Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 873
Filtrar
1.
Medicine (Baltimore) ; 101(26): e29788, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777003

RESUMO

Most of pleural effusions are caused by tuberculosis and malignant tumor. Difficult sampling and bacterial sparing nature of these diseases challenge doctors' diagnosis in China. This study aimed to develop a new convenient and effective method for the differentiation of tuberculous and malignant pleural effusion. A prospective cohort study of patients hospitalized with malignant (n = 90) and tuberculous (n = 130) pleural effusions from September 2018 to October 2020 was performed. The diagnostic performance of the age to pleural fluid ADA ratio (age/ADA) and other indicators to distinguish tuberculous and malignant pleural effusions was evaluated by receiver operating characteristic (ROC) curve analysis. The areas under the curve (AUC) of age/ADA and pleural fluid ADA were largest. Age/ADA showed sensitivity and specificity of 81.5% (95%CI 73.8%-87.8%) and 97.8% (95%CI 92.2%-99.7%) respectively. The sensitivity and specificity of pleural fluid ADA were 83.1% (95%CI 75.5%-89.1%) and 93.3% (95%CI 86.1%-97.5%) respectively. The positive likelihood [36.69 (95%CI 9.3-144.8)] of age/ADA was significantly higher than that of pleural fluid ADA [12.46 (95%CI 5.7-27.1)]. The AUCs for Cancer Ratio and Cancer Ratio plus were lower and showed a sensitivity of 80.0% (95%CI 72.1%-86.5%), 80.0% (95%CI 70.2%-87.7%) and a specificity of 81.5% (95%CI 73.8%-87.8%), 80.0% (95%CI 70.2%-87.7%) respectively. Age/ADA has a higher diagnostic accuracy than ADA. Age/ADA is a promising diagnostic index for tuberculous and malignant pleural effusion with high sensitivity and specificity, especially the high positive likelihood ratio. The diagnostic accuracy of Cancer Ratio and Cancer Ratio plus are inferior to those of age/ADA and ADA.


Assuntos
Neuroblastoma , Derrame Pleural Maligno , Derrame Pleural , Tuberculose Pleural , Adenosina Desaminase , Humanos , Neuroblastoma/complicações , Derrame Pleural/complicações , Derrame Pleural/diagnóstico , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Estudos Prospectivos , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico
2.
Orv Hetil ; 163(26): 1015-1022, 2022 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-35895483

RESUMO

INTRODUCTION: Malignant pleural effusion is a complication of tumors heralding poor outcome. It may be life-threatening, so advanced cases should be treated as an oncological emergency. OBJECTIVE: We aimed to provide complex care to patients with malignant pleural effusion during the COVID-19 pandemic at the University of Pécs Medical School, in the Department of Oncotherapy. During the pandemic, we introduced the thoracocentesis as a routine method in our department without previous experiences. METHOD: Results of diagnosing and treating pleural effusion of patients between March 18th of 2020 and May 31st of 2021 were summarized. RESULTS: We have analyzed data of 45 patients, two-thirds (66.7%) of them were women, the median age was 67 years. 57.8% of patients received systemic anticancer therapy during the study. The total number of thoracocentesis was over 120, one-third of the patients required more than five interventions. Only three iatrogenic pneumothorax cases were detected, no other serious complications were experienced. The procedures - that were aimed to mitigate symptoms in most cases (80%) - were considered successful. However, 48.9% of the patients were no longer alive at the end of the study period indicating very poor prognosis of pleural carcinosis. DISCUSSION AND CONCLUSION: Clinical care of oncological patients was continuous during the pandemic; patients treated as part of emergency care were often seen in advanced disease state. Treatment of malignant pleural effusion requires oncological foresight as well as implementing an invasive approach. Our study has shown that discussion of the topic is relevant, may reveal difficulties and need for improvement. Our results are consistent with literature data, we have experienced less complications than reported in the literature. Orv Hetil. 2022; 163(26): 1015-1022.


