Mesotelioma pleural maligno: a propósito de un caso / Malignant pleural mesothelioma: a case report

El mesotelioma difuso es una neoplasia maligna poco frecuente que proviene de las células mesoteliales; la pleura es su localización más habitual y se estima que un 10% de los casos se localizan a nivel peritoneal. El mesotelioma es habitualmente diagnosticado en la quinta década de la vida, con un claro predominio en el sexo masculino, debido esto último a su relación con la exposición laboral al asbesto. Se expone un caso con factores de riesgo y diagnóstico asociado. (AU)

Diffuse mesothelioma is a rare malignant neoplasm that comes from mesothelial cells; the pleura are the most common location and is estimated that 10% of the cases are located at the peritoneal level. Mesothelioma is usually diagnosed in the fifth decade of life, with a clear predominance in the male sex, due to its relation to occupational exposureto asbestos. A case is presented with risk factors and associated diagnosis. (AU)

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.

Pleuropulmonary blastoma in an infant.

Pleuropulmonary blastomas (PPB) are rare and highly aggressive tumors. Herein, we report an infantile case of type III PPB. A 9-mth-old boy presented to our unit with a history of cough and tachypnea for 2 days. Chest computed tomography revealed a mass in the left upper lobe, emphysema in the left upper lung, and mediastinum and heart shifted towards the right. The mass was removed completely by left upper lobectomy and histology confirmed diagnosis of type III PPB. The immature blastematous tissue was positive for vimentin while benign epithelium was positive for epithelial membrane antigen and cytokeratin. No lymph nodule metastasis was found in the 7 lymph nodules obtained from the hilum of the lung near the tumor. Currently, the patient is under close follow-up and is doing well.

Sonography of the lungs and pleura

The role of Transthoracic Sonography in the evaluation of chest diseases has already been accepted throughout the world. Though Ultrasound [US] is not widely established as a routine method, but the advantages of low-cost, bedside availability and lack of ionizing radiation exposure has made it an indispensable diagnostic tool in the modern pulmonary medicine. US supplements the conventional chest X-ray and computed tomography and closes the gap between them. Besides, it is invaluable in the interventional procedures of chest and pleural space and it is suited to critically ill patients in need of bedside investigations. This article reviews the sono-graphic morphology of the pleural and peripheral pulmonary diseases

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.

Massive pleural effusion without bony involvement: an unusual presentation of advanced carcinoma prostate.

As noted under the natural history, the bone of axial skeleton and the ileopelvic lymphnodes specially the obturator groups are the commonest sites of metastasis spread of cancer prostate. Visceral metastasis in the absence of the above is extremely rare. We present a 50-year-male patient of cancer prostate with pleural metastases, pleural effusion and lung collapse on right side. Bone scan was essentially normal. Bilateral orchiectomy was done. Pleural effusion subsided and PSA dropped to 1.4 ng/ml from the initial 120 ng/ml at three months. Patient is on regular follow-up at three monthly intervals and last PSA done at 9 months was 2.1 ng/ml.

An unusual mediastinal mass due to metastasis.

During childhood the common anterior middle mediastinal masses are either lymph node enlargement or teratomas/dermoids. A case of ossific mediastinal metastasis and pleural metastases from osteosarcoma, presenting three years after the primary disease (late metastasis) is reported for its rarity.

Value of computed tomography in the evaluation of pleural diseases

48 cases of localised and diffuse pleural diseases were evaluated with computerized tomography [CT] after perforimg plain X-ray chest [both P.A. and Lat. Views]. History of asbestos exposure was obtained in 12% of the cases, while past history of radiotherapy was found in 27% of the cases. Plain X-ray chest revealed unilateral opacification in 41 cases and bilateral opacification in 7 cases. The opacity was homogenous in 20 cases, heterogenous in 27 cases and nodular in 5 cases. Ipsilateral mediastinal shift was seen in 41 cases. CT revealed 25 cases with solid masses [17 cases associated with pleural effusion] and 23 cases with pleural effusion [free effusion in 20 cases and encysted in 3 cases]. Mediastinal lymphadenopathy was found in 5 cases [3 cases of proven lymphoma and 2 cases of pleural metastasis from cancer breast]. Diaphragmatic invasion and retroperitoneal extension of mesothelioma were found in 2 cases. Liver metastasis was detected in 2 cases. CT guided fine-needle aspiration biopsy [FNAB] was done in 25 cases, thoracotomy and wide resection of pleural mass was performed in 4 cases. CT could differentiate solid lesion from pleural effusion, clearly demonstrate extension of the lesion, associated lymphadenopathy, rib destruction, distant liver metastasis in addition to taking CT guided FNAB

Hemothorax from gestational trophoblastic disease: a case report.

A 19-year-old woman who presented with right-sided hemothorax was diagnosed to have gestational trophoblastic disease with pleural metastasis. A CT scan of the chest revealed a pleural mass and serum Beta-subunit of HCG was high. After treatment the hormonal level became normal and the patient remains asymptomatic.