Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 770
Filtrar
1.
Clin Nucl Med ; 45(3): e148-e150, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977466

RESUMO

We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up Tc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible focus of glucidic hypermetabolism. Our case report raises the association between prostate cancer patients treated with external beam radiotherapy and the development of pleural mesothelioma despite having no history of exposure to asbestos.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Mesotelioma/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/complicações , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Difosfonatos , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/complicações , Masculino , Mesotelioma/complicações , Compostos de Organotecnécio , Neoplasias Pleurais/complicações , Neoplasias da Próstata/sangue , Compostos Radiofarmacêuticos
2.
Medicine (Baltimore) ; 98(48): e18251, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770288

RESUMO

RATIONALE: Small cell carcinoma (SCC) occurs mostly in the lung, and small cell lung cancer accounts for 13% of newly diagnosed lung cancers. Only 2.5% of SCC occurs in extrapulmonary sites, and SCC of pleural origin is especially very uncommon. PATIENT CONCERNS: An 85-year-old man presenting with progressive dyspnea for more than 7 days. DIAGNOSES: Computed tomography scan of the chest showed massive pleural effusion and diffuse nodular thickening of the pleura on the right chest. Sonography-guided needle biopsy of the pleural mass was performed and histologic and immunohistochemical findings revealed SCC. Since no parenchymal lung lesion was observed, the patient was finally diagnosed with SCC of the pleura (SCCP). INTERVENTIONS: Due to the patient's old age and poor performance status, chemotherapy was not performed and only drainage of pleural effusion was conducted for symptom relief. OUTCOMES: Dyspnea improved after pleural effusion drainage. The patient was discharged and transferred to a local medical center for hospice care. LESSONS: Although primary SCCP is extremely rare, SCCP should also be considered as well as mesothelioma in case of presence of a pleural-based mass with massive pleural effusion.


Assuntos
Carcinoma de Células Pequenas , Dispneia , Derrame Pleural Maligno , Neoplasias Pleurais , Toracentese/métodos , Idoso de 80 Anos ou mais , Carcinoma de Células Pequenas/complicações , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/fisiopatologia , Dispneia/diagnóstico , Dispneia/etiologia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/fisiopatologia , Derrame Pleural Maligno/terapia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
3.
Anticancer Res ; 39(9): 5219-5223, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519636

RESUMO

AIM: This study evaluated the prognostic value of soluble mesothelin-related protein (SMRP) levels in pleural effusions (PE) from patients with pleural mesothelioma (MPM). PATIENTS AND METHODS: SMRP level in PE was tested using an enzyme-linked immunosorbent assay (ELISA) in 109 patients with MPM at diagnosis before any treatment. The Kaplan-Meier method and the Cox regression were applied to compare overall survival probabilities across tertile categories of SMRP level. RESULTS: No significant differences in Kaplan-Meier overall survival probabilities among the SMRP categories were found. A statistically non-significant trend for increased death rate ratio (RR) was computed (p=0.327) when the higher (>46.5 nM, RR=1.38) and intermediate (8.5-46.5 nM, RR=1.18) SMRP categories were compared to the lower category (<8.5 nM, RR=1.00). Cox regression modelling including a restricted cubic spline showed a moderately rising non-linear trend in death rate. CONCLUSION: The SMRP level in PE does not appear to have prognostic significance and its detection is not recommended in routine clinical management of patients with MPM.