Assuntos
COVID-19 , Derrame Pleural Maligno , Derrame Pleural , Pneumotórax , Idoso , COVID-19/complicações , Feminino , Humanos , Masculino , Pandemias , Derrame Pleural/terapia , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia , Pneumotórax/terapia
3.
Am J Case Rep ; 23: e935434, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35781519

RESUMO

BACKGROUND Gastric adenocarcinoma is a common malignancy, representing the third most common cause of cancer-related death globally. Most patients are initially asymptomatic, but as the cancer progresses, patients typically present with vague gastrointestinal complaints, including early satiety, heart burn, vomiting, or abdominal pain. Metastatic gastric cancer is relatively uncommon, with ~26% of patients having metastasis to a single site and 13% having metastases to multiple sites. The most common site of metastasis is the liver, followed by peritoneum, lung, and bone. CASE REPORT In this case report we describe a 73-year-old man who presented with shortness of breath, found to have large hiatal hernia along with segmental branch pulmonary embolism, bilateral pleural effusion, and diffuse interlobular septal thickening. The pleural effusion was later found to be malignant in nature and the patient was diagnosed with metastatic stage IV infiltrative gastric adenocarcinoma with metastasis to the lung and bone. Notably, the patient had no hepatic involvement. CONCLUSIONS This represents a unique case, as only 2% of malignant pleural effusions are attributable to gastric cancer. Furthermore, malignant pleural effusion is an extremely rare initial presentation of gastric adenocarcinoma, especially without liver involvement, with few existing cases documented in the literature. This case demonstrates that gastric cancer should be included on the differential diagnosis as a rare cause of pleural effusion.


Assuntos
Adenocarcinoma , Derrame Pleural Maligno , Derrame Pleural , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Idoso , Exsudatos e Transudatos , Humanos , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural Maligno/etiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico
4.
Chin J Physiol ; 65(3): 105-108, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35775528

RESUMO

Exudative pleural effusion includes tuberculous pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). An elevated pleural fluid adenosine deaminase (ADA) typically implies TPE, but the rule may not apply to every individual case. Recent studies proposed that the pleural fluid lactate dehydrogenase (LDH)-to-ADA ratio showed a higher diagnostic power than pleural fluid ADA alone in differentiating the etiology of pleural effusion. Hence, we aimed to investigate the performance of pleural fluid LDH-to-ADA ratio as a biomarker in assistance with the diagnosis of TPE, PPE, and MPE. All patients who underwent thoracentesis for the first time with a pleural fluid ADA >40 U/L were included in this retrospective study. The clinical data including pleural fluid ADA and LDH-to-ADA ratio were analyzed. A total of 311 patients were enrolled during the study interval. The pleural fluid LDH-to-ADA ratio <14.2 (sensitivity: 74.2%; specificity: 90.4%) favored TPE, while the pleural fluid LDH-to-ADA ratio >14.5 (sensitivity: 79.9%; specificity: 78.5%) favored PPE. Besides, the pleural fluid LDH-to-ADA ratio >46.7 (sensitivity: 56.3%; specificity: 78.3%) favored MPE owing to primary lung cancers. In conclusion, the pleural fluid LDH-to-ADA ratio was an effective indicator in differentiating the etiology of pleural effusions in the cases of high ADA level in the pleural fluid.


Assuntos
Derrame Pleural Maligno , Derrame Pleural , Tuberculose Pleural , Adenosina Desaminase , Humanos , L-Lactato Desidrogenase , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/patologia , Estudos Retrospectivos , Tuberculose Pleural/diagnóstico
5.
J Clin Lab Anal ; 36(2): e24179, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35152510

RESUMO

BACKGROUND: Periostin (POSTN) is an extracellular matrix protein that is overexpressed in lung cancer and is considered an effective diagnostic and prognostic biomarker for lung cancer. The purpose of this study was to investigate the diagnostic performance of POSTN and to further evaluate the diagnostic value of POSTN combined with carcinoembryonic antigen (CEA) and cancer ratio [CR: serum lactate dehydrogenase (LDH)/pleural effusion adenosine deaminase (PE ADA)] in lung cancer-related malignant PE (MPE). METHODS: A total of 108 patients with PE, including 54 with lung cancer and 54 with benign lung disease, were enrolled in this study. The POSTN levels of PE and serum were detected using an enzyme-linked immunosorbent assay. Information on the expression of PE and serum CEA, serum LDH, and PE ADA was collected from medical records. RESULTS: The levels of PE POSTN in MPE of patients with lung cancer were significantly higher than those in patients with benign PE (p < 0.0001). The receiver operating characteristic (ROC) curve indicated that the diagnostic sensitivity and specificity of PE POSTN for lung cancer-related MPE were respectively 77.78% and 68.52% when the cutoff value was determined to be 53.45 ng/ml. The ROC curve analysis demonstrated that PE POSTN has a high diagnostic value in MPE associated with lung cancer [area under the curve (AUC) = 0.764], and the combination of PE POSTN, PE CEA, and CR can improve the diagnostic accuracy of lung cancer-related MPE (AUC = 0.948). CONCLUSION: POSTN can be used as a potential marker for lung cancer-related MPE diagnosis.


