scholarly journals Histiocytic pleural effusion: The strong clue to malignancy

2021 ◽  
Author(s):  
Ganghee Chae ◽  
Jae-Bum Jun ◽  
Hwa Sik Jung ◽  
Chui Yong Park ◽  
Jin Hyoung Kim ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Malignant Pleural Effusion ◽  
Clinical Characteristics ◽  
Malignant Disease ◽  
White Blood Cells ◽  
University Hospital ◽  
Lung Cancers ◽  
Fluid Analysis ◽  
Tuberculous Pleurisy

Abstract Background There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. Methods In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of ≥ 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged > 18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. Results Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. Conclusions The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.

scholarly journals Histiocytic pleural effusion: the strong clue to malignancy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ganghee Chae ◽  
Jae-Bum Jun ◽  
Hwa Sik Jung ◽  
Chui Yong Park ◽  
Jin Hyoung Kim ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Malignant Pleural Effusion ◽  
Clinical Characteristics ◽  
Malignant Disease ◽  
White Blood Cells ◽  
University Hospital ◽  
Lung Cancers ◽  
Fluid Analysis ◽  
Tuberculous Pleurisy

Abstract Background There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. Methods In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of ≥ 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. Results Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. Conclusions The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.

scholarly journals Total Protein–Chloride Ratio in Pleural Fluid Independently Predicts Overall Survival in Malignant Pleural Effusion at the First Diagnosis

2022 ◽  
Vol 11 ◽  
Author(s):  
Xin Qiao ◽  
Zhi-Rong Zhang ◽  
Xin-Yu Shi ◽  
Feng-Shuang Yi
Keyword(s):  
Overall Survival ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Total Protein ◽  
Malignant Pleural Effusion ◽  
Univariate Analysis ◽  
White Blood Cells ◽  
Neuron Specific Enolase ◽  
Clinicopathologic Characteristics ◽  
Pre Treatment

ObjectivePre-treatment biomarkers to estimate overall survival (OS) for malignant pleural effusion (MPE) are unidentified, especially those in pleural fluid. We evaluated the relationship between OS and total protein–chloride ratio in malignant pleural effusion (PE TPClR).Materials and MethodsA retrospective study was undertaken to identify patients from 2006 to 2018 who had pathologically or cytologically confirmed MPE and received no tumor-targeted therapy. We recorded the pre-treatment clinicopathologic characteristics and follow-up status. OS was estimated by the Kaplan–Meier method, and the association between variables and OS was evaluated by Cox proportional hazards models.ResultsWe screened 214 patients who met the eligibility criteria. The optimal cutoff value for the PE TPClR was set at 0.53. The univariate analysis showed that there was a significant correlation between PE TPClR and OS (P < 0.001). The multivariate analysis between OS and the variables selected from the univariate analysis showed that the levels of neutrophil, alkaline phosphatase, neuron-specific enolase, platelets, albumin in peripheral blood, and white blood cells in pleural effusion were also independent predictors of OS.ConclusionIn patients with MPE, pre-treatment PE TPClR independently predicts OS. Although further research is necessary to generalize our results, this information will help clinicians and patients to determine the most appropriate treatment for MPE patients.

Enhanced diagnosis in suggested malignant pleural effusion using combined modality of genetic and biochemical tumor markers

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17137-17137
Author(s):  
J. Chang
Keyword(s):  
Lung Cancer ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Tumor Markers ◽  
Sensitivity And Specificity ◽  
Malignant Pleural Effusion ◽  
Primary Lung Cancer ◽  
Molecular Diagnostic ◽  
Control Group ◽  
Tuberculous Pleurisy

