Identification of Pleural Effusion with Low Levels of Adenosine Deaminase but Without Signs of Acute Inflammation or Pleural Thickening to Diagnose Early Malignant Pleural Mesothelioma

We herein report two cases of malignant pleural mesothelioma with marked lymphangiosis. The patients included a 68-year-old man and a 67-year-old man who both had a history of exposure to asbestos. Computed tomography (CT) on admission showed pleural effusion with pleural thickening. In both cases, a histopathological examination of the pleura confirmed the diagnosis of epithelioid malignant mesothelioma. They received chemotherapy, but the treatment was only palliative. The chest CT assessments during admission revealed marked pleural effusion and mediastinal lymphadenopathy. CT also showed a consolidative mass with bronchovascular bundle and septal thickening in the lungs suggesting pulmonary parenchymal involvement and the lymphangitic spread of the tumor. These CT findings mimicked lung cancer with pleuritis and lymphangitic carcinomatosis. Autopsy was performed in both cases. Macroscopically, the tumor cells infiltrated the lung with the marked lymphatic spread of the tumor. Microscopy also revealed that the tumor had invaded the pulmonary parenchyma with the marked lymphatic spread of the tumor. Although this growth pattern is unusual, malignant pleural mesothelioma should be considered as the differential diagnosis, especially in patients with pleural lesions.

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Adenosine Deaminase in Pleural Effusion and Its Relationship with Clinical Parameters in Patients with Malignant Pleural Mesothelioma

Cancer Investigation ◽

10.1080/07357907.2020.1776313 ◽

2020 ◽

Vol 38 (6) ◽

pp. 356-364

Author(s):

Yasuhiro Nakajima ◽

Kozo Kuribayashi ◽

Hirotoshi Ishigaki ◽

Akio Tada ◽

Yoshiki Negi ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Malignant Pleural Mesothelioma ◽

Pleural Mesothelioma ◽

Clinical Parameters

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A review of malignant pleural mesothelioma in a large North East UK pleural centre

Pleura and Peritoneum ◽

10.1515/pp-2020-0144 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Declan C. Murphy ◽

Alexander Mount ◽

Fiona Starkie ◽

Leah Taylor ◽

Avinash Aujayeb

Keyword(s):

Malignant Pleural Mesothelioma ◽

Survival Rates ◽

Case Series ◽

Pleural Mesothelioma ◽

Retrospective Case ◽

Pleural Thickening ◽

North East ◽

Total Cohort ◽

Anti Cancer ◽

One Year

AbstractObjectivesThe National Mesothelioma Audit 2020 showed Northumbria to have low rates of histopathological confirmation, treatment and one-year survival rates for malignant pleural mesothelioma (MPM). We hypothesized that an internal analysis over a 10-year period provides valuable insights into presentation, diagnosis, treatment and outcomes.MethodsA single-centre retrospective case series of all confirmed MPM patients between 1 January 2009 and 31 December 2019 was performed. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Statistical analysis was performed using SPSS V26.0.ResultsA total of 247 patients had MPM. About 86% were male, mean age 75.7 years. Dyspnoea (77.4%) and chest pain (38.5%) were commonest symptoms. 64.9 and 71.4% had pleural thickening and effusion, respectively. About 86.8% had at least one attempt to obtain a tissue biopsy, but histopathological confirmation in only 108 (43.7%). About 66.3% with PS 0 and 1 (62.7% of total cohort) had at least one anti-cancer therapy. Death within 12 months was associated with disease progression within 6 months (p≤0.001). Chemotherapy (p≤0.001) and epithelioid histological subtype (p=0.01) were protective.ConclusionsThis study confirms known epidemiology of MPM, demonstrates variability in practices and highlights how some NMA recommendations are not met. This provides the incentive for a regional mesothelioma multi-disciplinary meeting.

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Clinical Significance Of Pleural Effusion Mesothelin In Malignant Pleural Mesothelioma

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1575 ◽

2012 ◽

Author(s):

Shusai Yamada ◽

Chiharu Tabata ◽

Rie Tabata ◽

Kazuya Fukuoka ◽

Takashi Nakano

Keyword(s):

Pleural Effusion ◽

Clinical Significance ◽

Malignant Pleural Mesothelioma ◽

Pleural Mesothelioma

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The relation of the pleural thickening in tuberculosis pleurisy with the activity of adenosine deaminase

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2005.646 ◽

2005 ◽

Vol 63 (2) ◽

Cited By ~ 2

Author(s):

B. Uskul ◽

H. Turker ◽

C. Ulman ◽

M. Ertugrul ◽

A. Selvi ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Clinical Findings ◽

X Rays ◽

Biochemical Tests ◽

Pleural Thickening ◽

Group I ◽

Immunological Mechanisms ◽

Tuberculosis Pleurisy

Selvi, A. Kant, S. Arslan, M. Ozgel. Background: Residual pleural thickening (RPT) still occurs in most patients with tuberculosis pleurisy despite advances in the treatment of tuberculosis. The aim of this study was to evaluate the significance of RPT in tuberculosis pleurisy with the patients clinical findings, biochemical and microbiological properties of pleural effusion and with the total adenosine deaminase (ADA) and isoenzymes levels. Methods: 121 tuberculosis pleurisy patients were evaluated retrospectively. According to posteroanterior chest x-rays, the 63 (52%) cases with the thickness 2 mm or more in lower lateral hemithorax were grouped as I and the 58 (48%) cases without pleural thickness were grouped as II. The amount of pleural effusion was classified into small, medium or massive according to their chest x-rays. In both groups; sex, age, symptoms score, bacteriological and biochemical tests and ADA levels were recorded. Results: 81 (67%) male and 40 (33%) female, overall 121 patients were enrolled into the study. RPT was found higher in males (p=0.014) and the increase ran parallel with the amount of cigarette smoking (p=0.014). RPT was found to be lower in small effusions (p=0.001). The group with RPT, the serum albumin was found lower (p=0.002), pleural fluid total protein (p=0.047) and the ratio of pleural fluid protein to serum protein (p=0.002) were found higher. In group I, total ADA: 69.5±38.9 IU/L and ADA2: 41.3±31.6 IU/L were higher than the cases without RPT (p=0.032, p=0.017, respectively). Conclusions: We suggest that the immunological mechanisms are effective in the development of pleural thickening.

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