Cause Of Malignant Pleural Effusion Research Articles

Diagnostic analysis of pleural fluid cell blocks using relevant immunohistochemical markers in clinically suspicious cases of malignancy.

Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology.

A Novel Clinical Prognostic Model for Breast Cancer Patients with Malignant Pleural Effusion: Avoiding Chemotherapy in Low-Risk Groups?

Malignant pleural effusion (MPE) is a severe complication in patients with advanced cancer that is associated with a poor prognosis. Breast cancer is the second leading cause of MPE after lung cancer. We therefore aim to describe clinical characteristics of the patients with MPE combined with breast cancer and construct a machine learning-based model for predicting the prognosis of such patients. This study is a retrospective and observational study. Least absolute shrinkage and selection operator (LASSO) and univariate Cox regression analyses were applied to identify eight key clinical variables, and a nomogram model was established. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. 196 patients with both MPE and breast cancer (143 in the training group and 53 in the ex-ternal validation group) were analyzed in this study. The median overall survival in two cohorts was 16.20 months and 11.37 months. Based on the ROC curves for 3-, 6-, and 12-month survival, the areas under the curves were 0.824, 0.824, and 0.818 in the training set and 0.777, 0.790, and 0.715 in the validation set, respectively. In the follow-up analysis, both systemic and intrapleural chemotherapy significantly increased survival in the high-risk group compared to the low-risk group. Collectively, MPE confers a poor prognosis in breast cancer patients. We have developed a first-ever survival prediction model for breast cancer patients with newly diagnosed MPE and validated the model using an independent cohort.

Cytological, cell block and immunohistochemical analysis of spectrum of malignant pleural effusion with special reference to non-small cell lung carcinoma: A hospital based study of North East India

Malignant pleural effusions (MPE) can result from primary malignancies of the pleura or from underlying intrathoracic or extrathoracic malignancies that reach the pleural space by hematogenous, lymphatic, or contiguous spread. Conventional smear and cell block (CB) technique is one of the oldest methods for the evaluation of body cavity fluids. The principal advantage of cell block over conventional smears are an additional yield of malignant cells and obtaining multiple sections for ancillary tests such as immunohistochemistry (IHC). This study is a hospital-based cross-sectional study which was conducted for a period of 14 months from June 2021 to July 2022 in a tertiary care centre of North East India. Among 277 pleural effusion specimens 11.91% cases were positive for malignancy.Lung carcinoma was the most common cause of malignant pleural effusion. Non-small cell lung carcinoma comprised majority of lung carcinoma cases. Adenocarcinoma was the most common subtype of NSCLC with female preponderance. Cytological diagnosis had a Sensitivity of 76.19%, specificity of 100% andAccuracy of 96.5%. Immunohistochemistry of lung carcinoma in cell block preparation revealed 77.77% cases of adenocarcinoma of lung were positive for TTF-1(P<0.018). Immuno-expression of P63 and P40 showed positive expression in both the cases of squamous cell carcinoma. Conventional smear and cell block method with application of immunohistochemistry will help us in accurate diagnosis of primary site of the tumour aiding early treatment especially in resources restricted hospitals.

Diagnostic Accuracy of Cell Block and Immunohistochemistry in Effusion Cytology.