Assuntos
Proteínas Ligadas por GPI/metabolismo , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Mesotelioma/complicações , Mesotelioma/mortalidade , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/metabolismo , Neoplasias Pleurais/complicações , Neoplasias Pleurais/mortalidade , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/terapia , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/terapia , Prognóstico , Curva ROC , Resultado do Tratamento
4.
J Pak Med Assoc ; 69(8): 1103-1107, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431761

RESUMO

OBJECTIVE: To assess the diagnostic value of video-assisted thoracoscopic surgery in exudative pleural effusions, and to evaluated the frequency of malignancy development with long term follow-up of patients defined as nonspecific pleuritis after surgery. . METHODS: The retrospective study was conducted at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, and comprised data of patients with undiagnosed exudative pleural effusions seen between January 2008 and December 2013. Data related to clinical, radiological, thoracoscopical, histopathological and follow-up periods were obtained from the hospital records. SPSS 15 was used for data analysis. RESULTS: Of the 229 patients, 145(63.3%) were males and 84(36.7%) were females. The overall mean age was 54.5 }15.1 years. Malignancy was found in 84 (36.6%) patients, and tuberculosis in 26(11.4%). The remaining 119(52%) patients had nonspecific pleuritis and their mean follow-up period was 29.2}27.1 months (range: 1-103 months). Video-assisted thoracoscopic surgery was repeated in 3(2.52%) patients in the 1st, 4th and 16th months of followup period due to the recurrence of pleural effusion. Tuberculosis and mesothelioma were diagnosed in 1(0.8%) and 2(1.7%) cases, respectively. CONCLUSIONS: Video-assisted thoracoscopic surgery was found to be a valuable diagnostic procedure in patients with undiagnosed exudative pleural effusion.


Assuntos
Neoplasias Pulmonares/diagnóstico , Linfoma/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural/etiologia , Neoplasias Pleurais/diagnóstico , Pleurisia/diagnóstico , Tuberculose Pleural/diagnóstico , Adulto , Idoso , Biópsia , Exsudatos e Transudatos , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Linfoma/complicações , Linfoma/patologia , Masculino , Mesotelioma/complicações , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Pleurisia/complicações , Pleurisia/patologia , Estudos Retrospectivos , Toracentese , Cirurgia Torácica Vídeoassistida , Tuberculose Pleural/complicações , Tuberculose Pleural/patologia , Turquia
5.
J Bronchology Interv Pulmonol ; 26(3): 210-218, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31211722

RESUMO

BACKGROUND: This study aimed to prospectively evaluate the efficacy and reliability of a diagnostic workup, triaging pleural biopsy method according to baseline computerized tomography (CT) findings in the diagnosis of pleural diseases. METHODS: Patients with pleural pathology were divided into 3 arms according to findings on CT scan images. Arm A: patients with pleural thickening/lesion in addition to pleural effusion. These patients underwent CT scan-guided Abrams' needle pleural biopsy. Arm B: patients with pleural effusion alone or suspected benign asbestos pleurisy. This group underwent medical thoracoscopy (MT). Arm C: patients with only pleural thickening. This group underwent ultrasonography-guided cutting needle pleural biopsy. MT was planned in patients who did not have a specific diagnosis in the CT scan-guided Abrams' needle pleural biopsy group. When patients with a histopathologic diagnosis of fibrinous pleuritis after MT were assessed in terms of the risk factors for malignant pleural diseases, we offered a further invasive procedure. RESULTS: A total of 164 patients were enrolled in the study. Diagnostic sensitivity after the initial procedure was 90.2% in Arm A, 93.3% in Arm B, 95.2% in Arm C, and 92.4% in the entire workup. The negative predictive value of the entire workup was 90.4% for malignant pleural mesothelioma, 97.1% for metastatic malignant pleural diseases, and 100% for tuberculous pleurisy. Five cases who had a diagnosis of fibrinous pleuritis after MT were detected to have risk factors, 4 of which (80%) indicated malignant disease. Complication rates were low and acceptable. CONCLUSION: Use of CT scans to triage an appropriate pleural biopsy method is associated with high diagnostic success. We recommend that the proposed diagnostic workup in this study may be used as a diagnostic algorithm for pleural diseases that require a histopathologic analysis. Determination of risk factors predicting malignant disease in patients where fibrinous pleuritis is reported after MT would be useful for clinical practice.