Assuntos
Biomarcadores Tumorais/análise , Moléculas de Adesão Celular/análise , Neoplasias Pulmonares/complicações , Derrame Pleural Maligno/diagnóstico , Idoso , Líquido da Lavagem Broncoalveolar/química , Moléculas de Adesão Celular/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural Maligno/química , Derrame Pleural Maligno/etiologia , Curva ROC , Sensibilidade e Especificidade
6.
Thorac Cancer ; 13(7): 883-888, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35194945

RESUMO

OBJECTIVES: Breast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer. METHODS: A systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included. RESULTS: Thirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low. CONCLUSIONS: Intrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.


Assuntos
Neoplasias da Mama , Hipertermia Induzida , Neoplasias Ovarianas , Derrame Pleural Maligno , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/tratamento farmacológico , Derrame Pleural Maligno/tratamento farmacológico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/patologia , Pleurodese/efeitos adversos
7.
Intern Med J ; 52(7): 1154-1159, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35191191

RESUMO

BACKGROUND: Cytological examination of pleural fluid has good specificity, but imperfect sensitivity for the diagnosis of malignant pleural effusion (MPE). Published estimates of sensitivity vary and predictors of false negative cytology are not well established. AIMS: To estimate pleural fluid cytology sensitivity and identify risk factors for false negative cytology. METHODS: We conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand, from July 2017 to October 2019. Data on clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology or multidisciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results. RESULTS: Initial pleural fluid cytology was diagnostic in 117 of 156 patients, providing a sensitivity (95% confidence interval (CI)) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (odds ratio (OR) 0.12; 95% CI 0.03-0.54) and yellow/gold pleural fluid (OR 0.24; 95% CI 0.06-0.96) reduced the odds of false negative pleural cytology. Pleural thickening on computed tomography scan (OR 3.3; 95% CI 1.2-9.4) was a risk factor for false negative cytology. CONCLUSION: Sensitivity of pleural fluid cytology was greatest in primary lung and breast cancer, and lowest in mesothelioma. Clinicians should be alert to false negative results when suspecting mesothelioma or if pleural thickening is present.


Assuntos
Neoplasias da Mama , Mesotelioma Maligno , Mesotelioma , Derrame Pleural Maligno , Derrame Pleural , Neoplasias da Mama/patologia , Feminino , Humanos , Mesotelioma/patologia , Pleura , Derrame Pleural/diagnóstico por imagem , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/etiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Medicine (Baltimore) ; 101(1): e28517, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-35029914

RESUMO

ABSTRACT: Malignant mesothelioma (MM) is difficult to diagnose because of the lack of parenchymal opacities, often revealing minimal or absent pleural thickening. Furthermore, pleural effusion has diverse differential diagnoses, including malignancies, infections, as well as collagen vascular and other benign diseases. In general practice, lung cancer (LC) is the most common malignancy causing pleural effusion; therefore, a simple method using pleural diagnostic markers to differentiate between LC and mesothelioma is crucial.We retrospectively reviewed the data of 530 adult patients diagnosed with pleural effusion between January 2010 and December 2020 in an outpatient or inpatient setting. Patients with pathologically diagnosed MM or LC with cytologically positive (class IV or V) pleural effusion were analyzed, and the characteristics of these 2 diseases were compared.During the study period, 27 patients diagnosed with MM and 100 patients diagnosed with LC were enrolled. Receiver operating characteristic curve analysis demonstrated that pleural carcinoembryonic antigen (CEA) and hyaluronic acid (HA) could discriminate MM from LC with an area under the curve of 0.925 (95% confidence interval [CI]: 0.879-0.972, P < .001) and 0.815 (95% CI: 0.686-0.943, P < .001), respectively. To diagnose MM, the accuracy of pleural HA >30,000 ng/mL revealed a sensitivity of 75.0%, specificity of 72.6%, and odds ratio of 7.94 (95% CI: 2.5-25.2, P = .001); pleural CEA <6.0 ng/mL revealed a sensitivity of 95.2%, specificity of 84.9%, smaller negative likelihood ratio of 0.06, and odds ratio of 112.5% (95% CI: 14.4-878.1, P < .001). Multiple logistic regression analysis revealed that these 2 parameters could discriminate MM from LC, with a hazard ratio of 23.6 (95% CI: 2.437-228.1, P = .006) and 252.3 (95% Cl: 16.4-3888.1, P < .001), respectively, and their combination had a high specificity of 98.3%.Pleural CEA (≥6.0 ng/mL) can rule out MM with a high degree of certainty, and the positive results for combination of pleural CEA <6.0 ng/mL and HA >30,000 ng/mL can confirm MM with high specificity, prior to cytological or pathological examinations.