Introduction Although the cytology of effusion fluids is considered a routine laboratory test, it has recently emerged as an essential tool in determining the primary site of origin of carcinoma of unknown primary. The sensitivity for diagnosing malignancy has enhanced with the inclusion of cytospin, cell block (CB), and immunohistochemistry (IHC) to effusion fluid cytology due to the improvement in morphological preservation and good cellular yield. The purpose of this study was to assess the diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of IHC and CB in effusion cytology. Methodology An institution-based cross-sectional study was conducted over a period of six months on 150 cases of effusion fluids submitted for diagnostic purposes. After the preparation of cytospin, the residual amount of centrifuged deposit was mixed with CytoLyt solution, thrombin, and plasma, and CBs were prepared. IHC was applied to the CB. Calretinin was used for mesothelial cells, and BerEP4, TTF-1, ER, WT-1, and CD-X2 were used for the confirmation and origin of malignant cells. Results The mean age of the patients was 51.75 ± 16.63 years. The male-to-female ratio was 1:1.24. Out of 150 cases, 78 were pleural effusions, 68 were peritoneal effusions, and four were pericardial effusions. Out of 150 cases, based on cytological examination alone, 66 (44%) were classified as benign, 27 (18%) as malignant, and 57 (38%) were suspicious for malignancy. When cytology was combined with CB and IHC, the diagnostic yield was increased to benign 95 (63.33%), malignant 48 (32%), and suspicious for malignancy 7 (4.67%). The most common cause of malignant pleural effusion was breast carcinoma in females and lung carcinoma in males. The most common primary tumor in malignant peritoneal effusion was ovarian carcinoma in females and colonic adenocarcinoma in males. The sensitivity and specificity of combined cytology with cell block and IHC were 92.31% and 98.95%, respectively. This combination produced significantly better results (p-value = 0.001) for detecting malignancy and reduced suspicious cases from 38% to 4%. Conclusion CB, in combination with IHC, increases the diagnostic yield and aids in detecting malignancy at an unknown primary site in effusion fluids. Both of these techniques can thus enhance the sensitivity and specificity of the diagnosis of effusion cytology. Hence, CB and IHC have advanced utility over cytological smears in effusion fluid cytological diagnosis.

Value of human epididymis secretory protein 4 in differentiating malignant from benign pleural effusion: an analysis of two cohorts.

Lung cancer is the most common cause of malignant pleural effusion (MPE). Serum human epididymis secretory protein 4 (HE4) is a useful diagnostic marker for lung cancer. This study aimed to evaluate the diagnostic accuracy of pleural fluid HE4 for MPE. A prospective, double-blind diagnostic test accuracy study. Patients with undiagnosed pleural effusion were enrolled in two cohorts (Hohhot and Changshu). Electrochemiluminescence immunoassay was used to detect pleural fluid HE4. The diagnostic accuracy of HE4 was evaluated by a receiver operating characteristic (ROC) curve, and the net benefit of HE4 was assessed by a decision curve analysis (DCA). A total of 66 MPEs and 86 benign pleural effusions (BPEs) were enrolled in the Hohhot cohort. In the Changshu cohort, 26 MPEs and 32 BPEs were enrolled. In both cohorts, MPEs had significantly higher pleural fluid HE4 than BPEs. The area under the ROC curve (AUC) of HE4 was 0.73 (95% CI: 0.64-0.81) in the Hohhot cohort and 0.79 (95% CI: 0.67-0.91) in the Changshu cohort. At a threshold of 1300 pmol/L, HE4 had sensitivities of 0.44 (95% CI: 0.33-0.56) in the Hohhot cohort and 0.54 (95% CI: 0.35-0.73) in the Changshu cohort. The corresponding specificities were 0.90 (95% CI: 0.83-0.95) in the Hohhot cohort and 0.94 (95% CI: 0.84-1.00) in the Changshu cohort. In subgroup analyses, HE4 had an AUC (95% CI) of 0.78 (0.71-0.85) in exudates and an AUC of 0.69 (0.57-0.81) in patients with negative effusion cytology. The DCA revealed that HE4 determination had a net benefit in both cohorts. Pleural fluid HE4 has moderate diagnostic accuracy for MPE and has net benefit in pleural effusion patients with unknown etiology.

