in PE. The three SFs (in pellets of PE) and conventional tumor markers were analyzed using PE samples in patients with PE (N = 336). The sum of higher–molecular weight (Mw) forms of HNRNPA1 (Sum-HMws-HNRNPA1) and SRSF1 (Sum-HMws-SRSF1) and SRSF3 levels were upregulated in malignant PE (MPE) compared to benign PE (BPE); they were highest in cytology-positive MPE, followed by tuberculous PE and parapneumonic PE. Meanwhile, the lowest-Mw HNRNPA1 (LMw-HNRNPA1) and SRSF1 (LMw-SRSF1) levels were not upregulated in MPE. Sum-HMws-HNRNPA1, Sum-HMws-SRSF1, and SRSF3, but neither LMw-HNRNPA1 nor LMw-SRSF1, showed positive correlations with cancer cell percentages in MPE. The detection accuracy for MPE was high in the order of carcinoembryonic antigen (CEA, 85%), Sum-HMws-HNRNPA1 (76%), Sum-HMws-SRSF1 (68%), SRSF3, cytokeratin-19 fragments (CYFRA 21-1), LMw-HNRNPA1, and LMw-SRSF1. Sum-HMws-HNRNPA1 detected more than half of the MPE cases that were undetected by cytology and CEA. Sum-HMws-HNRNPA1, but not other SFs or conventional tumor markers, showed an association with longer overall survival among patients with MPE receiving chemotherapy. Our results demonstrated different levels of the three SFs with their Mw-specific profiles depending on the etiology of PE. We suggest that Sum-HMws-HNRNPA1 is a supplementary diagnostic marker for MPE and a favorable prognostic indicator for patients with MPE receiving chemotherapy.

P2.02-024 Phase I and II Trial of Intrapleural Paclitaxel Injection for Non-Small-Cell Lung Cancer Patients with Malignant Pleural Effusions

The presence of malignant pleural effusion (MPE) frequently indicates locally advanced non-small cell lung cancer (NSCLC). The conventional management of MPE involves pleurodesis using a sclerosant substance. The Perng et al. reported injection into chest cavity using paclitaxel for 18 MPE cases. In this report overall response rate was 92.9%. No disease progression was noted among evaluable patients. Therefore we focused on Paclitaxel which had antitumor effect and a pleural effusion control, and planned clinical trials phase I and II for the treatment of MPE. The primary objective of this study was to evaluate the efficacy of paclitaxel pleurodesis, the side effects and systemic antitumor effect. Patients were enrolled cytologically proven malignant pleural effusion of NSCLC. Radiotherapy and systemic chemotherapy were also not allowed within 4 weeks. After adequate drainage and assurance of lung re-expansion, paclitaxel diluted in normal saline was infused through a double lumen catheter. The starting dose was 100 mg/m2 with dose escalation schedule of 125, 150, and 175mg/m2. The catheter was clamped for 24 hrs. Chest drainage was continued until daily drainage was under 200 ml, and the tube was removed. To measure paclitaxel concentration, serum and pleural fluid samples were collected 0.5, 1, 3, 6, 24, 72hrs after the end of drug instillation. The treatment response of malignant effusion was evaluated according to the following criteria: complete response (CR), no fluid reaccumulation for at least 4 weeks as determined by CT scan; partial response (PR), recurrence of effusion to less than 50% of the original effusion volume within 4 weeks after treatment; failure, recurrence of effusion greater than 50% of the original volume, patients were symptomatic and need for thoracentesis to relieve symptoms within 4 weeks. The criteria for main tumor lesion response to intrapleural paclitaxel treatment were in accordance with Response Evaluation Criteria in Solid Tumors (Revised RECIST guideline version 1.1). From April 2009 to November 2012, 12 patients were enrolled. There were minimal local and systemic toxicities. The serum level of PXL of the cases with the effect of treatment was significantly higher than these of the cases without the effect. Over all response rate was 67%. No disease progression was noted among evaluable patients. We decided to plan a late phase II study of the therapy with 175 mg/m2, because it was not dosage-dependent even if it was a low dose and serum level-dependent.

