Malignant pleural effusion in multiple myeloma: a case report / Derrame pleural malign em mieloma múltiplo: relato de caso

Multiple myeloma (MM) is a malignant neoplasm of monoclonal plasma cells that accumulate in bone marrow (BM). Malignant pleural effusions (MPE), as part of multiple myeloma clinical presentation, are unusual. Is even more rare as the first sign of presentation, occurring in less than 1% of the cases. The most common associated immunoglobulin with malignant pleural effusions is IgA subtype (80%). This condition carry a poor prognosis. We aim to describe a refractory case of multiple myeloma with extensive disease that presented with extramedullary relapse with malignant pleural effusions , besides discussing the importance of differential diagnosis.

O mieloma múltiplo (MM) é uma neoplasia maligna de células plasmáticas monoclonais que se acumulam na medula óssea (MO). Os derrames pleurais malignos (EPM), como parte da apresentação clínica do mieloma múltiplo, são incomuns. É ainda mais raro como primeiro sinal de apresentação, ocorrendo em menos de 1% dos casos. A imunoglobulina associada mais comum a derrames pleurais malignos é o subtipo IgA (80%). Esta condição carrega um mau prognóstico. Nosso objetivo é descrever um caso refratário de mieloma múltiplo com doença extensa que apresentou recidiva extramedular com derrame pleural maligno, além de discutir a importância do diagnóstico diferencial

Talco estéril versus yodopovidona en pleurodesis como tratamiento del derrame pleural maligno. Estudio prospectivo no aleatorizado / Sterile talc versus povidone-iodine in pleurodesis as a treatment for malignant pleural effusion. Non-randomized prospective study

Comparar el uso del talco estéril versus yodopovidona como agentes químicos en pleurodesis para el tratamiento del derrame pleural maligno.Materiales y Métodos: Estudio clínico, analítico, observacional, prospectivo, el cual incluyó 12 pacientes con diagnóstico clínico e histopatológico de derrame pleural maligno, a quienes se les practicó pleurodesis empleando talco estéril y yodopovidona.Resultados : Edad promedio fue de 46,25 ± 17,3 y la neoplasia primaria más común fue el cáncer de mama, representando el 50% de los casos estudiados. El grupo de pacientes tratados con yodopovidona tuvo 100% de efectividad en la fusión pleural posterior a la pleurodesis, y presentaron menos complicaciones durante el procedimiento y 24 horas posteriores al mismo con respecto al grupo tratado con talco estéril, el cual tuvo un 71,4% de efectividad y un 28,6% de falla al procedimiento; asimismo, estos últimos presentaron mayor porcentaje de complicaciones. Por otra parte, no se evidenció recidiva del derrame pleural en los 30 días de valoración posteriores al procedimiento. Estas diferencias no fueron estadísticamente significativas.Conclusiones : Ambos agentes esclerosantes fueron eficaces para lograr la fusión de las pleuras en pacientes con derrame pleural maligno, siendo el talco estéril el agente con mayor tendencia a producir complicaciones y fallo del procedimiento, en comparación a la yodopovidona(AU)

To compare the use of sterile talc versus povidone-iodine as chemical agents on pleurodesis for the treatment of malignant pleural effusion.Materials and Methods : A total of 12 patients with clinical and histopathologic diagnose of malignant pleural effusion were enrolled in a clinical, analytic, observational and prospective trial, to whom sterile talc and povidone-iodine pleurodesis was applied.Results : The mean age was 46,25 ± 17,3 and the most common primary neoplasm was breast cancer, which was present in 50% of the surveyed cases. The group of patients who received povidone-iodine had 100% of effectiveness on post-pleurodesis pleural fusion, and had fewer complications during the procedure and 24 hours afterwards vis-à-vis the group who received sterile talc powder, which had 74.4% of effectiveness and 28.6% of procedure failure; furthermore, the last mentioned had higher percentage of complications. Moreover, there was no evidence of recurrence of pleural effusion in the 30 days post-procedure assessment.Conclusions : Both sclerosant agents were efficient to accomplish pleural fusion in patients with malignant pleural effusion, with sterile talc being the agent with higher tendency to generate more complications and procedure failure compared to povidone-iodine(AU)

Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion / Exactitud de la biopsia pleural cerrada para el diagnóstico de derrame pleural maligno