Assuntos
Biópsia Guiada por Imagem , Mesotelioma/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Pleural/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Masculino , Mesotelioma/complicações , Mesotelioma/patologia , Pessoa de Meia-Idade , Seleção de Pacientes , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural/etiologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Valor Preditivo dos Testes , Estudos Prospectivos , Toracoscopia , Triagem , Tuberculose Pleural/complicações , Tuberculose Pleural/patologia , Adulto Jovem
7.
QJM ; 112(8): 599-604, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31120124

RESUMO

BACKGROUND: Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM: To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN: Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected included gender, age, origin of malignancy, number of drains prior to IPC, whether they had received pleurodesis prior to IPC, presence of a trapped lung, date of insertion, documented complications, overall outcome and date of death. RESULTS: A total of 68 patients received an IPC, the majority were female (n = 38, 57%) with an overall median age of 68 years (range 40-90 years). The most common site of cancer origin was lung (n = 33, 49%) followed by pleura (n = 10, 15%) and breast (n = 9, 13%). The median survival of all patients was 141 days (IQR 26-181). Sixteen percent (n = 11) of patients underwent a spontaneous pleurodesis resulting in their IPC being removed. Only three individuals had a complication (4.4%). CONCLUSIONS: IPC insertion is a safe procedure and represents an exciting and expanding field in the management of pleural disease. Further longitudinal studies are required to fully delineate their place in the management of both malignant and benign effusions.


Assuntos
Cateterismo/instrumentação , Cateteres de Demora , Drenagem/instrumentação , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Cateterismo/efeitos adversos , Drenagem/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações , Estudos Retrospectivos , Taxa de Sobrevida
8.
Ann Biol Clin (Paris) ; 77(2): 187-190, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907376

RESUMO

Primary plasma cell leukemia (PPCL) is an aggressive and rare variant of multiple myeloma (MM), with frequent extramedullary involvement, mainly liver and splenic lesions. Pleuropulmonary involvement has rarely been described in the literature. We report a case of primary plasma cell leukemia in a 46-year-old patient, whose first symptom was pleural effusion with mediastinal adenopathies simulating a pleural localization of a lymphomatous process. However, blood smear examination, electrophoresis as well as immunofixation of plasma proteins and immuno-histochemistry have helped to guide the diagnosis. Pleurisy is a rare mode of revelation of plasma cell leukemia and is a factor of poor prognosis.


Assuntos
Leucemia Plasmocitária/diagnóstico , Neoplasias Pleurais/diagnóstico , Pleurisia/diagnóstico , Evolução Fatal , Feminino , Humanos , Leucemia Plasmocitária/complicações , Leucemia Plasmocitária/patologia , Pessoa de Meia-Idade , Marrocos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Pleurisia/etiologia , Pleurisia/patologia , Radiografia Torácica
10.
Cancer Epidemiol ; 59: 75-82, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30708341

RESUMO

BACKGROUND: Historically pleural infection was thought to be associated with longer survival in thoracic malignancies. The aim of this population-based cohort study was to investigate this hypothesis in mesothelioma, using national data from a high incidence country. METHODS: Case records for all patients with mesothelioma seen in English hospitals between 01/01/2005 and 31/12/2014 were extracted from Hospital Episode Statistics using International Classification of Diseases Tenth Edition (ICD-10) codes. Episodes of pleural infection were identified. Linked mortality data was obtained from the Office of National Statistics. The primary outcome was all-cause mortality. The explanatory variable was pleural infection. Cox proportional hazards model was used to analyse survival, with pleural infection, chemotherapy and thoracic surgery handled as time-variable co-factors. RESULTS: Of 22,215 patients with mesothelioma, 512 (2.3%) developed pleural infection at some point in their illness. Overall median survival was 7.0 months (IQR 2.3-16.4). Pleural infection was associated with shorter survival in the immediate post-infection period (up to 30 days - HR 1.81, 95% CI 1.45-2.22) and longer term (>30 days - HR 1.81, 95% CI 1.63-1.99). Other factors associated with increased mortality were age, male gender and being diagnosed as an inpatient. Receiving chemotherapy and being less economically deprived were associated with longer survival. CONCLUSION: Pleural infection occurred in 2.3% of people with mesothelioma and was associated with shorter survival. This refutes previous reports suggesting pleural infection may be associated with better outcomes in thoracic malignancy.