Retrospective analysis on the safety of 5,759 times of bedside hyperthermic intra-peritoneal or intra-pleural chemotherapy (HIPEC).

The current study was designed to analyze safety of the bedside hyperthermic intra-pleural or intra-peritoneal chemotherapy (HIPEC) from September 2007 to July 2015. Total of 5,759 times of bedside HIPEC in 985 cases of malignant pleural or peritoneal carcinomatosis were analyzed. Of them, 1,510 times was given to 315 cases of malignant pleural effusion, while 4,249 times was performed in 402 patients with malignant ascites and 268 patients without ascites (total 670 patients for peritoneal carcinomatosis). In average, patients with pleural effusion was given 5 times bedside HIPEC and stayed in the hospital for 6.7 days; while patients with peritoneal carcinomatosis was given 6 times of HIPEC and stayed in the hospital for 6.5 days. Overall HIPEC-associated mortality was zero. Overall HIPEC-associated incidence of side effect in the intra-pleural HIPEC was 2.0%. Specifically, 0.6% was pneumothorax, 0.3% was cytotoxic agent-induced pleural inflammation, 0.5% was pain at puncture location, and 0.3% was failure of HIPEC procedure. Overall HIPEC-associated incidence of side effect in the intra-peritoneal HIPEC was 2.4%, i.e., failure of HIPEC procedure in 1.3%, pain at puncture location was 0.5%, cytotoxic agent-induced peritoneal inflammation was 0.1%, intestinal obstruction was 0.1% and intestinal perforation was 0.07%. These findings indicated that bedside HIPEC applied in the current study is safe to be performed by a Physician or Oncologist under local anesthesia at a patient's bedside. The procedure is easy to perform and well-tolerated by the patients with late stage cancer or post-surgery recurrent cancer.

Atypical Pleural Fluid Profiles in Tuberculous Pleural Effusion: Sequential Changes Compared with Parapneumonic and Malignant Pleural Effusions.

Objective Although tuberculous pleural effusion (TPE) is commonly characterized by lymphocytic predominance and high adenosine deaminase (ADA) levels, it may present with neutrophilic predominance or low ADA levels, which are more commonly found in parapneumonic effusion (PPE) or malignant pleural effusion (MPE), respectively. A few studies have observed that the atypical pleural fluid profiles of these cases of TPE may resolve at follow-up thoracentesis. However, these observations were incompletely analyzed and lacked comparison with proper control groups. Thus, limited data are available comparing the sequential pleural fluid changes between TPE and PPE or MPE with similar pleural fluid profiles. Methods TPE, PPE, and MPE patients who underwent sequential thoracentesis were retrospectively reviewed. The sequential changes in the pleural fluid profiles were compared between neutrophilic TPE and PPE, and lymphocytic TPE and MPE with low ADA levels. Results Twenty-three TPE patients (16 with neutrophilic exudates, seven with lymphocytic exudates), 72 cases of PPE with neutrophilic exudates, and 18 cases of MPE with lymphocytic exudates were included in the analysis. A sequential shift to lymphocytic exudates occurred significantly more often in TPE than in PPE cases. The initial and follow-up ADA levels in TPE cases with a lymphocytic shift were significantly higher than those in PPE cases with a lymphocytic shift. The ADA levels in the TPE cases with initial lymphocytic exudates and low ADA levels significantly increased at follow-up thoracentesis. For the TPE and MPE cases with initial lymphocytic exudates and ADA levels <40 U/L, the frequency of effusion with ADA levels ≥40 U/L at the second thoracentesis was significantly higher in the TPE cases. Conclusion Follow-up thoracentesis may provide useful information for clinical decision-making in suspected atypical TPE cases with neutrophilic exudates or low ADA levels.