Assuntos
Antígeno Carcinoembrionário/sangue , Ácido Hialurônico/sangue , Neoplasias Pulmonares/diagnóstico , Mesotelioma Maligno/diagnóstico , Derrame Pleural Maligno/diagnóstico , Idoso , Biomarcadores Tumorais/sangue , Antígeno Carcinoembrionário/metabolismo , Feminino , Humanos , Ácido Hialurônico/metabolismo , Masculino , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Derrame Pleural Maligno/etiologia , Estudos Retrospectivos
9.
Future Oncol ; 18(6): 669-677, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35080187

RESUMO

Aim: To investigate the efficacy, safety and optimal dosage of bevacizumab in non-squamous, non-small-cell lung cancer (NSCLC) patients with malignant pleural effusion (MPE). Methods: 20 patients were enrolled and received intrapleural injection of bevacizumab (group A: 2.5 mg/kg d1, d8; group B: 5 mg/kg d1, d8; group C: 7.5 mg/kg d1, d8). Results: The objective response rate (ORR) of MPE was 50%. The median progression-free survival (PFS) of MPE was 7.0 months (95% CI 4.9-9.2). The ORR and PFS of MPE from group B were better than those of group A and group C. The most common adverse events (AEs) were hypertension (15%) and anemia (15%). Conclusion: Bevacizumab has certain efficacy in non-squamous NSCLC patients with MPE. Clinical Trial Registration: NCT02942043 (ClinicalTrials.gov).


Assuntos
Inibidores da Angiogênese/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Bevacizumab/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Pulmonares/complicações , Derrame Pleural Maligno/tratamento farmacológico , Idoso , Inibidores da Angiogênese/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Bevacizumab/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/etiologia , Intervalo Livre de Progressão , Estudos Prospectivos
10.
Eur Respir J ; 59(2)2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34413152

RESUMO

OBJECTIVE: Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care. METHODS: A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation. RESULTS: 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04). CONCLUSION: We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora/efeitos adversos , Drenagem/efeitos adversos , Dispneia/etiologia , Dispneia/terapia , Humanos , Pleura , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia
11.
Adv Exp Med Biol ; 1374: 41-49, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34787829

RESUMO

Malignant mesotheliomas (MM) are rare tumors with high mortality rates, whose incidence varies regionally and nationally, and the diagnosis is difficult. Histology-based diagnosis is considered the gold standard despite its low sensitivity of 57-84%. However, recent advances in cytological analysis offer promise for diagnostic advancements. In this study, we reappraised the current cytological guidelines for the MM diagnosis and concluded on their practicability and reliability. The study included 5731 consecutive specimens of pleural effusions from 4552 patients (3026 males of the average age of 67.5 years and 1526 females of the average age of 65.4 years) between December 2017 and January 2000. Out of these patients, 444 (9.8%) were diagnosed with MM. The effusions were examined by immunocytochemistry using routine Giemsa staining. Additionally, hyaluronic acid (HA) was assessed. Cytological findings confirmed 223 out of the 444 MM. The additional 88 cases with negative cytology were corroborated by supplemental assessments of HA above 30 mg/L. Cytological evaluation accomplished the sensitivity of 0.50, specificity of 0.99, and a positive predictive value (PPV) of 0.97 for MM diagnosis. The use of HA determination raised the sensitivity to 0.70 without affecting the specificity or PPV. We conclude that cytological evaluation of effusions aided by the assessment of HA demonstrates the diagnostic sensitivity and specificity for MM no less than the hitherto standard histological evaluation. The cytology-based MM diagnosis may thus be routinely considered when MM is suspected and may offer confirmatory advantages in difficult or doubtful diagnostic cases.


