Primary Pleural Tumors Research Articles

Primary Malignant Neuroendocrine Tumour of Pleura: First Case Report

Metastatic tumours of pleura are the most common malignant tumours causing malignant pleural effusion. Lungs are the most common primary sites. Primary pleural tumours are rarely seen and diffuse malignant mesothelioma is the most common malignant tumour of pleura. Primary malignant neuroendocrine tumour of pleura is not reported in the literature. Here, we report a rare case of primary malignant neuroendocrine tumour of pleura in a fifty-two-year-old, nonsmoker female who presented with right-sided pleural effusion and ipsilateral, dull aching chest pain. Clinical presentations of inflammatory lesions like tuberculous pleuritis and benign and malignant neoplasms of pleura are indistinguishable; hence, fluid cytology, pleural biopsy, and immunohistochemistry are necessary for exact tissue diagnosis of the tumours, which is mandatory for correct treatment and prognostic assessment.

Primary malignant melanoma of the pleura with rapid progression: A case report and literature review.

A primary melanocytic lesion arising from the pleura is a rare occurrence. This is the case report of a 36-year-old female patient with a primary pleural melanocytic tumor. The positron emission tomography/computed tomography scan revealed multiple nodular soft tissue thickenings of the left hemipleura and a large amount of pleural effusion in the left hemithorax. The results of the histological examination confirmed the diagnosis of melanoma. The disease progressed 4 months following immunotherapy and chemotherapy and the patient succumbed to the disease 2 months later. This type of tumor appears to exhibit a highly aggressive biological behavior and responds poorly to immunotherapy and chemotherapy, which are characteristics similar to those exhibited by melanomas arising in other regions.

Correlation between computed tomography of the chest and medical thoracoscopic findings in primary pleural tumors

Malignant pleural mesothelioma ( MPM) is an aggressive tumor arising from the mesothelial cells lining the pleura. It commonly presents with unilateral pleural effusion with variable degree of pleural thickening and nodularity. MPM usually develops on the parietal pleura, and involvement of the visceral pleura indicates more advanced stage. Treatment of MPM should not be started before correct diagnosis and staging with computed tomography (CT) and thoracoscopy. The aim of this study was to assess the correlation between findings on chest CT and those on thoracoscopy and to evaluate the sensitivity of chest CT to identify malignant pleural lesions. Patients with suspected MPM and indicated for medical thoracoscopy for diagnostic confirmation were enrolled in the present study. Twenty patients with confirmed diagnosis after tissue biopsies with medical thoracoscopy were selected. Comparison and correlation between CT findings and medical thoracoscopic findings were made. Thoracoscopy showed parietal pleural invasion in all patients, whereas noncontrast chest CT showed parietal pleural lesions in 14 patients (70%). Visceral pleural involvement was evident in 13 patients (65%) on thoracoscopy, but chest CT detected only one case (5%) with visceral pleural involvement. Three patients (15%) were found to have fibrous septations on thoracoscopy, compared with only one patient (5%) on chest CT. The sensitivity of noncontrast chest CT in the detection of MPM was 70%. Although the sensitivity of noncontrast chest CT in the detection of MPM is high, thoracoscopy is needed not only to confirm the diagnosis but also to assess the different parts of the pleura and to allow proper staging of the disease. Egypt J Broncho 2014 8:32–37

FDG PET/CT in the Management of Primary Pleural Tumors and Pleural Metastases

OBJECTIVE. FDG PET/CT is emerging as an important modality in the evaluation of pleural tumors. PET/CT has an established role in the diagnosis and staging and shows promise in therapy planning, therapy response assessment, and providing prognostic information in patients with malignant pleural mesothelioma. This modality has distinct advantages in characterizing other primary pleural tumors and pleural metastases. CONCLUSION. FDG PET/CT is a useful imaging modality in the management of patients with primary pleural tumors and pleural metastases.

Extrapleural Pneumonectomy for Primary Pleural Mullerian Tumor in a Young Woman

We present a case of a low-grade mullerian tumor of right pleural origin in a 23-year-old woman treated with an aggressive multimodal treatment paradigm. This tumor is heretofore undescribed in the medical literature. She received induction therapy of carboplatin and paclitaxel with minimal response, then had a maximally cytoreductive right extrapleural pneumonectomy. She subsequently underwent intensity-modulated radiotherapy to the right hemithorax. We propose a treatment paradigm for this previously undescribed primary pleural mullerian tumor.