17137 Background: Cancer is influenced by oncogenes and tumor suppressor genes. Several tumor markers have been applied clinically in malignancy. A malignant pleural effusion may be an initial presentation of cancer and the presence of malignancy is confirmed by pleural cytology and biopsy. However, other diagnostic modalities are limited and not defined clearly, especially in cases of negative results from traditional diagnostic tool. Here, I investigated p53 and FHIT mutations and microsatellite alterations(MA) in the pleural effusion associated with malignancy(ME). Also, the diagnostic values of CEA, NSE, and CYFRA 21–1 as markers of malignant pleural effusion in lung cancer were assessed together. Methods: The genetic analyses of pleural fluid were done in 40 patients with ME and in the pleural fluid of 17 patients with tuberculous pleurisy(TB) as a control group. Levels of CEA, NSE, and CYFRA 21–1 were measured by immunoassay in the serum and pleural fluid of 34 patients with primary lung cancer and of 16 patients with TB. Results: p53 mutations were detected in 13% of ME and 0% of TB, and FHIT mutations were detected in 18% of ME and 12% of TB. Among 4 microsatellite markers; D3S1234, D3S1285, D9S171, and TP53, loss of heterozygosity(LOH) and microsatellite instability(MI) were observed for each group. MA including LOH and MI in at least one marker was seen 63% of ME cases vs. 35% of TB cases. Patients with lung cancer were found to have significantly higher serum and pleural fluid levels of CEA and CYFRA 21–1 than patients with tuberculous pleurisy. Using cut-off values of 5 ng/ml, 20 ng/ml, and 45 ng/ml for pleural fluid CEA, NSE, and CYFRA 21–1, the sensitivities and specificities were as follows: CEA; 82% and 94%, NSE; 36% and 94%, and CYFRA 21–1; 61% and 81%. A combination of pleural fluid CEA and NSE increased sensitivity and specificity. Conclusions: Although still limited in terms of sensitivity and specificity, this study shows that the determinations of CEA and NSE in pleural fluid enhance diagnostic yield better than all the other combination of tumor markers in malignant pleural effusion, especially in lung cancer and molecular diagnostic strategies including microsatellite alterations are possibly applied for the diagnosis of malignant effusion. No significant financial relationships to disclose.

scholarly journals Pancreatico‑pleural Fistula: Case Series

2018 ◽  
Vol 09 (01) ◽  
pp. 026-031 ◽  
Author(s):  
Manoj Munirathinam ◽  
Pugazhendhi Thangavelu ◽  
Ratnakar Kini
Keyword(s):  
Magnetic Resonance ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Case Series ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Fluid Analysis ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Acute And Chronic Pancreatitis ◽  
Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

Pleural Fluid Analysis in Chylous Pleural Effusion

CHEST Journal ◽  
2008 ◽  
Vol 133 (6) ◽  
pp. 1436-1441 ◽  
Author(s):  
Vishal Agrawal ◽  
Peter Doelken ◽  
Steven A. Sahn
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Fluid Analysis ◽  
Chylous Pleural Effusion

scholarly journals CEA and ADA in Pleural Fluid for Differential Malignant Pleural Effusion and Tuberculous Pleural Effusion

2021 ◽  
Author(s):  
Jianhong Yu ◽  
Qirui Cai
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Roc Curve ◽  
Malignant Pleural Effusion ◽  
Diagnostic Value ◽  
Diagnostic Model ◽  
Diagnostic Efficacy ◽  
Tuberculous Pleural Effusion ◽  
Diagnostic Models ◽  
Independent Risk Factors

Abstract Objective This study aimed to establish a predictive model based on the clinical manifestations and laboratory findings in pleural fluid of patients with pleural effusion for the differential diagnosis of malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE). Methods Clinical data and laboratory indices of pleural fluid were collected from patients with malignant pleural effusion and tuberculous pleural effusion in Zigong First People's Hospital between January 2019 and June 2020，and were compared between the two groups. Independent risk factors or Independent protective factors for malignant pleural effusion were investigated using multivariable logistic regression analysis. Receiver operating characteristic curve (ROC) analysis was performed to assess the diagnostic performance of factors with independent effects, and combined diagnostic models were established based on two or more factors with independence effect. ROC curve was used to evaluate the diagnostic ability of each model, and the fit of the eath model was measured using Hosmer-Lemeshow goodness-of-fit test. Results Patients with MPE were older than those with TPE, the rate of fever of patients with MPE was lower than that of patients with TPE, and these differences were statistically significant (p < 0.05). Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin-19 fragment antigen (CYFRA21-1), cancer antigen 125 (CA125), and glucose (GLU) levels in the pleural fluid were higher, but total protein (TP), albumin (ALB) and Adenosine deaminase (ADA) levels in the pleural fluid were lower in MPE patients than in TPE patients, and the differences were statistically significant (P<0.05). In multivariate logistic regression analysis, CEA and NSE levels in the pleural fluid were independent risk factors for MPE, whereas ADA levels in pleural fluid and fever were independent protective factors for MPE. The differential diagnostic value of pleural fluid CEA and pleural fluid ADA for MPE and TPE were higher than that of pleural fluid NSE（p<0.05） and the area under the ROC curve was 0.901, 0.892, and 0.601, respectively. Four different binary logistic diagnostic models were established based on pleural fluid CEA combined with pleural fluid NSE, pleural fluid ADA or ( and ) fever. Among them, the model established with the combination of pleural fluid CEA and pleural fluid ADA (logit (P) = 0.513 + 0.457*CEA-0.101*ADA) had the highest diagnostic value for malignant pleural effusion, and its predictive accuracy was high with an area under the ROC curve of 0.968 [95% confidence interval (0.947, 0.988)]. But the diagnostic efficacy of the diagnostic model could not be improved by adding pleural fluid NSE and fever. Conclusion The model established with the combination of CEA and ADA in the pleural fluid has a high differential diagnostic value for malignant pleural effusion and tuberculous pleural effusion, and NSE in the pleural fluid and fever cannot improve the diagnostic efficacy of the diagnostic model.

