Clinical Profile of Patients Presenting with Malignant Pleural Effusion to a Tertiary Health Care Centre.

BACKGROUND: Malignant pleural effusions are one of the leading causes of exudative pleural effusions. We studied the clinical profile of patients presenting with malignant pleural effusion, their cytological and histopathological features and the efficacy of pleurodesis in preventing recurrence. MATERIALS AND METHODS: 100 patients who were positive for malignant cells in pleural fluid cytology or pleural biopsy were recruited. After history and clinical examination, Chest radiographs, Computed tomography of chest were performed. After diagnostic thoracocentesis and Pleural biopsy, Tube thoracostomy was done. Pleurodesis was performed in 40 patients. RESULTS: Most of the patients (65%) were in the age group of 61 to 70 years with a male to female ratio of 1.5:1. Most common presenting symptoms were breathlessness (86%) and cough (86%). All (100%) of the malignant pleural effusions were exudative. Pleural fluid cytology was positive in 86% while pleural biopsy was positive only in 44%. Pleural biopsy was positive only in 17% of patients with negative cytology. Adenocarcinoma (59%) was the most common type of cytological diagnosis. Pleurodesis was performed in 40 patients of which 30% had recurrence. CONCLUSIONS: In our tertiary health care centre, malignant pleural effusions presented as large pleural effusions. Most common presenting symptoms were breathlessness and cough. They were exudative, lymphocytic predominant with low ADA levels. Thoracocentesis and cytologic study should be the initial diagnostic approach to malignant pleural effusions. Adenocarcinoma of the lung was the most common cause of malignant pleural effusion. Pleurodesis with oxytetracycline was successful in majority of cases.

Primary ewings sarcoma of the lung.

Extraosseous ewings sarcoma is an extremely rare neuroectodermal tumour. We report the case of a 30-year-old female who presented with right sided pulmonary mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary Ewings sarcoma. This case highlights the fact that Ewings sarcoma should be considered in differential diagnosis of patients presenting with pulmonary mass.

Pneumocystis jirovecii infection and the associated dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR) mutations in HIV-positive individuals from Pune, India.

The present study was undertaken to detect Pneumocystis jirovecii infection among HIV-positive patients presenting with symptoms of lower respiratory tract infection and analyze the associated dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR) mutations. P. jirovecii infection was detected in 12.6% cases. We did not find DHPS gene mutations at the commonest positions of codon 55 and 57; however, mutation at codon 171 was detected in two cases. No mutations in DHFR gene were detected. The results indicate low prevalence of DHPS and DHFR mutations in Indian P. jirovecii isolates, suggesting that the selective pressure of sulfa drugs on the local strains has probably not reached the levels found in developed nations.