Diagnostic challenges: Equine thoracic neoplasia

SummaryThe diagnosis of thoracic neoplasia in the horse can be difficult due to the nonspecific nature of the clinical signs and their overlap with other pulmonary diseases. Haematological and serum biochemical evaluation, thoracic ultrasonography, radiography, endoscopic examination, and, where appropriate, thoracocentesis and pleural fluid cytology may all be helpful in reaching a diagnosis. Granular cell tumours are the most frequently reported primary pulmonary tumours of horses. They occur as single or multiple masses adjacent to bronchi and bronchioles, and the mass typically extends into the airway, resulting in partial or complete occlusion of the lumen. Thymic tumours are classified as benign or metastatic, based on evidence of tissue invasiveness, even though they uniformly appear benign histologically. These tumours are derived from epithelial reticular cells of the thymus and are rare in horses. Other primary thoracic neoplasms originate from various pulmonary tissues and are primarily reported as single case reports: pulmonary and bronchial carcinoma and adenocarcinoma, bronchogenic squamous cell carcinoma, bronchial myxoma, pulmonary chondrosarcoma, pulmonary leiomyosarcoma and pleuropulmonary blastoma. Clinical signs of these primary pulmonary neoplasms are dependent on the tumour type and location, but commonly include chronic cough, weight loss, anorexia, fever and respiratory difficulty; ventral oedema, pleural effusion and epistaxis are also frequently observed. Mesothelioma is a rare primary pleural tumour arising from the mesothelium of the pleura, pericardium and peritoneum. The clinical presentation in horses includes weight loss, respiratory difficulty and large volume pleural effusion. The tumour appears ultrasonographically as multiple small nodules on a thick serosal surface and pleural biopsy is diagnostic. Lymphoma is the most common haematopoietic neoplasm in horses, which can present with 4 main manifestations of lesions: mediastinal, multicentric, alimentary and cutaneous. Common clinical features include chronic weight loss, lethargy, anorexia, subcutaneous oedema, lymphadenopathy, colic, bleeding tendency and diarrhoea. Coughing and laboured respiratory effort are often apparent in individuals suffering from mediastinal masses. In such instances, pleural effusion may result in severe pulmonary atelectasis and pulmonary function is significantly compromised. Haemangiosarcoma is the second most common metastatic thoracic neoplasm in horses. Disseminated haemangiosarcoma is aggressive and rapidly progressive. The clinical presentation often includes tachypnoea, pale or icteric mucous membranes, respiratory distress, epistaxis, and subcutaneous, cutaneous or intramuscular masses. Other tumour types that metastasise to the thoracic cavity include adenocarcinoma, squamous cell carcinoma, fibrosarcoma, metastatic melanoma, mastocytoma and undifferentiated sarcoma. The clinical features of these tumours are generally nonspecific and often relate more to the primary site of tumour formation.

Pathology of the pleura: What the pulmonologists need to know

Primary and metastatic pleural neoplasms, and non-neoplastic pleural diseases, can have similar clinical, radiographic and gross features. However, treatments and prognoses of these diverse pleural conditions vary greatly. Accurate diagnosis of pleural disease is therefore extremely important, and histological interpretation of pleural biopsies is vital to rendering an accurate diagnosis. Smaller biopsies contribute to the difficulties in accurately characterizing pleural lesions, and immunostains are frequently employed in their assessment. Diffuse malignant mesothelioma, the most common primary pulmonary neoplasm, is rare; however, other less common primary pleural neoplasms, including solitary fibrous tumour, the most common benign primary pleural neoplasm, occur. These neoplasms are discussed. Also, non-neoplastic pleural diseases, including granulomatous pleuritis, eosinophilic pleuritis and fibrous and fibrinous pleuritis, among other diseases, are discussed.

