In order to discriminate between malignant and benign effusions, the values of carcinoembryonic antigen (CEA), ferritin, beta2-microglobulin (BMG), acid-soluble glycoprotein (ASP), tissue polypeptide anti-gen (TPA), adenosine deaminase (ADA), and immunosuppressive acidic protein (IAP) were measured in the pleural fluid of 54 patients with lung cancer, 20 with malignancies other than lung cancer, 18 with tuberculous pleurisy, and 22 with benign diseases other than tuberculosis. CEA levels in malignant effusions were significantly higher than those in benign effusions. At a cutoff level of 5 ng/ml, 68% of the patients with lung cancer and 44% of the patients with other malignancies showed elevated pleural fluid CEA levels. In 13 lung cancer cases with negative pleural fluid cytology, nine cases had elevated pleural fluid CEA levels. The mean pleural fluid BMG level of patients with benign diseases was significantly higher than that of patients with malignant diseases, but there was a marked overlap between those with malignant and benign diseases. No significant differences were found in the pleural fluid ferritin, ASP, TPA, and IAP levels between malignant and benign conditions. ASP and IAP pleural fluid levels showed significant correlations with the pleural fluid C-reactive protein (CRP) concentrations suggesting that they also reflect inflammatory activity. The mean ADA activity in tuberculous effusion was significantly higher than that resulting from other causes of pleural effusion. Cancer 61:298-302, 1988.
Thrombocytosis above 40.0 X 10(4)/mm3 occurred in five of six (83%) patients with malignant mesothelioma. In contrast, the incidence of thrombocytosis was 7.5% in patients with lung adenocarcinoma, 12.5% in squamous cell carcinoma, 5.1% in small cell carcinoma, and 41.7% in large cell carcinoma, respectively. The platelet count in large cell carcinoma was significantly higher than that in other cell types of lung cancer; however, the platelet count in malignant mesothelioma was much higher than that in large cell carcinoma. These results show that the incidence of thrombocytosis seems to be high in malignant mesothelioma, although the mechanism is thus far unknown.
The quantitative analysis on glycosaminoglycan (GAG) in the tumor tissues of five patients with malignant pleural mesothelioma and in the pleural fluid of two patients was performed with the use of biochemical methods. In the tumor tissues, it was found that the average of the total amount of GAG was more than 7.9 times as high as that in adenocarcinoma of the lung, and that hyaluronic acid and chondroitin sulfate were main constituents of mesothelioma GAG. However, there was no significant difference in the content of dermatan sulfate and heparan sulfate between this neoplasm and adenocarcinoma. In the pleural fluid, the amount of hyaluronic acid was about 40 to 230 times higher than that in adenocarcinoma of the lung with the increment of chondroitin sulfate (11-87 times). These findings suggest that a marked increase in the total amount of GAG and the elevation of either the hyaluronic acid or the chondroitin sulfate level, or both, are characteristic abnormalities in malignant pleural mesothelioma.
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