Clinical analysis of thoracoscopy of 30 coalworker's pneumoconiosiswith pleural effusion cases

To investigate the diagnostic value of thoracoscopy on idiopathic coalworker's pneumoconiosis with pleural effusion in general medicine. Routine (general medicine) thoracoscopyof patients suffering from iIdiopathiccoalworker's pneumoconiosis with pleural effusion, pathological examination of lesions obtained (direct vision). Pathological examination revealed grayish-white miliary nodules with multiple protruding nodules, irregular focal pleura thickening, pulmonary congestion, edema, fibrous adhesion. Thorascopy produced a diagnostic rate of 93.3%. Confirmed cases includes 13 cases of tuberculous pleurisy, 11 cases of malignant pleural effusion, 4 cases of cardiac insufficiency with pleural effusion and 2 cases of idiopathic pleural effusion, with no serious complications. Thoracoscopy of idiopathic coalworker's pneumoconiosis with pleural effusion is a safe, accurate diagnostic methodin general medicine, and could benefit the establishment of a treatment method quickly, visual observation of the lesions of patients suffering from coalworker's pneumoconiosis with pleural effusion using thoracoscopy, and at the same time offer preliminary investigationof the correlation between the intensity and compactibilityof coal macule distribution and clinical stages of coalworker's Pneumoconiosis.

Expressions and diagnostic value of interleukin-31 in tuberculous pleural effusion

Objective To analyze the expression of interleukin (IL)-31 in tuberculous pleural effusion, and to evaluate its diagnostic value of tuberculous effusion. Methods Seventy-one patients with pleural effusion were enrolled, including 40 cases of tuberculous pleural effusion and 31 cases of malignant pleural effusion. Luminex method was applied to detect the IL-31 expression in pleural effusion. IL-31 levels were compared using non-parametric Mann-Whitney U test, and the receiver operator characteristic (ROC) curve was used to elvaluate the diagnostic value of IL-31. Results IL-31 expression in tuberculous pleural effusion was significantly higher than that in malignant pleural effusion with statistical significance (529.4 ng/L vs 13.8 ng/L, U=62, P<0.01). Based on the level of IL-31 expression, area under the ROC curve was 0.95 with the optimum cut-off value of 67.5 ng/L. Thus, the sensitivity and specificity of IL-31≥67.5 ng/L for diagnosis of tuberculous pleurisy were 82.5% (95%CI: 73.3%-94.2%) and 100.0% (95%CI: 91.4%-100.0%), respectively. Conclusion IL-31 is highly sensitive and specific for the diagnosis of tuberculous pleural effusion, which favors the differentiation of tuberculosis from malignance. Key words: Interleukin-31; Pleural effusion, malignant; Tuberculosis, pleural; Differential diagnosis

Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy

Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion. Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy. Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment. After operation, 45(60.8%) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment, 14cases(18.9%), which were partial remission(PR),were less pleural adhesion and most lung recruitment, and 10cases(13.6%) were stable diseases(SD), while 5cases(6.7%), which were progressive diseases(PD), were without pleural reaction. The total effective rate, including CR,PR and SD, was 93.3%(69/74). The complications of simple powdery talcage under medical thoracoscopy were included in:95.9%(71/74) with chest pain,64.8%(48/74) with fever,28.4%(21/74) with shortness of breath,12.2%(9/74) with mediastinal and subcutaneous emphysema,5.4%(4/74)with nausea and vomiting,4.1%(3/74) with abdominal distension, while the complications of acute pulmonary edema, massive hemorrhage, pulmonary embolism and wound infection were not observed. Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect, which is safe, costeffective, less trauma and worthy of clinical application. Key words: Pleural effusion,malignant; Thoracoscopy; Pleurodesis; Talc

Systemic sclerosis complicated with malignant pleural effusion with high serum CA-125 tumor marker

The malignant pleural effusion in systemic sclerosis (SSc) is an uncommon condition than its common manifestation like interstitial lung fibrosis, pulmonary hypertension, and lung malignancy. We reported here a case of malignant pleural effusion in a 40-year-old female suffering from SSc with high serum tumor marker cancer antigen-125 (CA-125). Computed tomogram guided fine needle aspiration cytology from the lung nodule revealed adenocarcinoma lung. The frequency or reasons of an elevated level of a serum or pleural fluid CA-125 in this case are unclear. Excepting ovarian and lung malignancy, increased CA-125 level in serum, and pleural fluid is also detectable in nonmalignant conditions including SSc as a part of serositis. We emphasized here the malignant potential of SSc and the need for long-term follow-up to detect underlying malignancy. High CA-125 level might be interpreted cautiously.

