Background: Pleural malignancy either primary or due to metastatic involvement can be presented by different macroscopic appearances in thoracoscopic examination of pleural cavity.Purpose: To identify the relationship between thoracoscopic view of different malignant pleural lesions and pathological types of malignancy in malignant pleural effusion.Patients and methods: A retrospective study reviewing medical reports of sixty-nine (69) patients who underwent medical thoracoscopy and were confirmed to be malignant pleural effusion by pleural tissue biopsy as well as macroscopic appearances of malignant pleural lesions were identified.Results: Metastatic adenocarcinoma was the main type of malignancy (46 cases 66.7%), followed by malignant lymphoma (9 cases 13%), malignant mesothelioma (4 cases 5.8%), squamous cell carcinoma (4 cases 5.8%), small cell carcinoma (3 cases 4.3%), sarcoma (2 cases 2.9%) and lastly spindle cell tumor (single case 1.4%). Nodular appearance of malignant pleural lesions was the main thoracoscopic finding (75.45%) followed by masses (50.7%), plaques (20.3%) and lastly adhesions (14.5%) of cases. Nodules represented the main thoracoscopic finding in both metastatic adenocarcinoma and malignant lymphoma (82.6% and 77.78%, respectively) afterward masses (45.65% and 66.67%, respectively). However; masses represented the main thoracoscopic finding (100%) in malignant mesothelioma followed by nodules (50%).Conclusion: Inspecting pleural cavity via medical thoracoscopy and identification of macroscopic appearance of different malignant pleural lesions may give a good prospect about the suspected pathological type of malignancy in malignant pleural effusion.
Purpose: The aim of this study is to differentiate between the histopathological features of pleural tuberculosis both free and encysted forms of pleural effusion as regards pleural fluid cytology and pleural tissue granulomatous tissue reaction and assess the effects of combined microbial infection on histopathological and clinical residuals.Patients and methods: One hundred and ninety patients were confirmed to be tuberculous by pleural tissue biopsy. Pleural fluid cytopathology and TB granulomatous tissue biopsy samples were studied.Results: Within histopathological features in TB pleural effusion is typical granulomatous TB reaction that was prevalent in both free and encysted forms of pleural effusion with high percentage (97% and 87.5% respectively). On the other hand, lymphocytic exudative smear was predominant in the free TB effusion group than both inflammatory and hemorrhagic ones (74.7% versus 23.5% and 1.8% respectively) while the encysted effusion group presented higher predominance to inflammatory exudative smear than other types (54.2% versus 41.7% and 4.2% respectively). Moderate cellularity was higher in percentage in both free and encysted groups 77.7% and 62.5% respectively. Also, langerhans cells prevailed in both effusion types. Lastly, non TB culture was present in all cases of encysted pleural effusions but accounted only for 3% of free effusion cases.Conclusion: Differentiation between free and encysted forms of pleural tuberculous effusion as regards effusion cytopathological criteria and pleural tissue histopathological patterns represent an important support in understanding the pathogenesis of pleural tuberculous tissue reactions and other positive cultural diagnosis can aggravate TB granulomatous reactions.
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