Assuntos
Adenocarcinoma , Mesotelioma Maligno , Mesotelioma , Derrame Pleural Maligno , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Masculino , Mesotelioma/complicações , Mesotelioma/diagnóstico , Mesotelioma/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/patologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Expert Rev Respir Med ; 16(1): 99-108, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34112035

RESUMO

OBJECTIVE: To accurately evaluate the diagnostic value of carcinoembryonic antigen (CEA) for malignant pleural effusion associated with lung cancer in the Chinese population. METHODS: Three English databases, PubMed, Embase and Web of Science, and two Chinese databases, China National Knowledge Infrastructure (CNKI) and Wanfang Data, up to 5 November 2020, were searched. The literature on the diagnosis of lung cancer-related malignant pleural effusion by CEA in the Chinese population were collected. The data was analyzed by Stata15.0 software. RESULTS: A total of 15 studies were included in the meta-analysis. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio were 0.80 (95% CI: 0.74-0.84), 0.92 (95% CI: 0.89-0.95), 10.46 (95% CI: 7.29-15.00), 0.22 (95% CI: 0.17-0.28), 47.26 (95% CI: 28.84-77.44), respectively . The area under the receiver operating characteristic curve was 0.93 (95% CI: 0.91-0.95). No significant publication bias was found (P > 0.05). CONCLUSION: CEA has anexcellent diagnostic value for patients with lung cancer-related malignant pleural effusion in the Chinese population.


Assuntos
Neoplasias Pulmonares , Derrame Pleural Maligno , Derrame Pleural , Biomarcadores Tumorais , Antígeno Carcinoembrionário , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Curva ROC , Sensibilidade e Especificidade
13.
Chest ; 161(5): 1407-1425, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34896096

RESUMO

Pleural disease is a common presentation and spans a heterogeneous population across broad disease entities; a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. This narrative review was based on a structured search of the literature. Searches were limited to 2010 onward, in recognition of the transformation in procedural complications following the mainstream use of thoracic ultrasound. Procedures of interest were limited to thoracocentesis, intercostal drains, indwelling pleural catheters (IPCs), and local anesthetic thoracoscopy. A total of 4,308 studies were screened, and 48 studies were identified for inclusion. Iatrogenic pneumothorax remains the most common complication following thoracocentesis (3.3%; 95% CI, 3.2-3.4), although pneumothorax requiring intervention was rare (0.3%; 95% CI, 0.2-0.4) when the procedure was ultrasound guided. Drain blockage and displacement were the most common complications following intercostal drain insertion (6.3% and 6.8%, respectively). IPC-related infections can be a significant problem (5.8%; 95% CI, 5.1-6.7). However, most cases can be managed without removal of the IPC. Local anesthetic thoracoscopy has an overall mortality of 0.1% (95% CI, 0.03-0.3). Data on safety and complication rates in procedural interventions are limited by methodologic problems, and novel methods to study this topic should be considered. Although complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events to ensure high quality and, above all, safe care.


Assuntos
Derrame Pleural Maligno , Pneumotórax , Anestésicos Locais , Cateteres de Demora/efeitos adversos , Tubos Torácicos , Humanos , Derrame Pleural Maligno/etiologia , Pneumotórax/etiologia , Fatores de Risco
14.
J Cancer Res Ther ; 17(6): 1580-1582, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34916402

RESUMO

Pulmonary pleomorphic carcinoma, a relatively rare histopathological subtype of non-small cell lung cancer, is a malignant neoplasm with a poor prognosis. Despite the reports of a good response to immune-checkpoint inhibitor, only a few reports of pembrolizumab as the first-line treatment exist. We report the case of a 78-year-old male with right lung mass, mediastinal, right neck, and supraclavicular lymphadenopathies. He was diagnosed with pulmonary pleomorphic carcinoma, cT4N3M1c, Stage IVB. The tumor cells showed high programmed death-ligand 1 (PD-L1) expression but no microsatellite instability. After three cycles of pembrolizumab as the first-line therapy, chest computed tomography revealed marked reduction in tumor diameter. No remarkable adverse events occurred. The patient is alive with no complaints and no disease progression and has continued pembrolizumab for 8 months. Thus, first-line pembrolizumab therapy appears beneficial against pulmonary pleomorphic carcinoma, at least when PD-L1 expression is high. It is also effective in elderly patients.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Carcinoma/tratamento farmacológico , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Derrame Pleural Maligno/tratamento farmacológico , Idoso , Antígeno B7-H1/análise , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/metabolismo , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Clin Chest Med ; 42(4): 625-635, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34774170

RESUMO

Pleural effusions (PEs) are frequently encountered in routine clinical practice, affecting more than 3000 people per million population every year. Heart and liver failures are two of the most common causes of transudative PE. Because these effusions have nonmalignant etiologies, they are commonly referred to as benign effusions despite of the poor prognosis they foretell in their refractory stages. Like malignant effusions, symptom management is important and plays a significant role in palliation when these effusions become refractory to medical therapy.


