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1.
Medicine (Baltimore) ; 100(18): e25692, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950950

RESUMO

INTRODUCTION: The relationship between chronic empyema and malignant tumors, most of which are lymphoma, has been recognized for many decades. Sarcomatoid carcinoma associated with chronic empyema is extremely rare, may metastasize to other organs in the early stage, and rapidly progresses to death. As far as we know, this was the first case report on sarcomatoid carcinoma associated chronic empyema. THE PATIENTS MAIN CONCERNS AND IMPORTANT CLINICAL FINDINGS: A 59-year-old man presented to our hospital with a 9-year history of chronic empyema and a chief complaint of left chest wall pain for 5 months. The diagnostic contrast-enhanced computed tomography (CT) showed a large irregular soft tissue mass located on the left lower hemithorax at the margin of the empyema cavity extending to the adjacent chest wall and lung parenchyma. In addition, CT revealed pleural and pulmonary metastases surrounded by ground glass opacity. THE MAIN DIAGNOSIS, THERAPEUTICS INTERVENTIONS, AND OUTCOMES: The patient underwent CT guided percutaneous core needle biopsy (PCNB). The histopathological evaluation showed carcinomatous proliferation of pleomorphic spindle cells with extensive necrosis. Immunohistochemically, tumor cells were positive for cytokeratin and vimentin. The final histopathological diagnosis was sarcomatoid carcinoma underlying chronic empyema. The tumors showed rapid progression on serial simple radiography. Palliative treatments were performed, but the patient still developed severe dyspnea and died shortly after on day 16. CONCLUSION: Sarcomatoid carcinoma can occur very rarely as a complication of chronic empyema, and is more aggressive than usual. Early detection of developing malignancy during the follow-up of chronic empyema is an important factor for patient prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Dor no Peito/etiologia , Empiema Pleural/diagnóstico , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pleurais/diagnóstico , Biópsia com Agulha de Grande Calibre , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/secundário , Empiema Pleural/etiologia , Evolução Fatal , Humanos , Neoplasias Renais/diagnóstico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pleura/diagnóstico por imagem , Pleura/patologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/secundário , Tomografia Computadorizada por Raios X
3.
Ann Thorac Surg ; 110(2): e81-e83, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035917

RESUMO

This report describes a rare case of osteosarcoma of the right distal femur and secondary spontaneous pneumothorax in a 13-year-old girl. Secondary spontaneous pneumothorax complicating metastatic osteosarcoma is a rare but well-known phenomenon, with several suggested hypotheses for its pathogenesis. However, these hypotheses have not been confirmed. In the present case, the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma was determined grossly, radiologically, and histopathologically. These findings may help to clarify further the pathogenesis of secondary spontaneous pneumothorax complicating metastatic osteosarcoma.


Assuntos
Neoplasias Femorais/patologia , Osteossarcoma/complicações , Osteossarcoma/secundário , Neoplasias Pleurais/complicações , Neoplasias Pleurais/secundário , Pneumotórax/etiologia , Adolescente , Feminino , Humanos
4.
J Vasc Interv Radiol ; 31(2): 294-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31899108

RESUMO

PURPOSE: To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS: This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS: Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS: Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia , Manejo da Dor , Dor/prevenção & controle , Cuidados Paliativos , Neoplasias Pleurais/cirurgia , Parede Torácica/cirurgia , Idoso , Analgésicos Opioides/administração & dosagem , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Fatores de Tempo , Resultado do Tratamento
5.
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 por Emissão de Pósitrons combinada à Tomografia Computadorizada , 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
6.
Chest ; 156(6): e121-e126, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31812210

RESUMO

CASE PRESENTATION: A man in his 20s presented to the ED after several months of progressive dyspnea, dry cough, and night sweats. He had no chest pain, fevers, weight loss, or sick contacts. He was previously healthy and took no medications. Social history was notable for 5 pack-years of tobacco use. The patient was sexually active with male partners and had a recent partner infected with human T-lymphotropic virus. The patient worked in set design and window installations, and wore a respirator when working around solvents and resins. From ages 2 to 7 years, he frequently visited buildings at his parents' workplace that were undergoing asbestos abatement. From ages 7 to 24 years, he frequently visited pottery studios where talc-containing products were used. He frequently visited northern Massachusetts, and infections with Borrelia burgdorferi and Bartonella henselae were common in family members. His stepfather had recently been infected with Anaplasma. There was no family history of cancer.


Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural Maligno/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico , Adenocarcinoma de Pulmão/diagnóstico , Adulto , Asbestos , Infecções por Bartonella/diagnóstico , Biópsia , Tosse/etiologia , Diagnóstico Diferencial , Dispneia/etiologia , Exposição Ambiental , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico , Masculino , Mesotelioma/complicações , Mesotelioma/patologia , Tonsila Palatina/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Tomografia por Emissão de Pósitrons , Baço/diagnóstico por imagem , Sudorese , Talco , Cirurgia Torácica Vídeoassistida
7.
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
8.
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
9.
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
10.
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
11.
Rev Esp Enferm Dig ; 111(6): 494-495, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31166112

RESUMO

Malignant mesothelioma usually originates from the pleura or peritoneum, and has a poor prognosis. The incidence of this type of tumor is increasing worldwide, which is probably a result of occupational or environmental exposure to asbestos. In 90% dyspnea, chest pain or a combination of both are usually the initial symptoms. Dysphagia only occurs in 1.4% and is very rare as the initial symptom. We present the case of a middle-aged patient, in whom the initial symptom was dysphagia, so an endoscopy was performed. This showed extrinsic compression of the esophagus that was demonstrated when performing the chest X-ray, in which it was revealed a posterior mediastinal mass surrounding the esophagus concentrically without mucosal invasion.


Assuntos
Transtornos de Deglutição/etiologia , Mesotelioma/complicações , Neoplasias Pleurais/complicações , Idoso , Humanos , Masculino
13.
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
15.
Respiration ; 98(2): 133-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31018210

RESUMO

BACKGROUND: There is no randomized study comparing pleural cryobiopsy (CB) and flexible forceps biopsy (FFB) in subjects undergoing medical thoracoscopy for the diagnosis of pleural effusions. OBJECTIVE: In this crossover study, we compared the diagnostic yield of CB versus FFB in subjects undergoing semirigid thoracoscopy. METHODS: Subjects undergoing semirigid thoracoscopy for undiagnosed pleural effusions were subjected to both CB and FFB, with the order of performing the biopsy randomized in a 1:1 ratio. The primary outcome was the diagnostic yield obtained with CB versus FFB. The secondary outcomes included the biopsy size, depth, histologic interpretability, artefacts, the difficulty of performing biopsy on an operator-rated visual analog scale, the severity of bleeding observed at the time of the biopsy, and the duration of the procedure. RESULTS: Of the 201 subjects screened, 50 (mean age 52.4 years; 18 women) were included. The diagnostic yield of CB (78.0%) was not different from FFB (76.0%, p = 1.00). CB yielded a larger specimen than FFB (median size 7.0 vs. 4.0 mm; p < 0.001), and a greater depth of specimens (up to the pleural fat or deeper, CB vs. FFB 65.2 vs. 40.8%; p = 0.02). The CB procedure was quicker than FFB (median duration 10 vs. 15 min; p < 0.001). There were no significant differences in the difficulty of performing the biopsy, the severity of bleeding, histologic interpretability, or artefacts in the specimens between the CB and FFB groups. CONCLUSION: The diagnostic yield of pleural CB was comparable to FFB during semirigid thoracoscopy.


Assuntos
Biópsia/métodos , Criocirurgia/métodos , Pleura/patologia , Derrame Pleural Maligno/patologia , Derrame Pleural/patologia , Toracoscopia/métodos , Tuberculose Pleural/patologia , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Instrumentos Cirúrgicos , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico , Adulto Jovem
16.
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
18.
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
19.
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
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