Development of treatment of malignant pleural effusion

Malignant pleural effusion is caused by the pleural invasion of malignant tumors such as lung cancer, or by primary pleural tumors. It is a troublesome and debilitating complication of advanced malignancies. If malignant pleural effusion is not treated in time, the average life span of these patients is only several months. An effective treatment can improve the quality of life and prolong the average life spans. Key words: Neoplasms; Pleural effusion, malignant; Pleurodesis

18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography and positron emission tomography/computed tomography imaging of malignant pleural mesothelioma*

Malignant pleural mesothelioma (MPM) is the most common primary pleural tumor and its incidence is rising. Its diagnosis, staging and response assessment are challenging for imaging. Integrated positron emission tomography (PET)/CT increases the accuracy of overall staging in patients with mesothelioma and improves the selection of patients for curative surgical resection. It is particularly useful in identifying occult distant metastases. It may be used to predict prognosis and to assess the metabolic response to therapy.

Radiologic manifestation of primary pleural tumors

To show the radiological manifestations of primary pleural tumors. we carried out a retrospective analysis of radiological findings in 62 patients with primary malignant tumor of pleura. Study included 39 male and 23 female patients. Malignant tumors were present in 92.7% of the patients and benign ones in 7.2%. The most common malignant tumor was mesothelioma (85.4%), and solitary fibrous tumor prevailed among benign tumors (9.7%). Diffuse malignant mesothelioma manifested on computed tomography (CT) as a pleural thickening and effusion in 67.4% of the patients, tumors and effusion in 11.7%, and only as an effusion in 9.8% cases. Thickening of the pleura appeared diffuse in 54% of patients and most often it had nodular pattern. Both localized malignant and all benign tumors presented as tumor-like changes with the signs of necrosis in 50%. The imaging methods have a key role in the diagnosis of pleural tumors. CT shows different morphologic features of pleural lesions that have been established as a useful tool for differentiating malignant from benign disease. However, magnetic resonance is preferred imaging method for assessing the extent and resectability of pleural tumors.

Malignant pleural diseases: Diagnosis and treatment

To evaluate efficacy of diagnostic procedures, results of surgery, and complications in malignant pleural diseases. From 1999 to 2006, 169 patients underwent treatment in the Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University. Patients were divided into two groups: group I, patients with primary pleural malignant diseases (93 patients, 55.0%), and group II, secondary pleural tumors (76 patients, 45%). Of the 76 patients, 40 patients (52.6%) were diagnosed with metastatic pleural tumors and 36 patients (47.4%) with tumors invading parietal pleura. We used noninvasive and invasive methods for diagnosis. Noninvasive methods included chest x-ray, chest computed tomography, magnetic resonance imaging, chest ultrasound, positron emission tomography/computed tomography (performed in Germany), and invasive methods included puncture of pleural effusions, transthoracic pleural puncture, drainage, pleural biopsy and video-assisted thoracoscopic pleural biopsy, pleural resection, and ultrasound-guided needle biopsy of the pleura. The following procedures were performed in group I: pleurectomy in 15 patients (16.1%), pleural pneumonectomy in 42 patients (45.2%), pleural decortication in 12 patients (12.9%), extended pleuropneumonectomy with diaphragm and pericardium resections and plastic surgery in 14 patients (15.0%), pleurectomy with costal resections in 10 patients (10.1%). Procedures performed in group II included video-assisted thoracoscopic pleurectomy in 15 patients (19.7%), pleural biopsy in 10 patients (13.2%), pleurectomy in 15 patients (19.7%), pleural drainage and fenestration in 5 patients (6.5%), lung and pleura resection in 12 patients (15.8%), chest wall and pleura resection in 10 patients (13.2%), diaphragm and pleura resections in 9 patients (11.8%). Early stage primary pleural tumors were found in 24 patients (25.8%). Metastatic pleural disease was found in 32 patients with early primary tumors (80.0%). In all 36 patients (100.0%) with chest wall tumors, disease of advanced stage was determined. Main surgical complications of the group I were observed in 26 patients (27.9%). Six patients (6.5%) died after surgery. In group II, 23 patients (30.2%) had postoperative complications; 3 patients (3.9%) died. In noninvasive methods, the highest sensitivity was achieved for chest computed tomography and magnetic resonance imaging (97%); the specificity of chest magnetic resonance imaging was 100%, and the specificity chest computed tomography and magnetic resonance imaging--98%. The accuracy of chest x-ray plus computed tomography was 98%. In invasive methods, accuracies of pleural biopsy, video-assisted thoracoscopic pleural biopsy, and pleurectomy were 100%, 90%, and 100%, respectively. In case of primary pleural tumors, the main surgery was extended pleuropulmonectomy (45.2%) with or without mediastinal resection. Mortality rate was 6.5%. In case of metastatic pleural disease, the main surgery was video-assisted thoracoscopic pleurectomy (19.7%). Mortality was rate 5%. In cases of pleural invasion by other thoracic malignancies, the main surgeries were chest wall and pleural resection (13.2%) and lung and pleural resection (15.8%). Mortality rate was 2.8%. After 169 operations due to malignant pleural diseases, the rate of postoperative complications ranged from 1.3% to 7.8%.