Diagnostic utility of LUNX mRNA and VEGF mRNA in pleural fluid for differentiating benign from malignant origin.

The purpose of this study was to evaluate the diagnostic utility of lung-specific X protein (LUNX) mRNA and vascular endothelial growth factor mRNA in differentiating pleural effusion of different origin. A total of 136 patients with pleural effusion (46 cases of malignant pleural effusion caused by lung cancer, 30 cases of malignant pleural effusion caused by other cancers and 60 cases of benign pleural effusion) were enrolled in this study. Levels of LUNX mRNA and vascular endothelial growth factor mRNA in pleural fluid were detected by real-time quantitative polymerase chain reaction. Pleural fluid carcinoembryonic antigen and Cyfra21-1 were also measured simultaneously. The LUNX mRNA level was significantly higher in malignant pleural effusion caused by lung cancer than in malignant pleural effusion caused by other cancers and in benign pleural effusion. In malignant pleural effusion caused by cancers of different origin, the vascular endothelial growth factor mRNA level was significantly higher than in benign pleural effusion. For the diagnosis of malignant pleural effusion caused by lung cancer, LUNX mRNA exhibited higher sensitivity (80%), when compared with vascular endothelial growth factor mRNA (65%), carcinoembryonic antigen (67%) and Cyfra21-1 (61%), with the same specificity (95%). The combination of LUNX mRNA and cytology achieved a sensitivity of 85%. The combined use of LUNX mRNA and vascular endothelial growth factor mRNA and cytology raised the sensitivity to 89%, with 95% specificity. In initial cytology-negative pleural effusion from lung cancer, LUNX mRNA achieved the highest positive result (65%) among the four markers. The detection of LUNX mRNA and vascular endothelial growth factor mRNA in pleural fluid may be a complementary tool for the diagnosis of malignant pleural effusion. In particular, pleural fluid LUNX mRNA provided a valuable adjunct in distinguishing malignant pleural effusion caused by lung cancer from benign pleural effusion.

Pleural Metastasis as Initial Presentation of Occult Gastric Cardia Cancer: A Possible Role of PET-CT in Diagnosis.

We report on a case of malignant pleural effusion as initial metastatic presentation of occult gastric cardia cancer in a young woman. To the best of our knowledge, this is the first report of gastric adenocarcinoma metastasized to pleura as an initial presentation. Location of cardia and signet ring cell histology may contribute to the manifestation. Utilization of positron emission tomography-computed tomography was helpful for proper diagnosis. For patients with such distinct clinical presentations, it would be appropriate to consider gastric cancer as one of the possible primary sites.

Tru-Cut Needle Pleural Biopsy and Cytology as the Initial Procedure in the Evaluation of Pleural Effusion

Introduction and objectivesThe evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. MethodologyRetrospective study of TCPB in a hospital center (2010–2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analyzed. ResultsOne hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (P=.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume >2/3 (P=.04). ConclusionsTCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis.

Biopsia pleural con aguja Tru-cut y citología como primer procedimiento en el estudio del derrame pleural

Introduction and objectivesThe evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. MethodologyRetrospective study of TCPB in a hospital centre (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analysed. ResultsOne hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (p=0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume >2/3 (P=.04). ConclusionsTCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis.