Assuntos
Infecções/complicações , Mesotelioma/mortalidade , Pleura , Neoplasias Pleurais/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Mesotelioma/complicações , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Modelos de Riscos Proporcionais
11.
BMJ Open Respir Res ; 6(1): e000368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30687504

RESUMO

Introduction: One of the most debilitating symptoms of malignant pleural mesothelioma (MPM) is dyspnoea caused by pleural effusion. MPM can be complicated by the presence of tumour on the visceral pleura preventing the lung from re-expanding, known as trapped lung (TL). There is currently no consensus on the best way to manage TL. One approach is insertion of an indwelling pleural catheter (IPC) under local anaesthesia. Another is video-assisted thoracoscopic partial pleurectomy/decortication (VAT-PD). Performed under general anaesthesia, VAT-PD permits surgical removal of the rind of tumour from the visceral pleura thereby allowing the lung to fully re-expand. Methods and analysis: MesoTRAP is a feasibility study that includes a pilot multicentre, randomised controlled clinical trial comparing VAT-PD with IPC in patients with TL and pleural effusion due to MPM. The primary objective is to measure the SD of visual analogue scale scores for dyspnoea following randomisation and examine the patterns of change over time in each treatment group. Secondary objectives include documenting survival and adverse events, estimating the incidence and prevalence of TL in patients with MPM, examining completion of alternative forms of data capture for economic evaluation and determining the ability to randomise 38 patients in 18 months. Ethics and dissemination: This study was approved by the East of England-Cambridge Central Research Ethics Committee and the Health Research Authority (reference number 16/EE/0370). We aim to publish the outputs of this work in international peer-reviewed journals compliant with an Open Access policy. Trial registration: NCT03412357.


Assuntos
Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Derrame Pleural Maligno/cirurgia , Neoplasias Pleurais/cirurgia , Pleurodese/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Cateteres de Demora , Ensaios Clínicos Fase III como Assunto , Inglaterra/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/complicações , Mesotelioma/mortalidade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Projetos Piloto , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/mortalidade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/mortalidade , Pleurodese/efeitos adversos , Pleurodese/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Análise de Sobrevida , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/instrumentação , Resultado do Tratamento
12.
Thorac Cancer ; 10(2): 365-368, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30511801

RESUMO

Intrathoracic liposarcoma can occur in the lung, mediastinum, pleura, and chest wall, and tends to remain clinically silent until becoming large enough to displace adjacent structures. Treatment usually includes sufficient surgical resection followed when necessary by adjuvant chemoradiotherapy. We report a case of an uncommon presentation of a rapidly growing pleural liposarcoma, the diagnosis of which may have been obscured by coexisting thoracic trauma with suspected extrapleural hematoma.


Assuntos
Hematoma/diagnóstico , Lipossarcoma/diagnóstico , Neoplasias Pleurais/diagnóstico , Diagnóstico Diferencial , Feminino , Hematoma/complicações , Hematoma/diagnóstico por imagem , Humanos , Lipossarcoma/complicações , Lipossarcoma/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico por imagem , Prognóstico , Tomografia Computadorizada por Raios X
13.
J Thorac Oncol ; 14(2): 288-293, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30366103