Primary Pleural Neoplasia: Entities Other Than Diffuse Malignant Mesothelioma

Overwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it is nonetheless the most common neoplasm primary to the pleura. Metastatic carcinoma and diffuse malignant mesothelioma each have their own prognostic and therapeutic characteristics. Other primary pleural neoplasms occur uncommonly or rarely, with their own prognostic and therapeutic characteristics. To review primary pleural neoplasms other than diffuse malignant mesothelioma, to better ensure correct diagnosis and optimal assessment of prognosis and treatment. Literature review and primary material from the authors' institutions. A nonexhaustive group of uncommon to rare benign and malignant primary pleural neoplasms--other than diffuse malignant mesothelioma--are presented, of which one must be aware in order to maintain an appropriate index of suspicion to include them in the differential diagnosis of a pleural tumor.

Pathologie der primären Pleuratumoren

In the WHO classification, pleural tumours of mesothelial and mesenchymal origin as well as lymphoproliferative disorders are distinguished, with malignant mesotheliomas forming the most common primary pleural tumour. Histologically, a prognostically relevant differentiation between epitheloid (40-60 %), sarcomatoid (20-30 %), and biphasic mesotheliomas (20-30 %) is made. Besides other rare primary tumours of the pleura, the differential diagnoses of malignant mesotheliomas comprise carcinomatous pleuritis of intra- and extrapulmonary malignancies. Especially in early tumour stages, the differentiation from reactive pleural changes requires a close interdisciplinary cooperation with a careful correlation between histopathological findings and clinical presentation.

Primary pleural hemangiopericytoma-like tumor: an unusual localized fibrous tumor of the pleura (2007: 4b)

In this report, the case of a 65-year-old woman with cough and dyspnoea is described. The chest radiographs showed a sharply demarcated mass located in the left paravertebral hemithorax and a left pleural effusion. Computed tomography after intravenous contrast material showed a heterogeneous, mainly cystic mass with peripheral enhancement and enhancing intratumoral foci and septa. Magnetic resonance imaging confirmed the location and enhancement pattern of the lesion. Histology following the surgical excision of the tumor showed a localized fibrous tumor of the pleura and specifically the hemangiopericytoma-like type.

Infrequent existence of simian virus 40 large T antigen DNA in malignant mesothelioma in Japan

Malignant mesothelioma is the most common primary pleural neoplasm. Association of simian virus 40 (SV40) with malignant mesothelioma has been reported, suggesting that SV40 plays an important role in the origin of a subset of these tumors. However, significant geographic variation is present as to how often this association occurs. As no study concerning SV40 in malignant mesothelioma has been reported from Japan, we examined the frequency of SV40 infection in Japanese malignant mesothelioma cases. In pleural malignant mesothelioma tissue from 35 patients in Japan, we sought the presence of SV40 large T antigen DNA using real-time polymerase chain reaction (PCR), as well as expression of the viral protein using immunohistological methods. Real-time PCR demonstrated that two of 35 mesotheliomas contained DNA sequences encoding portions of SV40 large T antigen. None of the 35 malignant mesothelioma specimens showed immunoreactivity for SV40 large T antigen. SV40 infection does not appear to have a major role in the development of malignant mesothelioma in Japan.

