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30 Cards in this Set
- Front
- Back
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Pleural diseases
Etiology |
Most pleural pathology is secondary to an underlying disease process elsewhere
Two examples of primary pleural pathology: - Primary intrapleural infections - Primary tumors (malignant mesothelioma) |
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Pleural effusion
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Increased accumulation of fluid in the pleural cavity
Normally the pleural cavities contain less than 15 ml of clear serous fluid Pleural effusions are a common manifestation of pleural disease (primary or secondary) |
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Transudate
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fluid that has “oozed” through a membrane as a result of an imbalance in hydrostatic and osmotic forces
usually low in protein |
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Exudate
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fluid that has “oozed” out of a tissue due to injury or inflammation
high in protein |
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What causes Pleural effusions?
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Increased hydrostatic pressure (CHF)
Decreased oncotic pressure (nephrotic syndrome)... b/c lose large amounts of protein in urine Increased vascular permeability (pneumonia) Increased intrapleural negative pressure (atelectasis) Decreased lymphatic drainage (tumor) |
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Pleura-inflammatory
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Serofibrinous pleuritis
Suppurative pleuritis (empyema) Hemorrhagic pleuritis |
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Serofibrinous pleuritis
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Serofibrinous exudate
e.g,, secondary to pulmonary inflammation, collagen vascular diseases |
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Suppurative pleuritis (empyema)
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Pus
e.g., secondary to pneumonia |
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Hemorrhagic pleuritis
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Bloody exudate
e.g., secondary to tumor |
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Pleura-noninflammatory
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Hydrothorax
Hemothorax Chylothorax |
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Hydrothorax
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Transudate
e.g., secondary to CHF |
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Hemothorax
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Blood
e.g., ruptured aortic aneurysm |
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Chylothorax
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Chyle (lymph)
e.g., secondary to obstruction of lymphatics by tumor or thoracic duct trauma |
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Pneumothorax
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Air in the pleural space
- Spontaneous (Emphysema, asthma, TB) - Traumatic - Therapeutic Tension pneumothorax |
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Pleural neoplasms
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Solitary fibrous tumor
Malignant mesothelioma |
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Solitary fibrous tumor
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Rare
Malignant transformation rare Usually incidental finding on CXR NOT associated with asbestos Usually arise from visceral pleura - origin: mesothelial vs submesothelial fibroblasts May be found at other sites |
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Solitary fibrous tumor
Grossly |
white, rounded, firm, several centimeters
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Solitary fibrous tumor
Histologically |
fibroblast-like cells in a background of collagen (it is well-circumscribed)
haphazard arrangement of cells (“patternless” pattern) CD34 positive (immunoreactive stain) |
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Histologic findings of Pleural Plaque
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hypocellular tissue rich in collagen
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Malignant Mesothelioma
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A malignant tumor derived from the lining cells (that is, mesothelial cells) of a serous cavity.
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Malignant Mesothelioma
WHO classification |
Epithelioid mesothelioma
Sarcomatoid mesothelioma - desmoplastic mesothelioma Biphasic mesothelioma |
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Malignant Mesothelioma
Epidemiology |
Uncommon
Most are asbestos related (estimate 70-90%) exposure histories increased numbers of asbestos bodies in lungs of patients with mesothelioma capacity of asbestos to produce mesotheliomas when injected into the serous cavities of experimental animals Carcinogenicity of asbestos fibers probably related to its physical characteristics - the types of asbestos with long thin fibers are more potent carcinogens long latency between asbestos exposure and development of mesothelioma (20-50 years; avg 35 years) |
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Malignant mesothelioma
Clinical features |
Most patients are 50-70 years of age
Males predominate (~75%) Symptoms: chest pain, dyspnea Average survival for pleural mesothelioma from onset of symptoms=12-15 months and from time of diagnosis=8-12 months but longer survival times have been reported |
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Malignant Mesothelioma
Gross Pathology |
small nodules increase in size, eventually becoming confluent and encasing the lung
tumor may invade the chest wall/mediastinum tumor often spreads to pericardium, contralateral pleura and peritoneum may metastasize to mediastinal lymph nodes distant metastases may be present but are not usually clinically evident |
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Malignant mesothelioma
Epithelial type |
50% of Mesotheliioma cases
Usually tubulopapillary, but may be solid Main differential diagnosis is metastatic adenocarcinoma Diagnosis often requires histochemical stains, immunohistochemical stains and possibly electron microscopy |
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What is the main DDX for Epithelial Type Malignant Mesothelioma?
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Main differential diagnosis is metastatic adenocarcinoma
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Calretinin
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Immunoreactive substance for malignant mesothelioma
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Cytokeratin AE1/AE3
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immunoreactive substance for epitheial cells
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Malignant Mesothelioma
Sarcomatoid type |
15% of Mesothelioma
Malignant-appearing spindle or oval cells-can resemble a variety of sarcomas In the desmoplastic variant, more than 50% of the tumor is fibrous and poorly cellular; it may be difficult to distinguish from reactive fibrosis |
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Malignant Mesothelioma
Mixed type |
25% of Mesothelioma
The malignant-appearing elements have both epithelial and a mesenchymal appearances |