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

RESUMEN Objetivo: Estudios previos demuestran que la biopsia pleural cerrada (BPC) para diagnóstico de malignidad tiene una sensibilidad menor al 60%, por lo que recientemente ha despertado controversia su valor como prueba diagnóstica. Nuestro objetivo fue evaluar la exactitud de la BPC para diagnóstico de malignidad en pacientes con derrame pleural. Métodos: Estudio prospectivo de 8 años en individuos que se sometieron a la realización de BPC para establecer la etiología del derrame. La información de cada paciente se tomó de los registros de anatomopatología y del expediente clínico. Cuando el resultado de la BPC demostró malignidad o tuberculosis, esto se tomó como biopsia diagnóstica y quedó éste como diagnóstico definitivo. En los casos en que el resultado del estudio histopatológico de la biopsia resultó inespecífico, el diagnóstico definitivo se estableció en base a otros procedimientos diagnósticos, como toracoscopia, toracotomía, fibrobroncoscopia, estudio bioquímico y celular del líquido pleural y/o pruebas microbiológicas. Mediante una tabla de contingencia de 2 × 2 se midieron los indicadores para una prueba diagnóstica. Resultados: Se estudiaron 1034 biopsias de pacientes con derrame pleural, de las cuales se excluyeron 171 (16.54%) por muestra inadecuada o información insuficiente. El desempeño para malignidad fue: sensibilidad, 77%; especificidad, 98%; valores predictivos positivo y negativo, 99% y 66%, respectivamente; índices de probabilidad positivo y negativo, 38.5 y 0.23, respectivamente; probabilidad antes y después de la prueba, 2.13 y 82, respectivamente. Conclusión: La BPC es útil como prueba diagnóstica en la práctica clínica, debido a que produce un cambio importante de la probabilidad antes de la prueba a la probabilidad después de la prueba.

A Case of Salivary-Type Amylase-Producing Multiple Myeloma Presenting as Mediastinal Plasmacytoma and Myelomatous Pleural Effusion

No abstract available.

Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico / Clinical and pathological factors influencing the survival of breast cancer patients with malignant pleural effusion

OBJETIVO: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. MÉTODOS: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. RESULTADOS: Das 145 pacientes avaliadas, 87 (60%) apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82%) apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%), as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80%) evoluíram a óbito durante o período de seguimento (até junho de 2011). A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. CONCLUSÕES: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor.

OBJECTIVE: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. METHODS: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related to the pleural metastasis. RESULTS: We evaluated 145 patients, 87 (60%) of whom had tested positive for malignant cells in the pleural fluid. Ductal histology was observed in 119 (82%). The triple-negative breast cancer phenotype was seen in 25 cases (17%). Those patients had the worst prognosis (with a sharp decline in the survival curve), and 20 of the 25 (80%) died during the follow-up period (through June of 2011). The mean survival after the identification of malignant pleural effusion was 6 months. CONCLUSIONS: In patients with triple-negative breast cancer who test positive for malignant cells in the pleural fluid, the prognosis is poor and survival is reduced.

impact of repeated thoracentesis on the outcome of chemical pleurodesis in malignant pleural effusion

Repeated thoracentesis may cause pleural inflammation and induce local release of proinfammatory cytokine as tumor necrosis factor-alpha [TNF-alpha] which may subsequently enhance the release of plasminogen activator inhibitor-1 [PAI-1] and lead to fibrin formation in malignant effusion. The presence of fibrin strands after repeated thoracentesis may be of considerable value in predicting the success of subsequent pleurodesis in patients with malignant pleural effusions [MPEs]. So, the aim of this work is to study the impact of repeated thoracentesis on the outcome of chemical pleurodesis in MPE. This is a retrospective study included 116 patients with MPE, they were diagnosed finally by pleural fluid [PF] cytology and/or either computed tomography [CT]-guided biopsy or tissue biopsy [Abram's or thoracoscopic biopsy]. These patients were admitted and subjected to the following: a] Pleural tapping and the aspirated fluid was sent for chemical, cytological and bacteriological examinations for determination of the inclusion criteria, [b] Tube thoracostomy insertion, [c] Pleurodesis, and assessment of the response to pleurodesis was done once after 30 days and another after 60 days. Regarding pleurodesis success or failure in this work, there was statistically highly significant decrease in the duration of chest tube before pleurodesis in patients with successful pleurodesis than that in patients with failed one. But, statistically non-significant decrease was observed in the duration of chest tube after pleurodesis in patients with successful pleurodesis than that in patients with failed one. There was statistically significant negative correlation between the number of pleural fluid [PF] aspiration and the duration of chest tube after pleurodesis and statistically nonsignificant negative correlation between the number of PF aspiration and the duration of chest tube before pleurodesis. Also, to predict the success of the pleurodesis, after 30 days of pleurodesis with cut-point of PF aspiration number >7 times, sensitivity and specificity were 75.3% and 65.7% respectively and after 60 days of pleurodesis, also, at cut-point of PF aspiration number >7 times, sensitivity of 80.3% was higher than that after 30 days of pleurodesis and specificity of 64.4% which was near that after 30 days of pleurodesis. Repeated thoracentesis may be of considerable value in predicting the success of subsequent chemical pleurodesis in MPE. Repeated thoracentesis of MPE >7 times has good sensitivity, but low specificity in predicting success of subsequent chemical pleurodesis. Measurement of PF glucose levels and PF cytology provide information about the outcome of chemical pleurodesis in MPE

Videotoracoscopía en cáncer de ovario avanzado con sospecha de compromiso torácico / Video-assisted thoracoscopy in advanced ovarian cancer with a probable thoracic involvement

Objetivo: Evaluar la experiencia con videotoracoscopía en pacientes con sospecha de cáncer de ovario avanzado con probable compromiso del tórax. Método: Se analiza las pacientes con sospecha clínica e imagenológica de cáncer de ovario avanzado que presentan derrames pleurales moderado y severo, así como procesos tumorales torácicos para evaluar la posibilidad de citorreducción óptima o completa. Todos los casos sometidos a este procedimiento entre enero de 2009 a Agosto de 2011, son analizados con énfasis en el diagnóstico y en los hallazgos a la videotoracoscopía, así como sus resultados. Resultados: 11 pacientes con clínica y tomografía axial computarizada de tórax sospechoso de compromiso pleural o pulmonar, son sometidas al procedimiento previo al intento de citorreducción abdominopélvica. La edad promedio fue de 62 años y Ca 125 promedio de 1030 U/ml. En 6 pacientes se encontró enfermedad macroscópica pleural, la biopsia fue positiva para adenocarcinoma en 5. Dos de ellas se consideraron no citorreducible en abdomen y se indicó neoadyuvancia. La tercera se citorredujo en forma óptima. En 2 pacientes se indicó neoadyudancia por tener residuo tumoral torácico mayor a 1 cm, consideradas citorreducibles en abdomen. De las 6 pacientes sin enfermedad torácica, 4 se citorredujeron óptimamente, una falleció previo a la cirugía abdominal y otra resultó un tumor ovárico benigno. Conclusión: La videotoracoscopía es útil para evaluar enfermedad torácica y tomar decisiones en relación a la citorreducción abdominal o neoadyuvancia en cáncer avanzado de ovario.

Objective: To describe the experience with video-assisted thoracic evaluation in patients with suspected advanced ovarian cancer with a probable thoracic involvement. Method: Patients with clinical and imaging suspicion of advanced ovarian cancer who have pleural effusions, and thoracic tumor processes are examined to evaluate the possibility of optimal debulking. All cases that underwent this procedure between January 2009 to August 2011, were studied with emphasis on diagnosis, results and findings at videotho-racoscopy. Results: 11 patients with a suspected thoracic commitment, with clinical and computerized axial tomography scan, undergo the procedure previous to an abdominopelvic cytoreductive surgery attempt. The average age was 62 years and CA 125 of 1030 U/ml average. Macroscopic pleural disease was found in 6 patients, but in 5 of them the biopsy gave positive for adenocarcinoma. Two of them were not considered for a cytoreductive surgery in the abdomen and neoadjuvant therapy was indicated. The third patient of the 5 previously mentioned, underwent an optimal cytoreduction. In 2 patients, neoadjuvant therapy was indicated for having residual tumor in the thorax greater than 1 cm, although they were considered for a cytoreductive surgery in the abdomen. Of the 6 patients without chest involvement, 4 underwent an optimal cytoreductive surgery, and one died before the abdominal surgery and the other had a benign ovarian tumor. Conclusion: Videothoracoscopy is useful for diagnosing thoracic metastasis and making decisions regarding cytoreduction and neoadjuvant therapy in advanced ovarian cancer.

Subtle Pleural Metastasis without Large Effusion in Lung Cancer Patients: Preoperative Detection on CT

OBJECTIVE: We wanted to describe the retrospective CT features of subtle pleural metastasis without large effusion that would suggest inoperable lung cancer. MATERIALS AND METHODS: We enrolled 14 patients who had open thoracotomy attempted for lung cancer, but they were proven to be inoperable due to pleural metastasis. Our study also included 20 control patients who were proven as having no pleural metastasis. We retrospectively evaluated the nodularity and thickening of the pleura and the associated pleural effusion on the preoperative chest CT scans. We reviewed the histologic cancer types, the size, shape and location of the lung cancer and the associated mediastinal lymphadenopathy. RESULTS: Subtle pleural nodularity or focal thickening was noted in seven patients (50%) having pleural metastasis and also in three patients (15%) of control group who were without pleural metastasis. More than one of the pleural changes such as subtle pleural nodularity, focal thickening or effusion was identified in eight (57%) patients having pleural metastasis and also in three patients (15%) of the control group, and these findings were significantly less frequent in the control group patients than for the patients with pleural metastasis (p = 0.02). The histologic types of primary lung cancer in patients with pleural metastasis revealed as adenocarcinoma in 10 patients (71%) and squamous cell carcinoma in four patients (29%). The location, size and shape of the primary lung cancer and the associated mediastinal lymphadenopathy showed no significant correlation with pleural metastasis. CONCLUSION: If any subtle pleural nodularity or thickening is found on preoperative chest CT scans of patients with lung cancer, the possibility of pleural metastasis should be considered.

p53 Immunostaining in benign and malignant effusions

To evaluate p53 immunostaining as a marker of malignancy in pleural and peritoneal effusions and to compare the results with HE staining. Design: Pleural and peritoneal effusion samples were obtained from patients suffering from benign and malignant diseases. H and E staining and p53 immunostaining were performed on smears prepared from these samples. Setting: The samples were obtained from patients admitted in Mayo Hospital, Services Hospital, Gulab Devi Chest Hospital and Institute of Nuclear Medicine and Oncology [INMOL]. Subjects: One hundred cases having either pleural or peritoneal effusions were selected. Fifty of these cases were positive for malignant cells on H and E staining. Fifty cases contained only mesothelial cells. Main outcome measures: To compare the specificity and sensitivity of p53 immunostaining with HE stain as a diagnostic marker of malignancy. Out of the 50 malignant cases, 31 [62%] were found to be p53 positive. None of the benign cases showed positive staining. p53 was found to have a specificity of 100%, sensitivity of 62%, a positive predictive value of 100% and a negative predictive value of 72.4%. Conclusions: p53 is a highly specific and moderately sensitive marker of malignancy

Detection of Malignant Cells in Pleural Fluid or Ascites by CD44v8-10/CD44v10 competitive RT-PCR

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.

Frequência de adenocarcinomas em derrames cavitários / Frequency of adenocarcinomas in serious effusions

Objetivo. Identificação de freqüência de adenocarcinomas de diferentes sítios primários em derrames cavitários. Material e Métodos. Foram estudados 2.317 casos: 1.146 de derrame pleural (943 mulheres e 203 homens), 1.168 de ascite (727 mulheres e 441 homens) e três pericárdio (duas mulheres e um homem) e realizada análise retrospectiva dos prontuários dos pacientes e correlação dos achados clínico-laboratoriais. Resultados. Os sítios primários mais freqüentes em derrames pleurais foram: mama (N=586 - 51,1 por cento), pulmão (N=185 - 16,1 por cento: 102 homens e 83 mulheres), ovário (N=124 - 10,8 por cento); em ascites: estômago (N=473 - 40,5 por cento: 300 homens e 173 mulheres), ovário (N=306 - 26,2 por cento) e mama (N=83 - 7,1 por cento). Desses, 555 casos foram citologicamente positivos para malignidade em derrames pleurais, 541 em ascite e dois em pericárdio. Os sítios primários mais freqüentes em derrames pleurais citologicamente positivos foram: mama (N=288 - 51,9 por cento), pulmão (N=92, 16,6 por cento: 45 homens e 47 mulheres) e ovário (N=54, 9,7 por cento); e, em ascites: ovário (N=205 - 37,9 por cento), estômago (N=202, 37,3 por cento: 119 homens e 83 mulheres) e mama (N=31 - 6,8 por cento). Em 47 derrames pleurais (8,5 por cento) e 37 ascites (6,8 por cento), a origem dos adenocarcinomas persistiu indeterminada. Conclusão. As freqüências estabelecidas poderão, em associação e dados clínicos, orientar a investigação dos sítios primários de adenocarcinomas metastáticos.