Solitary Fibrous Tumors of the Pleura: Report of Eight Cases and Literature Review

Primary pleural tumors have been classified as diffuse or localized types. The diffuse type or malignant mesothelioma (MM) is the most frequently encountered lesion. Localized variety is less frequent and defined. Although its hystogenesis is not well established, new histological and immunohistochemical techniques are giving us a better understanding of it. Now, the common consensus is that this tumor origins from a primitive submesothelial mesenchymal cell (16,17,18,19). Concerning the advances done during the last decade in the understanding, imaging, diagnostic and therapeutic approaches to this rare tumor, we decided to conduct a retrospective study of the cases seen at our institution and a review of the available English literature.

Review and Update of Uncommon Primary Pleural Tumors: A Practical Approach to Diagnosis

Abstract Objective.—We address the current classifications and new changes regarding uncommon primary pleural tumors. Primary pleural tumors are divided according to their behavior and are discussed separately as benign tumors, tumors of low malignant potential, and malignant neoplasms. Data Sources.—Current literature concerning primary pleural neoplasms was collected and reviewed. Study Selection.—Studies emphasizing clinical, radiological, or pathologic findings of primary pleural neoplasms were obtained. Data Extraction.—Data deemed helpful to the general surgical pathologist when confronted with an uncommon primary pleural tumor was included in this review. Data Synthesis.—Tumors are discussed in 3 broad categories: (1) benign, (2) low malignant potential, and (3) malignant. A practical approach to the diagnosis of these neoplasms in surgical pathology specimens is offered. The differential diagnosis, including metastatic pleural neoplasms, is also briefly addressed. Conclusions.—Uncommon primary ple...

Review and Update of Uncommon Primary Pleural Tumors: A Practical Approach to Diagnosis

We address the current classifications and new changes regarding uncommon primary pleural tumors. Primary pleural tumors are divided according to their behavior and are discussed separately as benign tumors, tumors of low malignant potential, and malignant neoplasms. Current literature concerning primary pleural neoplasms was collected and reviewed. Studies emphasizing clinical, radiological, or pathologic findings of primary pleural neoplasms were obtained. Data deemed helpful to the general surgical pathologist when confronted with an uncommon primary pleural tumor was included in this review. Tumors are discussed in 3 broad categories: (1) benign, (2) low malignant potential, and (3) malignant. A practical approach to the diagnosis of these neoplasms in surgical pathology specimens is offered. The differential diagnosis, including metastatic pleural neoplasms, is also briefly addressed. Uncommon primary pleural neoplasms may mimic each other, as well as mimic metastatic cancers to the pleura and diffuse malignant mesothelioma. Correct diagnosis is important because of different prognosis and treatment implications for the various neoplasms.

A Slowly Growing Extraparenchymal Mass: Imaging Considerations

Abstract: Solitary fibrous tumor of the pleura (SFTP) is a rare primary pleural neoplasm that most commonly arises from visceral pleural surfaces. SFTPs consist of spindle cells embedded within variable amounts of connective tissue, and may stain positive for vimentin and antibodies to CD 34. Grossly, SFTPs often are attached to pleural surfaces via a pedicle. Most SFTPs are benign, although malignant degeneration may occur in approximately 40% of lesions. Histopathologically, malignancy is favored when high mitotic counts (greater than 4–10 per high power fields), pleomorphism, high cellularity with crowding and overlapping nuclei, tumor giant cells, necrosis, and hemorrhage are encountered. Chest radiography may show a peripheral mass that may show characteristics suggestive of an extraparenchymal location: obtuse angles with the chest wall associated with a circumscribed border on one side of the lesion and a fading margin on the other side. Cross sectional imaging findings of SFTP include a variable sized mass in contact with the chest wall or diaphragm that shows enhancement following intravenous contrast administration. Calcification and effusion are uncommon. Magnetic resonance imaging may show decreased T1 and T2 signal, consistent with the fibrous nature of the lesion. The treatment of choice for SFTP is wide surgical resection.

Pedunculated Localized Fibrous Tumor of the Pleura Presenting as a Moving Chest Mass

Localized fibrous tumor of the pleura is a rare primary pleural neoplasm. The tumors are usually discovered incidentally on routine chest radiography. A change in the lesion's position with respiration and/or posture of the patient indicates a pedunculated pleural lesion. Computed tomography and magnetic resonance imaging reveal the relation of the lesions to adjacent structures. Magnetic resonance imaging is also useful for the characterization of the lesions on the basis of signal features. These tumors usually consist of mature fibrous tissue.