Pleural Fluid Mesothelin as an Adjunct to the Diagnosis of Pleural Malignant Mesothelioma

Rationale. The diagnosis of pleural malignant mesothelioma (MM) by effusion cytology may be difficult and is currently controversial. Effusion mesothelin levels are increased in patients with MM but the clinical role of this test is uncertain.Objectives. To determine the clinical value of measuring mesothelin levels in pleural effusion supernatant to aid diagnosis of MM.Methods and Measurements. Pleural effusion samples were collected prospectively from 1331 consecutive patients. Mesothelin levels were determined by commercial ELISA in effusions and their relationship to concurrent pathology reporting and final clinical diagnosis was determined.Results. 2156 pleural effusion samples from 1331 individuals were analysed. The final clinical diagnosis was 183 MM, 436 non-MM malignancy, and 712 nonmalignant effusions. Effusion mesothelin had a sensitivity of 67% for MM at 95% specificity. Mesothelin was elevated in over 47% of MM cases in effusions obtained before definitive diagnosis of MM was established. In the setting of inconclusive effusion cytology, effusion mesothelin had a positive predictive value of 79% for MM and 94% for malignancy.Conclusions. A mesothelin-positive pleural effusion, irrespective of the identification of malignant cells, indicates the likely presence of malignancy and adds weight to the clinical rationale for further investigation to establish a malignant diagnosis.

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The role of cytological evaluation of pleural fluid in diagnosing malignant mesothelioma

Medicinski pregled ◽

10.2298/mpns1202005l ◽

2012 ◽

Vol 65 (1-2) ◽

pp. 5-8

Author(s):

Aleksandra Lovrenski ◽

Milana Panjkovic ◽

Dragana Tegeltija ◽

Ljiljana Tadic-Latinovic ◽

Jelena Krcedinac

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Malignant Mesothelioma ◽

Lung Diseases ◽

Clinical Symptoms ◽

X Rays ◽

Malignant Cells ◽

Cytological Evaluation ◽

Low Sensitivity

Malignant mesothelioma is the most significant pleural tumour and it can be divided into three types: epithelial, sarcomatoid and biphasic mesothelioma. The most significant clinical manifestation of this tumour is pleural effusion. This paper was aimed at determining the role of cytological evaluation of pleural fluid in the diagnosis of malignant mesothelioma. This retrospective study included 33 medical records of patients with pleural malignant mesothelioma referred to the Institute for Lung Diseases of Vojvodina, in Sremska Kamenica in the period from 2004 to 2009. In 24 out of 33 patients, x-rays confirmed pleural effusion, thoracentesis was performed and specimens of effusion were cytologically examined at the Department of Pathology of the Institute for Lung Diseases of Vojvodina. Forty-nine cytological examinations were done. Only 2 of the first specimens were positive for malignant cells and 6 were suspicious. In repeated cytological examinations, 5 out of 6 initially suspicious specimens were positive for malignant cells, and the remaining 1 was negative. To sum up, 7 of 49 cytological examinations were positive and the sensitivity of our cytological study for the diagnosis of malignancy was 29%. Due to the low sensitivity of the cytological examinations, it has been recommended to perform biopsy of the pleura for definitive diagnosis in every patient with clinical symptoms and suspicious radiography.

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The Role of CD90 in the Differential Diagnosis of Pleural Malignant Mesothelioma, Pulmonary Carcinoma and Comparison with Calretının

Pathology & Oncology Research ◽

10.1007/s12253-016-0135-9 ◽

2016 ◽

Vol 23 (3) ◽

pp. 487-491 ◽

Cited By ~ 3

Author(s):

Nurhan Sahin ◽

Ayse Nur Akatli ◽

Muhammet Reha Celik ◽

Hakkı Ulutas ◽

Emine Turkmen Samdanci ◽

...

Keyword(s):

Differential Diagnosis ◽

Malignant Mesothelioma ◽

Pulmonary Carcinoma ◽

Pleural Malignant Mesothelioma

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P3.03-009 Role of microRNAs as Biomarkers of Malignant Mesothelioma in Patients with Pleural Effusion

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2016.11.1908 ◽

2017 ◽

Vol 12 (1) ◽

pp. S1348-S1349

Author(s):

Alessandro Palleschi ◽

Valentina Bollati ◽

Chiara Favero ◽

Carolina Mensi ◽

Claudia Bareggi ◽

...

Keyword(s):

Pleural Effusion ◽

Malignant Mesothelioma

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Microfilarae in malignant mesothelioma associated pleural effusion with blood microfilaremia: a rare association

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193300 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1349

Author(s):

Dinesh Chandra Sharma ◽

Deepanjali Sharma

Keyword(s):

Pleural Effusion ◽

Malignant Mesothelioma ◽

Wide Spectrum ◽

Peripheral Eosinophilia ◽

Rare Association ◽

Blood Smears ◽

Peripheral Blood Smears ◽

Eosinophil Counts ◽

Fluid Cytology

Filariasis has a wide spectrum of presentation and usually involves the lung in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association with filarial pleural effusion is extremely rare. In this context, we hereby report a case of 45 year old male who presented with right sided chest pain, cough, fever and generalized weakness. Pleural fluid cytology revealed microfilaria and pleural biopsies from pleural nodules confirmed malignant mesothelioma. Peripheral blood smears taken at night exhibited microfilaria with normal eosinophil counts, which is further uncommon. Role of filariasis in tumorigenesis is controversial.

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Clinical Value of Pulmonary Metastasectomy for Thyroid Malignancies: A Systematic Review

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v7i31.583 ◽

2019 ◽

Vol 7 (31) ◽

pp. 24-33

Author(s):

Yusuf Dundar ◽

Quinton Mandle ◽

Julia Samantray ◽

Jeffrey Hotaling ◽

Syed Rizvi ◽

...

Keyword(s):

Systematic Review ◽

Surgical Complication ◽

Pulmonary Metastasectomy ◽

R0 Resection ◽

Clinical Value ◽

Clinical Role ◽

Systematic Lymphadenectomy ◽

Younger Age ◽

Thyroid Malignancies

Background:There is currently no consensus on the role of pulmonary metastasectomy(PM) for thyroid malignancies. The main objective of this study is therefore to systematically determine if there is any survival benefit to PM and determine good candidates for metastasectomy. Methods: A systematic review of relevant studies was performed, evaluating articles identified using the PubMed, Cochrane and MEDLINE databases according to PRISMA-guidelines. Results:The initial literature search yielded 18 articles of which 7 met inclusion criteria. Only data on thyroid cancers were included in the systematic review. A total of 174 patients who underwent PM were analyzed. The mean age was 54.8(range: 10-90), and 52.5% of patients were female. The overall absolute 5-year survival rate was 67.7% (range: 32.5-84.0%) for patients undergoing PM. The reported post-surgical complication rate overall was 14.4% and two peri-operative deaths were reported. Three papers reported the following as good prognostic factors: Papillary histology, younger age(<45), disease free interval>3 years, R0 resection, systematic lymphadenectomy, thyroglobulin <10 ng and thyroglobulin reduction >80% after metastasectomy. Conclusion:This study is the first systematic review evaluating the clinical role of PM for thyroid cancer in the literature to date. PM may offer prolonged survival over traditional therapy for selected patients.

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