RESUMO
We present the case of a 33-year-old male patient suffering from lymphocytic pleural effusion, as a result of pleural mesothelioma. Mesothelioma is a malignant tumor of the pleura that is mainly caused by chronic exposure to asbestos fibers and more than 40 years of exposure are needed to develop the disease. Early studies on the relationship of asbestos and mesothelioma were issued in the 1960s. Fibers migrate from the parenchyma of the lung to the visceral pleura. It is widely known that asbestos is an oncogenic factor which can cause damage to DNA. A chest x-ray may reveal pleural effusion with or without pleural thickening, whereas a chest CT may also reveal pleural thickening, uniform and/or lobular. Specific tests, such as immunohistochemical staining, are used in order to help differential diagnosis. Extrapleural pneumonectomy is used as a therapeutic option which involves removal of the lung as well as both the visceral and parietal pleura, the affected part of the pericardium and diaphragm. Surgery should be followed up by radiotherapy and chemotherapy. The surgery may lead to a mean survival rate of approximately 9-21 months. The case presented underlines that in the event of pleural effusion with a lymphocyte type physicians should consider the possibility of a pleural mesothelioma during differential diagnosis, even in relatively young patients.
Assuntos
Asbestose/complicações , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Broncoscopia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/etiologia , Mesotelioma/cirurgia , Mesotelioma Maligno , Neoplasias Pleurais/etiologia , Neoplasias Pleurais/cirurgia , PneumonectomiaRESUMO
Stages I and II non small cell lung cancer (NSCLC) are primarily treated by anatomic pulmonary resection. Selected patients with stage IIIB disease are still candidates for surgical treatment. Unfortunately most patients with locally advanced NSCLC don't benefit by surgery alone or even by the combination of chemotherapy and radiotherapy. In order to achieve local and distant disease control, which seems to be the cause of failure of the above mentioned treatments, surgery after induction chemoradiotherapy has been proposed. This approach seems to be the state of the art of therapy for these patients improving survival but with eventual increased risks, especially pulmonary and septic complications. This review of previously published studies indicates the important role of this combined treatment in terms of survival and its risks related either to induction treatment or to surgery.