HUMAN T-CELL LYMPHOTROPIC VIRUS TYPE 1-ASSOCIATED ADULT T-CELL LEUKEMIA/LYMPHOMA AND PROGRESSION TO HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A CASE REPORT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus to be discovered [1]. Its infection can lead to adult T-cell leukemia/lymphoma (ATLL). Hemophagocytic lymphohistiocytosis (HLH) is a syndrome with a mortality of 95% caused by overstimulation of the immune system [2,3,4]. This case report presents a male with HTLV-1—associated ATLL who developed HLH. CASE PRESENTATION: A 75 year-old Haitian male with a 22 pack-year smoking history presented to our hospital after a pre-syncopal episode with a 10 day history of pleuritic chest pain. Labs were significant for leukocytosis of 26.2 *10^9/L with lymphocyte predominance. Chest x-ray showed bilateral pleural effusions. Cytometry of the pleural fluid showed an aberrant population of CD4(+) T lymphocytes consistent with post-thymic T-cell lymphoma and atypical T lymphocytes, positive for CD45RO, CD25, and TCRab and negative for CD26 and CD56, consistent with ATLL. Bronchoscopy with endobronchial ultrasound-guided fine needle aspiration of lymph node stations 4R, 7, and 11L revealed aberrant T-cells. TCR gene rearrangement and HTLV-1 western blot confirmed ATLL due to HTLV-1. He was started on CHOP and brentuximab, but was readmitted weeks later with encephalopathy and acute hypoxic respiratory failure. CMV viremia was confirmed via serum PCR and ganciclovir was initiated. Labs were significant for elevated ferritin 9,464 ng/mL, triglycerides 162 mg/dL, D-dimer 549 ng/mL, low fibrinogen 150 mg/dL, and worsening cytopenia with hematocrit 27.1% and platelets 58*10^9/L. Bone marrow biopsy demonstrated histiocytes with engulfed erythroid cells, confirming HLH. The patient was treated with dexamethasone, but was too unstable for etoposide and died 12 days after readmission. DISCUSSION: Lymphoma is the third most common cause of malignant pleural effusion (MPE) and patients have an overall survival of 3-12 months after diagnosis [5]. Diagnostic tests for ATLL are usually done with serum and rarely from MPE, as was done in this case [6]. Signs of HTLV-1—associated ATLL include marked leukocytosis with atypical lymphocytes, rash, and lymphadenopathy [1]. Our patient did not have a rash, but had other signs and symptoms consistent with the presentation of HTLV-1—associated ATLL. HLH likely occurred from progression of HTLV-1—associated ATLL, but CMV viremia or chemotherapy could have contributed. The diagnosis of HLH is difficult because symptoms are nonspecific, requiring a high index of suspicion [7]. The optimal treatment for HLH is still unknown and a multidisciplinary approach is essential. CONCLUSIONS: This case demonstrates HLTV-1—associated ATLL that initially presented as MPE, and was a subsequent trigger for HLH. REFERENCE #1: Rodriguez-Zuniga MJM, Corte-Franco F, Qujiano-Gomero E. Adult T-Cell Leukemia/Lymphoma. Review of the Literature. Actas Dermosifiliogr. 2018;109(5):399-407 REFERENCE #2: Atteritano M, David A, Bagnato G, et al. Haemophagocytic syndrome in rheumatic patients. A systematic review. Eur Rev Med Pharmacol Sci. 2012;16(10):1414-1424 REFERENCE #3: Bindra BS, Garcia de de Jesus K, Cisneros O, Jorge VM, Kaur H. Hemophagocytic Lymphohistiocytosis: Management and Special Consideration in Human Immunodeficiency Virus Positive Patients with Immune Reconstitution Syndrome. Cureus. 2019;11(8):e5402 DISCLOSURES: No relevant relationships by Michael Bender, source=Web Response No relevant relationships by Liane Emerson, source=Web Response No relevant relationships by Chaim Rube, source=Web Response

A rare cause of malignant pleural effusion: Poorly differentiated thyroid carcinoma

A rare cause of malignant pleural effusion: Poorly differentiated thyroid carcinoma

A rare cause of malignant pleural effusion: Poorly differentiated thyroid carcinoma

A rare cause of malignant pleural effusion: Poorly differentiated thyroid carcinoma

A rare cause of malignant pleural effusion: Poorly differentiated thyroid carcinoma

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Malignant pleural effusions with unknown primary sites: A 6 years cytological study

Introduction: Malignant pleural effusion is an important complication found in patients of advanced cancers and lead on to exudative effusions. Not much data is available regarding malignant pleural effusions with unknown primary sites so we had conducted a retrospective study to highlights the primary sites in cases of malignant pleural effusions. Materials and Methods: The present study was conducted at a tertiary care centre at Ludhiana, Punjab. Retrospective analysis of case records of 104 patients, diagnosed as malignant pleural effusions on cell cytology out of 2948 cases of pleural fluids during a 6 years period (2012 to 2017) was done and the results were analysed to assess the causes and various primary sites of malignant pleural effusion. Results and Conclusion: A total of 104 pleural fluid samples were found to be positive for malignancy out of 2948 cases of pleural fluids during the study period time. Lung carcinoma was found to be the most common cause of malignant pleural effusion. On morphology, adenocarcinoma was the most common type of cytological diagnosis in all pleural effusions. Unknown primary malignancies presented as pleural effusions in many cases with no specific signs & symptoms. Cytological study can reveal the morphological diagnosis & clinch the primary site of origin in more than 50% of cases. Cytological analysis of pleural fluid should be the initial diagnostic approach to diagnose malignant pleural effusions and tapped effusions must always be sent for cytological study. Keywords: Effusion, Lung, Malignancy, Primary site.