RESUMO

INTRODUCTION: Malignant pleural mesothelioma (MPM) is an uncommon cancer with a poor prognosis and heterogeneous survival. Surgery for MPM is offered in some specialist centers to highly selected patients. A previously described classification and regression tree (CART) model stratified survival in unselected MPM patients using routinely collected clinical data. This study aimed to examine the performance of this CART model on a highly selected surgical population. METHODS: Data were collected from subjects undergoing cytoreductive surgery for MPM from specialist centers in Hyõgo, Japan, and Sydney, Australia, between 1991 and 2016. The CART model was applied using the combination of clinical variables to stratify subjects into risk groups (1 through 4); survival characteristics were then compared. RESULTS: Two hundred eighty-nine cases were included (205 from Australia, 84 from Japan). Overall median survival was 34.6 (interquartile range: 17.5-56.1) months; median age was 63.0 (interquartile range: 57.0-67.8) years, and 83.0% (n = 240) were male. There were no clinically meaningful differences between the two cohorts. Survival across the four risk groups was significantly different (p < 0.0001); the model stratified survival well with a Harrell's concordance statistic of 0.62 (95% confidence interval: 0.57-0.66) at 36 months. The group with the longest survival (median, 82.5 months) had: no weight loss, hemoglobin > 153 g/L and serum albumin > 43 g/L at time of referral to the surgical center. CONCLUSIONS: Using routinely available clinical variables, the CART model was able to stratify surgical patients into risk groups with statistically different survival characteristics with fair to good performance. Presence of weight loss, anemia, and low albumin should confer caution when considering surgical therapy for MPM.


Assuntos
Mesotelioma/cirurgia , Modelos Estatísticos , Neoplasias Pleurais/cirurgia , Idoso , Anemia/sangue , Dor no Peito/etiologia , Procedimentos Cirúrgicos de Citorredução , Dispneia/etiologia , Feminino , Indicadores Básicos de Saúde , Hemoglobinas/metabolismo , Humanos , Masculino , Mesotelioma/sangue , Mesotelioma/complicações , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Pleurais/sangue , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Medição de Risco/métodos , Fatores de Risco , Albumina Sérica/metabolismo , Taxa de Sobrevida , Perda de Peso
18.
Ann Thorac Surg ; 106(4): e201-e203, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29689238

RESUMO

A 44-year-old man presented with spontaneous massive hemothorax. Computed tomographic scan revealed thickened and nodular pleura with no evidence of lung tumor. The patient underwent right open total pleurectomy. Histopathologic and immunohistochemical studies of the pleura confirmed poorly differentiated sarcomatoid squamous cell carcinoma of the lung with metastasis to the pleura. The carcinoma was psuedomesothelimatous type because of its presentation as diffuse pleural thickening. This presentation of sarcomatoid cancer as pseudomesotheliomatous type with massive hemothorax is rare and can be considered as a differential diagnosis in diffuse pleural thickening or hemothorax, especially in the absence of a clinically identifiable primary lung tumor.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Hemotórax/etiologia , Mesotelioma/diagnóstico , Neoplasias Pleurais/complicações , Sarcoma/complicações , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Hemotórax/diagnóstico , Hemotórax/cirurgia , Humanos , Masculino , Mesotelioma/complicações , Mesotelioma/cirurgia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/cirurgia , Sarcoma/diagnóstico , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X
19.
Intern Med ; 57(17): 2541-2545, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29607973

RESUMO

A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.


Assuntos
Neoplasias Ósseas/secundário , Mesotelioma/patologia , Neoplasias Pleurais/patologia , Biópsia , Humanos , Dor Lombar/etiologia , Masculino , Mesotelioma/complicações , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico
20.
BMC Pulm Med ; 18(1): 56, 2018 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-29615010

RESUMO

BACKGROUND: Malignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients. METHODS: From July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors. RESULTS: Eventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6-20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM. CONCLUSIONS: MT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.


Assuntos
Neoplasias Pulmonares , Mesotelioma , Pleura , Neoplasias Pleurais , Toracoscopia/métodos , Adulto , Idoso , Biópsia/métodos , China/epidemiologia , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/complicações , Mesotelioma/diagnóstico , Mesotelioma/mortalidade , Mesotelioma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA