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

Myelomatous Effusion in Multiple Myeloma.

Multiple myeloma (MM) is a systemic disease characterized by monoclonal proliferation of plasma cells. The clinical manifestations of the disease are due to tumour cell infiltration and monoclonal immunoglobulins and / or light chains secreted by the neoplastic cells. Effusions may develop in cases of multiple myeloma due to various causes but myelomatous effusion is uncommon. Moreover, multiple myeloma presenting as bilateral pleural effusion is exceptional and a case of multiple myeloma presenting with bilateral pleural effusion and anaemia is reported.

Combined blood and pleural levels of mesothelin and osteopontin for the diagnosis of malignant pleural mesothelioma

Malignant pleural mesothelioma [MPM] is a highly aggressive tumor with poor survival rate. It is difficult to diagnose MPM at an early stage. Soluble mesothelin remains the best available biomarker for MPM, however the lack of sensitivity for early stage disease provides a motivation for the search of an additional marker that could be combined with mesothelin for early malignancy detection. The aim was to evaluate the diagnostic value of soluble mesothelin and osteopontin both in blood and pleural fluid of MPM patients and to assess whether combination of these markers could improve the diagnostic accuracy of mesothelin. In this study mesothelin and osteopontin were measured by ELISA method in 197 samples [123 blood and 74 pleural] obtained from 123 participants, divided into 4 groups: 38 MPM patients, 24 patients with metastatic pleural effusion [Mets] of various carcinomas, 29 patients with hydrothorax and 32 healthy asbestos exposed subjects. Receiver operating characteristic [ROC] curves were generated to compare the diagnostic capability of these biomarkers. Combination of markers was done through logistic regression analysis. The median blood and pleural levels of the two markers were significantly higher in MPM patients than in hydrothorax or asbestos exposure groups [P < 0.0001], however the difference between MPM and Mets group was not significant. Combining the data from blood mesothelin and osteopontin using logistic regression model raised the area under the ROC curve [AUC] from 0.774 for serum mesothelin and 0.828 for plasma osteopontin to 0.867 to differentiate MPM from hydrothorax and asbestos exposed subjects. Combining the diagnostic capability of both pleural markers raised the AUC from 0.871 for pleural mesothelin and 0.847 for pleural osteopontin to 0.905 to differentiate MPM from hydrothorax patients. The performance of serum and pleural mesothelin in diagnosing MPM was improved when combined with plasma and pleural osteopontin [respectively] through logistic regression analysis model. This will be a great advance in screening and management of MPM

Metastatic pleural effusion: A rare presentation of salivary gland adenoid cystic carcinoma.

Adenoid cystic carcinoma, an uncommon malignant salivary gland neoplasm, is known for its long clinical course, indolent growth, local recurrence and late distant metastasis. We report an unusual case of adenoid cystic carcinoma of the palate in a 64-year-old woman, undiagnosed for more than 15 years, who presented as malignant pleural effusion.

Etiology of pleural effusion among adults in the State of Qatar: a 1-year hospital-based study

There have been no systematic studies of diseases causing pleural effusion in Qatar. This prospective, hospital-based study involved all adult patients [> 15 years] with pleural effusions who were admitted to referral hospitals over a 1-year period. A total of 200 cases of pleural effusion were identified [152 males and 48 females]; mean age 45.1 [SD 18.5] years. A majority of patients [73.5%] were non-Qataris, mostly from the Asian subcontinent. The most frequent cause of pleural effusions was tuberculosis [32.5%], followed by pneumonia [19%], cancer [15.5%] and cardiac failure [13%]. The most frequent cause of malignant effusion was bronchogenic carcinoma [38.7%], whereas Gram-positive organisms were the most frequent isolates from empyema fluid [62.5%]. Histological examination and culture of pleural biopsy were the most useful diagnostic workup for tuberculosis effusions, whereas repeated cytological examination of pleural fluid and pleural biopsy were most useful for malignant effusions

Módulo pleuroscopía patología pleural: toracoscopía y videotoracoscopía / Video assisted thoracic surgery (VATS) and medical thoracoscopy in pleural diseases

In the last years important advances have taken place in the surgical field allowing to treat practically all pleural pathologies by video-assisted thoracic surgery (VATS), with prompt recovery and minimal morbidity and mortality. Internists had also perfected the medical thoracoscopy, a technique used for the study of pleural diseases, which also allows performing some therapeutic procedures. The present article briefly comments the history of medical thoracoscopy and VATS and their current applications. A critical analysis of the principal indications of medical thoracoscopy is presented: study of pleural effusions, management of malignant pleural effusion and spontaneous pneumothorax. The results are compared, in view of the existing evidence, with other less complex surgical procedures and VATS.

En los últimos años se han producido importantes avances en las técnicas quirúrgicas que permiten tratar prácticamente todas las patologías pleurales y pulmonares por videotoracoscopía, con una rápida recuperación postoperatoria y mínima morbi-mortalidad. Se ha perfeccionado además por médicos internistas la toracoscopía médica, técnica utilizada para el estudio de las enfermedades de la pleura, que permite también realizar algunos procedimientos terapéuticos. En el presente artículo se comenta brevemente la historia de la videotoracoscopía y la toracoscopía médica y sus aplicaciones actuales. Se realiza un análisis crítico de las principales indicaciones de la toracoscopía médica: estudio de derrames pleurales, manejo del derrame pleural de origen neoplásico y del neumotorax espontáneo. Sus resultados se comparan, a la luz de la evidencia existente, con otros procedimientos quirúrgicos menos complejos y con la videotoracoscopía.

Pulmonary lymphangioleiomyomatosis: a rare presentation.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare idiopathic, cystic disease. We report a case of LAM who presented with nonchylous, bilateral pleural effusion and progressive respiratory failure.

Sclerosing hemangioma of the lung.

An extremely rare case of sclerosing hemangioma lung is described in a patient who presented as right sided pleural effusion with recurrence.

Diagnóstico Etiológico de la Efusión Pleural: Casos Presentados entre 1986-1993 / Etiologic Diagnosis of Pleural Effusion: Case Series 1986-1993

INTRODUCCION: El objetivo del estudio fue establecer la causa de la efusión pleural de los pacientes que consultaron al Hospital Universitario Ramón González Valencia en un período de siete años y realizar comparaciones por edad y sexo. MATERIALES Y METODOS: A todos los pacientes que ingresaron al estudio se les realizó historia clínica, examen físico, citología de líquido pleural, biopsia pleural y estudios complementarios cuando fuere necesario. RESULTADOS: Se estudiaron 200 pacientes con efusión pleural, con edad promedio de 46.5 años. Las cuatro principales causas en orden de frecuencia fueron: Tuberculosis (38.5 por ciento), cardiopatías (13.5 por ciento) y enfermedad infecciosa aguda del pulmón (11 por ciento). No se encontraron diferencias según sexos pero si fue más frecuente entre los 41-60 años y menos frecuente en los extremos de la vida. CONCLUSIONES: Continúan siendo la citología de líquido pleural y la biopsia las pruebas más eficaces que el médico debe elegir para esclarecer la etiología de la efusión pleural. La tuberculosis y las neoplasias continúan siendo las principales causas de esta entidad

Radiation: an alternative agent for pleurodesis.

Radiotherapy as an alternative agent has been tried for pleurodesis in four proven cases of adenocarcinoma of the lung. This non-invasive technique appears to be beneficial, however, this requires further trials.