Etiology and prognostic evaluation of malignant pleural effusion

Background: Malignant pleural effusion is a common medical problem in patients with cancer. The survival of patients with malignant pleural effusion is generally poor. The objectives of our study were to reveal possible prognostic factors of malignant pleural effusion.Methods: Fifty-three consecutive patients, 34 male and 19 female patients of malignant pleural effusion diagnosed by pleural fluid positive for malignant cytology and/or pleural tissue positive for malignancy by thoracoscopy biopsy. Performance status by the Eastern Cooperative Oncology Group (ECOG) score and LENT score was calculated at the time of diagnosis. Median survival time was calculated using Kaplan-Meier analysis curve. Survival time was defined as the time from diagnosis to death or the last follow-up.Results: Most common cause of malignant pleural effusion was lung carcinoma 46 (86.79%). Adenocarcinoma was the most common 31 (58.5%) followed by NSCLC 10 (18.0%). Low, moderate and high-risk LENT score was found in 3 (5.7%), 35 (66%) and 15 (28.3%) respectively. The median survival time of pleural fluid sugar less than 20 were 3 months. The median survival time of LENT low, medium and high risk was 12 months, 5.2 months and 2.5 months respectively. The median survival time of patients with ECOG score of 1 and 4 was 6.5 months and 1 month respectively. Patients with bilateral pleural fluid had a mean survival time of 2 months.Conclusions: Adenocarcinoma lung is the most common etiology of malignant pleural effusion. The median overall survival time was 4 months. Higher ECOG score and LENT score are associated with shorter survival time.

A clinicopathological study of pleural effusion with special reference to malignant aetiology in a tertiary care hospital in West Bengal

Background: Pleural effusion has varied aetiological factors. It constitutes one of the major causes of morbidity in India as well in other parts of world. Because of the various aetiologies that can cause pleural effusion, itoften present a diagnostic problem, even after extensive investigations. Objective: In this study, authors aimed to identify the common aetiologies causing pleural effusion and their clinical profile in a tertiary care hospital. Materials and Methods: A hospital based cross-sectional study is conducted over a period of one year in tertiary care hospital in West Bengal. 150 patients of pleural effusion above 10 yrs of age were studied. Clinico-pathological, radiological, hematological and biochemical parameters were documented. Results: The most common cause pleural effusion in this study was tuberculosis (64.67%), followed by malignancy (14.67%), parapneumonic effusion (7.33%), cardiac failure (5.33%) and other minor causes. It was commonly seen in male (70%). The occurrence of tubercular pleural effusion was maximum in the age group 31-40 years. Right-sided effusions were more common. Pleural fluid cytology and adenosine deaminase played a pivotal role in the diagnosis of tubercular pleural effusion. Conclusion: The present study highlights tuberculosis as the common causative factor for pleural effusion, labels lung carcinoma as the most common cause of malignant pleural effusion, and defines the clinico-pathological, biochemical and imaging characteristics of different aetiologies of pleural effusion.

Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment.

Pleural effusion is common in routine medical practice and can be due to many different underlying diseases. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause. This review is based on pertinent publications retrieved by a selective search in PubMed and on the authors' personal experience. The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which remains, at present, the foundation of the further diagnostic work-up. When a pleural effusion arises in the setting of pneumonia, the potential devel- opment of an empyema must not be overlooked. Lung cancer is the most common cause of malignant pleural effusion, followed by breast cancer. Alongside the treatment of the underlying disease, the specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy (with early consultation of a thoracic surgeon), to the placement of a permanently indwelling pleural catheter. The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis. The range of therapeutic options has recently become much wider. More data can be expected in the near future concerning diagnostic test- ing for the etiology of the effusion, better pleurodetic agents, the development of interventional techniques, and the genetic background of the affected patients.

Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters

Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other common causes. The impact of MPE on prognosis in this cohort remains unclear. Indwelling pleural catheters (IPCs) are routinely placed for palliation of recurrent symptomatic MPEs, but perceived concerns over infection and bleeding may limit their use in patients with hematologic malignancies. However, recent evidence suggests IPCs are both well tolerated and effective in this cohort. In this review, the evaluation of pleural effusions in hematologic malignancies and their management with an IPC are outlined. Two retrospective studies have been published regarding the use of IPCs in hematologic malignancies. Lymphomatous effusions are the most common cause of MPE in this cohort. The rates of complications and pleurodesis with IPC in hematologic malignancies are similar to those with solid organ tumors. Pleural effusions in patients with hematologic malignancies may be managed safely with an IPC. Sterile technique, barrier protection, standardized algorithms for placement and removal, and quality assurance initiatives are crucial to centers that place IPCs for all patients. The safety of IPC in hematologic malignancies warrants a paradigm shift in the management of pleural disease for this cohort.

The role of VEGF in the diagnosis and treatment of malignant pleural effusion in patients with non‑small cell lung cancer (Review).

Malignant pleural effusion (MPE) is a severe medical condition, which can result in breathlessness, pain, cachexia and reduced physical activity. It can occur in almost all types of malignant tumors; however, lung cancer is the most common cause of MPE, accounting for ~1/3 of clinical cases. Although there are numerous therapeutic approaches currently available for the treatment of MPE, none are fully effective and the majority can only alleviate the symptoms of the patients. Vascular endothelial growth factor (VEGF) has now been recognized as one of the most important regulatory factors in tumor angiogenesis, which participates in the entire process of tumor growth through its function to stimulate tumor angiogenesis, activate host vascular endothelial cells and promote malignant proliferation. Novel drugs targeting VEGF, including endostar and bevacizumab, have been developed and approved for the treatment of various tumors. Data from recent clinical studies have demonstrated that drugs targeting VEGF are effective and safe for the clinical management of MPE. Therefore, VEGF-targeting represents a promising novel strategy for the diagnosis and treatment of MPE. The present review summarized recent advances in the role of VEGF in the pathogenesis, diagnosis and clinical management of MPE in patients with non-small cell lung cancer.

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.

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.

A pilot study-is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?

Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients. A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, in Croatia. Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47-84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months. MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation.

A study of malignant serous effusions in a tertiary teaching hospital in western Uttar Pradesh

Background: The study of cells in effusional fluid was among the early domains in cytology to draw interest of clinicians and pathologists. Identification of effusional cells as benign reactive or malignant is a diagnostic primary purpose of evaluation. Clinical history when taken into account while evaluating effusions can avoid erroneous diagnosis. Materials and Methods: It was a prospective type of study. A total of 540 cases of serous effusions were cytologically evaluated following detailed history taking and clinical examination. Out of 540 cases all cases of malignant effusions were segregated and categorized according to sex, site (peritoneal or pleural), and origin (primary or metastatic). Results: A total of 50 cases were positive for malignancy.. Most common primary tumors associated with malignant effusions in males and females were of lung and ovary respectively. Most common cause of malignant pleural effusion in males was lung cancer and in females was breast cancer respectively. Most common cause of malignant peritoneal effusion in males was carcinoma GIT and in females was carcinoma ovary respectively. Conclusion: Malignancy emerged as the third most common cause of serous effusions following inflammatory and reactive causes. Malignant effusions were more common in females. Malignant effusions were mainly due to metastatic cancers, mostly adenocarcinomas. The most common cause of malignant pleural effusion in males was carcinoma lung and in females is carcinoma breast, while the most common cause of malignant peritoneal effusion in males was carcinoma GIT and in females was carcinoma ovary respectively. Keywords: Malignancy, Exudates, Effusion, Cytology

Trapped in a Breathless Condition - A Case Report and Discussion of a Malignant Pleural Effusion and Trapped Lung

Malignant pleural effusions (MPE) are a common complication of underlying malignancies, frequently requiring management by specialty practitioners. Although the most common cause of malignant pleural effusions is bronchogenic carcinoma with a frequency of 7-23%, it is also seen with other malignancies .