Pleural Neoplasms

Pleural neoplasms discusses the radiographic and computed tomography (CT) manifestations of primary and secondary pleural neoplasms. Four CT features suggest malignant pleural thickening including nodular pleural thickening, circumferential pleural thickening, pleural thickening measuring greater than 1 cm in thicknesss, and thickening of the mediastinal pleural surface. The most common pleural malignancy is metastatic disease, generally from adenocarcinomas of the lung, breast, or gastrointestinal tract. Thymoma may spread to the pleura via direct extension or drop metastases. Mesothelioma is uncommon but is the most common primary pleural malignancy and is almost universally associated with asbestos exposure. It manifests with rind-like pleural thickening which may involve interlobar fissures and often causes volume loss in the affected hemithorax. Localized fibrous tumor of the pleura usually arises from the visceral pleural surface and manifests as a lobular or smooth pleural mass usually in the mid or lower hemithorax.

Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms

Context.— A vast majority of neoplasms arising from lung or pleura are initially diagnosed based on the histologic evaluation of small transbronchial, endobronchial, or needle core biopsies. Although most diagnoses can be determined by morphology alone, immunohistochemistry can be a valuable diagnostic tool in the workup of problematic cases. Objective.— To provide a practical approach in the interpretation and immunohistochemical selection of lung/pleura–based neoplasms obtained from small biopsy samples. Data Sources.— A literature review of previously published articles and the personal experience of the authors were used in this review article. Conclusion.— Immunohistochemistry is a useful diagnostic tool in the workup of small biopsies from the lung and pleura sampled by small biopsy techniques.