scholarly journals Release of growth factors after mechanical and chemical pleurodesis for treatment of malignant pleural effusion: a randomized control study

2015 ◽  
Vol 49 (4) ◽  
pp. 386-394 ◽  
Author(s):  
Aljaz Hojski ◽  
Maja Leitgeb ◽  
Anton Crnjac
Keyword(s):  
Quality Of Life ◽  
Growth Factors ◽  
Growth Factor ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Malignant Pleural Effusion ◽  
Transforming Growth Factor ◽  
Chemical Pleurodesis ◽  
Thoracic Drainage

Abstract Background. Growth factors are key inducers of fibrosis but can also mediate inflammatory responses resulting in increasing pleural effusion and acute respiratory distress syndrome. The primary aim of the study was to analyse growth factors release after performing chemical and mechanical pleurodesis in the first 48 hours at the patients with malignant pleural effusion. The secondary endpoints were to evaluate the effectiveness of the both pleurodeses, symptoms release and the quality of life of patients after the treatment. Patients and methods. A prospective randomized study included 36 consecutive female patients with breast carcinoma and malignant pleural effusion in an intention-to-treat analysis. We treated 18 patients by means of thoracoscopic mechanical pleurodesis and 18 patients by chemical pleurodesis with talcum applied over a chest tube. We gathered the pleural fluid and serum samples in the following 48 hours under a dedicated protocol and tested them for growth factors levels. A quality of life and visual analogue pain score surveys were also performed. Results. Median measured serum vascular endothelial growth factor (VEGF) level after chemical pleurodesis was 930.68 pg/ml (95% CI: 388.22–4656.65) and after mechanical pleurodesis 808.54 pg/ml. (95% CI: 463.20-1235.13) (p = 0.103). Median pleural levels of transforming growth factor (TGF) β1 were higher after performing mechanical pleurodesis (4814.00 pg/ml [95% CI: 2726.51–7292.94]) when compared to those after performing chemical pleurodesis (1976.50 pg/ml [95% CI: 1659.82–5136.26]) (p = 0.078). We observed similar results for fibroblast growth factor (FGF) β; the serum level was higher after mechanical pleurodesis (30.45 pg/ml [95% CI: 20.40–59.42]), compared to those after chemical pleurodesis (13.39 pg/ml [95% CI: 5.04 – 74.60]) (p = 0.076). Mechanical pleurodesis was equally effective as chemical pleurodesis in terms of hospital stay, pleural effusion re-accumulation, requiring of additional thoracentesis, median overall survival, but, it shortened the mean thoracic drainage duration (p = 0.030) and resulted in a higher symptoms release and in a better quality of life (p = 0.047). Conclusions. We recorded an increase in serum VEGF levels after chemical pleurodesis, however on the contrary, an increase in the pleural fluid level of TGFβ1 and FGFβ] after mechanical pleurodesis with respect to compared group. Although the differences did not reach statistical significance, VEGF, TGFβ1 and FGFβ remain the most interesting parameters for future research. Considering the mechanisms of growth factors action, we conclude that in our study group mechanical pleurodesis might be more efficient in terms of growth factors release, thoracic drainage duration and resulted in a higher symptoms release and in a better quality of life than chemical pleurodesis.

Pleural Effusion

Chest Imaging ◽  
2019 ◽  
pp. 165-170
Author(s):  
Christopher M. Walker
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Lateral Displacement ◽  
Pleural Space ◽  
Gravitational Effects ◽  
Pleural Thickening ◽  
Air Bubble ◽  
Fluid Analysis ◽  
Exudative Pleural Effusion

Pleural effusion discusses the radiographic and computed tomography (CT) manifestations of this entity. Pleural effusion is classified based on pleural fluid analysis using Light’s criteria: transudative and exudative. Free pleural fluid collects in the most dependent aspect of the pleural space due to gravitational effects. It exhibits a meniscus configuration on upright chest radiography. Pleural effusion in a supine or semiupright patient is more difficult to identify but may be suspected in cases with a homogeneous or gradient-like opacity over the lower hemithorax, elevation of the hemidiaphragm contour, or an apical cap. Subpulmonic pleural effusion manifests with lateral displacement of the apex of the ipsilateral hemidiaphragm contour and increased distance between the gastric air bubble and pseudodiaphragmatic contour. Exudative pleural effusion should be suspected in cases with CT findings of pleural thickening, enhancement, septations, and/or loculations.

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