Pulmonary Adenocarcinoma in Malignant Pleural Effusion Enriches Cancer Stem Cell Properties during Metastatic Cascade

BackgroundMetastasis occurs in a series of discrete steps involving invasion, angiogenesis, lymphovascular space permeation, and establishment of secondary tumors. Malignant pleural effusion (MPE), a type of tumor metastasis, is usually a poor prognostic sign for patients with pulmonary adenocarcinoma, although its underlying mechanism has received less attention than other types of metastases have. The objective of the current study was to confirm whether cancer stem cells (CSCs) in MPE contribute to the “metastatic cascade” through the epithelial – mesenchymal transition (EMT), anoikis, and adaptation in the microenvironment.MethodsPulmonary tissue and corresponding cell blocks of MPE samples from 20 patients with primary adenocarcinoma were analyzed by immunohistochemical staining with CSC-representative markers (CD133, Nanog, and OCT-4) and EMT-associated markers (E-cadherin and vimentin). Correlations between these variables and clinico-pathological parameters were analyzed. Primary cultures from eight cases of MPE were investigated to characterize the CSC properties, including marker expression, sphere formation, and differentiation.ResultsExpressions of CSC-representative markers for 20 cases of MPE cell blocks were quite diverse and variable ranging from 15% to 90%. Stronger expression of CSC-representative markers and alteration of EMT-associated markers were found at the invasive fronts and in MPEs compared with the expression in primary pulmonary tumor tissues. The expression of OCT-4 in MPEs significantly related to distant metastasis and stage, as well as inversely correlated with patient survival. Primary cultures confirmed the CSC properties in MPE. Five of eight cases of MPE yielded adequate cell clusters, which also showed variable expressions of CSC markers in addition to sphere formation and the ability for differentiation and metastasis.ConclusionThis pilot study offers a better understanding of the metastatic cascade. Establishing a model of MPE will provide further insight into the role of CSCs in metastasis and may explain the high therapeutic failure rates for patients with MPE.

EMT markers in lung adenocarcinoma pleural effusion spheroid cells

Epithelial-to-mesenchymal transition (EMT) is a process in which cells undergo a developmental switch from epithelial to mesenchymal phenotype. This process has been related to embryologic morphogenesis but also to cancer progression and metastasis. The aim of the current study was to investigate the expression of EMT-related markers in adherent and spheroid cell cultures derived from malignant pleural effusions (MPEs) of patients affected by lung adenocarcinoma. On the basis of efficient in vitro propagation, six cases of MPEs were selected and analyzed by immunocytochemistry staining for EMT markers and by RT-PCR for transcription factors known to orchestrate EMT. EMT markers immunostaining showed in spheroids a statistically significant correlation between the loss of E-cadherin immunoreactivity and overexpression of N-cadherin (P < 0.001). Likewise loss of EpCAM epithelial marker was coincident with Vimentin overexpression (P < 0.001). RT-PCR analysis of transcription factors Snail, Slug, and Twist showed a highly variable expression, although a general trend to increase was observed. Importantly, in some selected cases it was possible to establish a precise relationship between spheroid formation, EMT switch and increased upregulation of the marker related to cancer stemness such as ALDH positivity. Therefore, MPE-derived cell cultures, while recapitulating the heterogeneity of lung cancer, are a suitable system to study the mechanisms at the basis of EMT and to understand its relationship with the generation of cancer stem cells.

The differential diagnosis value of sICAM-1, VEGF and CRP in benign and malignant pleural effusion

Objective To discuss the differential diagnosis value of sICAM-1,VEGF and CRP in benign and malignant pleural effusion.Methods The levels of sICAM-1,VEGF and CBP were detected in 46 cases of malignant pleural effusion and 43 cases of benign pleund effusion.Results The levels and positive rates of sICAM-1,VEGF in malignant pleural effusion group was significantly higher than those in benign pleural effusion group ( t =7.125、6.271,x2 =33.929,all P ＜ 0.05 ),while CRP was significantly lower than that in benign effusion group ( t =5.963,x2 =31.430,all P ＜0.05).Conclusion The levels of sICAM-1,VEGF and CBP were significantly different between benign and malignant pleural effusion,which could be selected as the indexes for discriminating benign and malignant pleural effusion. Key words: Cell adhesion molecules; Angiogenesis; C-reactive protein; Pleural effusion

Malondialdehyde (MDA) Superoxide dismutase (SOD) levels - distinguishing parameters betweenbenign malignant pleural effusions

Introduction: Pleural effusion is a common clinical disorder and is either a manifestation or a complication of one or other respiratory or non-respiratory diseases. Increased oxidative stress participates in the pathogenesis of both airways and parenchymal lung diseases. There is a critical balance between free radical generation and antioxidant defences. The local production of free radicals and the role of oxidative stress in the pathogenesis of pleural effusions have not been extensively studied. Objective: To assess the levels of malondialdehyde (MDA), superoxide dismutase (SOD), total proteins (TPR) and lactate dehydrogenase (LDH) in pleural fluid and serum, also to analyse that whether malondialdehyde and superoxide dismutase can be used as potential markers for distinguishing between benign and malignant pleural effusion. Research Design and Methods: 96 participants were included in this prospective study and were divided into two groups. Group-I consisted of 48 cases of malignant pleural effusion and group-II consisted of 48 cases of benign pleural effusion. Results: Mean serum levels of malondialdehyde, superoxide dismutase, lactate dehydrogenase and total proteins in malignant (group-I) were 131.88±12.17 nmol/ml, 39.28±5.28 U/ml, 285.20±33.06 IU/L, 6.0±0.67 gm % and in benign (group-II) were 72.83±5.58 nmol/ml, 34.35±3.61 U/ml, 227.69±10.01 IU/L, 6.13±0.58 gm % respectively. In pleural fluid mean levels of malondialdehyde, superoxide dismutase, lactate dehydrogenase and total proteins malignant pleural effusion (group-I) were 126.83±12.26 nmol/ml, 38.63±5.67 U/ml, 185.28±21.48 IU/L, 4.34±0.84 gm % and in benign pleural effusion (group-II) were 53.01±8.92 nmol/ml, 32.21±3.27 U/ml, 120.29±15.37 IU/L, 4.12±0.47 gm % respectively. This study showed statistically significant increase in malondialdehyde levels (p-value &lt; 0.001), activities of superoxide dismutase enzymes (p-value &lt; 0.001) and lactate dehydrogenase levels (p-value &lt; 0.001) in malignant pleural fluids when compared to the benign pleural fluids. Non significant change was observed in total protein levels (p-value &gt; 0.01) in malignant pleural fluids when compared to the benign pleural fluids. Conclusion: Oxidative stress is increased in malignant pleural effusion malondialdehyde and superoxide dismutase being oxidative stress markers, can be used for differentiating between malignant and benign pleural effusions.

Pre‐Clinical Mouse Models of Primary and Metastatic Pleural Cancers of the Lung and Breast and the Use of Bioluminescent Imaging to Monitor Pleural Tumor Burden

Malignant pleural disease (MPD) results in an estimated 150,000 cases of malignant pleural effusions (MPE) annually. The most common malignancies associated with MPD are primary malignant pleural mesothelioma (MPM) and metastatic lung cancer, breast cancer, and lymphoma. MPM is a rare, regionally aggressive malignancy whose incidence is increasing secondarily to the latency of disease progression. MPD is characteristic of advanced-stage pleural disease and portends a grave clinical prognosis with a median survival between 3 and 12 months. Preclinical investigations conducted in flank and intraperitoneal tumor models do not fully recapitulate the pleural tumor microenvironment, and the results are not directly translatable to the clinical setting. The protocol described herein provides a mouse model of MPM and MPD from nonhematogenous tumors, resulting in reproducible tumor location, tumor progression, animal survival, and histopathology. Pleural tumor growth in this model resembles the regionally aggressive clinical course and tumor microenvironment of human pleural cancers and provides an optimal animal model to investigate MPD biology and therapies.

Four Cases of Malignant Pleural Effusion in Patients with Papillary Thyroid Carcinoma

Papillary thyroid carcinoma could be a rare cause of malignant pleural effusion. The development of malignant pleural effusion in patients with papillary thyroid cancer is an extremely adverse prognostic indicator. Here, we report four cases that showed development of malignant pleural effusion during the clinical course of the papillary thyroid carcinoma and consider the prognosis. In four patients, the median survival time after the development of malignant pleural effusion was only 17 months. (Endocrinol Metab 26:330334, 2011)