The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients

Abstract

This study reports the cytopathologic diagnoses rendered on all malignant pleural effusions received and processed over a period of 14 years. Specimens of fluid from various body sites (25,464) were examined. Of these, 5888 (23%) were specimens of pleural effusions. Five hundred eighty-four specimens (9.9% of total pleural fluid specimens) taken from 472 patients were diagnosed as containing cancer cells. Of the malignant pleural effusions, 75.7% were classified as carcinomatous in type. Adenocarcinomas comprised 47.4% of the 584 specimens. The groups of large cell undifferentiated carcinoma and lymphoma/leukemia approximated one another in being the second most common cancer groups (14.3% and 15.0%, respectively). For both males and females, the frequency of organ site or primary tumor type was lung (35.6%), lymphoma/leukemia (15.9%), breast (14.8%), female genital tract (8.1%), and gastrointestinal tract (5.9%). Among male patients, the order of frequency was lung (49.1%), lymphoma/leukemia (21.1%), gastrointestinal tract (7.0%), genitourinary tract (6.0%), and malignant melanoma (1.4%). In female patients, the order of frequency was breast (37.4%), female genital tract (usually ovary) (20.3%), lung (15.0%), lymphoma/leukemia (8.0%), and gastrointestinal tract (4.3%). In 48 patients (10.2%) the primary site of neoplasm was never determined. In 90.5% of patients a cytopathologic diagnosis conclusive for cancer was obtained on the first specimen of fluid. There were no false positive diagnoses.

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

“…In the present study, all of the effusions were exudates, with a slight increase in the levels of protein and lactate dehydrogenase. Although increased triglyceride levels in pleural fluid have been reported in cases of lymphoma, (13,14,17) only 4 (≈14%) of the lymphoma patients investigated in the present study showed triglyceride levels higher than 110 mg/dL, which explains the low mean values obtained in that group, as well as the absence of statistical significance when those values were compared with those obtained in the tuberculosis group. Although high levels of cholesterol in pleural fluid are associated with pseudochylous effusions, a condition that is generally associated with chronic fluid collections, (21) cholesterol in pleural fluid can be used in order to classify pleural exudates.…”

“…(14,(16)(17)(18) In addition, ADA levels are commonly increased in the pleural fluid of patients with lymphoma, regardless of the cell subtype (T or B cells). (13) From a clinical standpoint, both tuberculosis and lymphoma predominate in males in the second decade of life, although tuberculosis can also affect younger patients.…”

“…(13) From a clinical standpoint, both tuberculosis and lymphoma predominate in males in the second decade of life, although tuberculosis can also affect younger patients. (7,(17)(18)(19) The clinical similarities between tuberculosis patients and lymphoma patients are noteworthy. In both types of patients, complaints are usually related to the magnitude of the effusion and to constitutional symptoms, such as weight loss.…”

Minimally invasive localization of oncolytic herpes simplex viral therapy of metastatic pleural cancer

“…While NSCLC is the most common cause of malignant disease of the pleura, the pleural model used in this study is also relevant to other cancer types, including mesothelioma, breast, ovarian, and lymphoid cancers (48)(49)(50). Pleural spread of NSCLC is thought to result from either exfoliation and/or lymphatic spread.…”

Profile of exudative pleural effusion in the region of Bhuj people

“…20,28,29 Lymphocytes predominant in tubercular pleural effusion. Cytology for malignant cells was positive in 33-87%; Light demonstrated predominantly polymorphs in bacterial pneumonia.…”