Estudio del líquido pleural / Pleural fluid study

El líquido pleural es un filtrado capilar producido en la pleural parietal y que aumenta cuando se eleva la presión hidrostática; disminuye la coloidosmótica o se incrementa la permeabilidad de los capilares pleurales a consecuencia de procesos infecciosos, inflamatorios o tumorales. Los derrames pleurales se detectan semiológicamente y se confirman por exámenes de imágenes(radiografía, ecografía o tomografía) y por toracocentesis que es de utilidad en alrededor del 90 por ciento de los casos. El aspecto macroscópico del líquido obtenido por punción tiene cierto valor de orientación diagnóstica. Lo más importante es precisar si se trata de un exudado o de un transudado, lo que se logra casi siempre aplicando los criterios de Light. Criterios adicionales se obtienen determinando la concentración de colesterol. En casos particulares pueden ayudar al diagnóstico etiológico las determinaciones de glucosa, lactato amilasa, triglicéridos, adenosindeaminasa. etc. En términos generales, es conveniente realizar siempre un estudio citológico (células neoplásicas y leucocitos mono y polinucleares) y microbiológico (Gram, baciloscopia y cultivo). Ocacionalmente es conveniente disponer de un estudio histológico de biopsias pleurales. A pesar de todos los exámenes disponibles, hay casos en los que no se logra establecer un diagnóstico etiológico. La mayoría de los derrames pleurales curan espontáneamente pero deben ser estrictamente controlados

Cytological study of serous effusions with the aid of tumour markers.

Clinicocytological evaluation with the help of tumour markers was done in 25 cases presenting with serous effusions. The main aim was to differentiate between reactive mesothelial cells and malignant cells, type the tumour cells in effusions with the aid of tumour markers--carcino-embryonic antigen (CEA), epithelial membrane antigen (EMA), cytokeratin and vimentin. It was observed that immunocytochemistry has complemented conventional cytology in diagnosis of carcinoma specially in cases labelled as suspicious of malignancy. EMA was found to be the most reliable epithelial marker and very useful in differentiating carcinoma cells from reactive mesothelial cells.

Neoplasias malignas en efusiones pleurales peritoneales y pericardicas: aspectos citomorfológicos (1991-1996) / Malignant neoplasias un pleural peritoneal and pericardit effusiones: cytomorphologic aspects (1991-1996)

Se estudiaron 1530 citologías de efusiones pleurales, peritoneales y pericárdicas, procesadas en la Sección de Citopatología Instituto Anatomopatológico "J.A. O'Daly" de la Universidad Central de Venezuela. Se revisaron además las historias clínicas de los pacientes y se hizo correlación de los hallazgos citológicos con los histológicos. Se encontraron 107 efusiones neoplásicas predominando los derrames pleurales (61,68 por ciento), seguidos por los peritoneales (41,12 por ciento), y en proporción los pericárdicos (0,93 por ciento). El sexo femenino predominó en las lesiones metastásicas pleurales y peritoneales. Los adenocarcinomas pulmonares constituyeron la primera causa de efusión pleural, y los de ovario en la peritoneal. Con este procedimiento se evidenció una alta sensibilidad y especificidad. Los resultados sugieren que el estudio de las efusiones constituye una herramienta diagnóstica en el estudio de un paciente con neoplasia de primario conocido o desconocido

Comparison of pleural fluid cytology and pleural biopsy in the evaluation of pleural effusion.

Pleural fluid cytology and pleural biopsy results were studied in 65 cases of pleural effusion. The efficacy of pleural biopsy in diagnosis of neoplastic and non-neoplastic pleural diseases was compared. Of the 24 cases with confirmatory evidence of cancer, 17(70.8%) has positive cytologic findings in pleural fluid, whereas pleural biopsy was diagnostic in only 13 cases (54.1%). For non-malignant pleural effusion in 41 cases 40(97.5%) has a definite diagnosis (tuberculous pleuritis, acute fibrinous pleuritis or hydatid cyst) which could be made by cytology while only 31(75.6%) out of 41 were diagnosed on pleural biopsy. The study indicates that cytologic evaluation of pleural fluid is more efficaceous in the diagnosis of malignant and non-malignant pleural disease than percutaneous pleural biopsy.

Escovado pleural sob anestesia local / Pleural brushed under local anesthesia

Foram submetidos ao escovado pleural, às cegas, sob anestesia local, 20 pacientes portadores de derrame pleural livre. Coletou-se amostra do líquido pleural por toracocentese antes e depois do escovado pleural. Os preparados citológicos obtidos foram submetidos a coloraçöes com May-Grunwald-Giemsa e Schoor-Harris para a análise citológica. Obteve-se 16// de diagnóstico na primeira amostra de líquido pleural, 50// na segunda amostra e também 50// no escovado pleural. A associaçäo dos resultados elevou o índice diagnóstico para 66//. Foi relatado dor discreta para a execuçäo do escovado pleural em 4(25//) pacientes. Conclui-se que o escovado pleural aumentou o índice de diagnóstico de derrame neoplásico sem acarretar complicaçöes pleuro-pulmonares