Assuntos
Insuficiência Cardíaca , Hidrotórax , Derrame Pleural Maligno , Derrame Pleural , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Fígado , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/terapia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia
17.
Pathol Res Pract ; 228: 153650, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34695620

RESUMO

A middle-aged female with history of multinodular goiter, Hashimoto disease, and chronic vitamin B12 deficiency presented with palpitations and subsequent exertional dyspnea. Initial radiographic analysis suggested mediastinal cavernous hemangioma, but biopsy showed features consistent with pleural hemangioma. Pleural hemangioma should be considered among the differential diagnoses for recurrent unilateral pleural effusion. Pleural hemangioma should be distinguished from other more common entities including the similarly benign pulmonary hemangioma and the more aggressive pleural hemangioendothelioma.


Assuntos
Hemangioma/patologia , Neoplasias Pleurais/patologia , Feminino , Hemangioma/complicações , Humanos , Pessoa de Meia-Idade , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações
18.
Zhongguo Fei Ai Za Zhi ; 24(9): 653-659, 2021 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-34256901

RESUMO

Lung cancer is the malignancy with the highest mortality rate worldwide. Malignant pleural effusion (MPE) caused by advanced lung cancer severely affects the quality of life and prognosis of patients. Tumor-associated genetic testing is the basis for making precise treatment decisions. There are some risks of tissue biopsy, and it is difficult to sample repeatedly. Due to its non-invasive and can reflect the full profile of tumor gene characteristics, liquid biopsy is increasingly used in the diagnosis and treatment of lung cancer. Because of the extremely low DNA level of circulating tumor, the sensitivity and specificity of liquid biopsy based on blood samples are limited. Tumor cells is enriched in MPE. The detection of cell-free DNA, extracellular vesicles and microRNA in MPE will be helpful to the diagnose, treatment and assess prognosis of patients with lung cancer. This review aims to discuss the research progress of liquid biopsy based on MPE in the diagnosis and treatment of lung cancer patients.
.


Assuntos
Biópsia Líquida , Neoplasias Pulmonares , Derrame Pleural Maligno , Humanos , Biópsia Líquida/tendências , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/patologia , Derrame Pleural Maligno/terapia , Qualidade de Vida
20.
World J Surg Oncol ; 19(1): 180, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134706

RESUMO

BACKGROUND: There have been many studies on the clinical characteristics of neutrophilic, lymphocytic, and/or eosinophilic pleural effusion. While caring for patients with pleural effusion, we found that histiocytic pleural effusion (HisPE) was not uncommon. However, few studies have explored HisPE. The purpose of the present study was to determine the clinical characteristics and etiologies of HisPE. METHODS: In this retrospective study, HisPE was defined as pleural fluid white blood cells comprised of ≥ 50% histiocytes. Using a clinical data warehouse, patients with HisPE among all patients aged >18 years who underwent thoracentesis and pleural fluid analysis between January 2010 and December 2019 at Ulsan University Hospital were enrolled. A total of 295 (9.0%) of 3279 patients who underwent thoracentesis were identified as HisPE patients. Among them, 201 with exudative HisPE were included. Clinical characteristics and etiologies were extracted from medical records and analyzed. RESULTS: Among the 201 patients with exudative HisPE, the major causes were malignant pleural effusion (n = 102 [50.7%]), parapneumonic effusion (n = 9 [4.5%]), and tuberculous pleurisy (n = 9 [4.5%]). In the 102 patients with malignant pleural effusion, the main types of cancer were lung (n = 42 [41.2%]), breast (n = 16 [15.7%]), and stomach cancer (n = 11 [10.8%]). Among lung cancers, adenocarcinoma (n = 34 [81.0%]) was the most common histology. CONCLUSIONS: The leading cause of exudative HisPE was malignancy, particularly lung cancer. Physicians should consider the possibility of malignant disease if histiocytes are predominantly present in pleural effusion.


Assuntos
Derrame Pleural Maligno , Derrame Pleural , Tuberculose Pleural , Diagnóstico Diferencial , Histiócitos , Humanos , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Derrame Pleural Maligno/etiologia , Prognóstico , Estudos Retrospectivos , Tuberculose Pleural/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...