• Asian Pacific Journal of Cancer Prevention
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• v.16 no.7
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• pp.3057-3060
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• 2015

Background: Cytological examination of pleural effusions is very important in the diagnosis of malignant lesions. Thoracentesis is the first investigation to be performed in a patient with pleural effusion. In this study, we aimed to compare traditional with cell block methods for diagnosis of lung disease accompanied by pleural effusion. Materials and Methods: A total of 194 patients with exudative pleural effusions were included. Ten mililiters of fresh pleural fluid were obtained by thoracentesis from all patients in the initial evaluation. The samples gathered were divided to two equal parts, one for conventional cytological analysis and the other for analysis with the cell block technique. In cytology, using conventional diagnostic criteria cases were divided into 3 categories, benign, malignant and undetermined. The cell block sections were evaluated for the presence of single tumor cells, papillary or acinar patterns and staining with mucicarmine. In the cell block examination, in cases with sufficient cell counts histopathological diagnosis was performed. Results: Of the total undergoing conventional cytological analyses, 154 (79.4%)were reported as benign, 33 (17%) as malignant and 7 (3.6%) as suspicious of malignancy. With the cell block method the results were 147 (75.8%) benign, 12 (6.2%) metastatic, 4 (2.1%) squamous cell carcinoma, 18 (9.3%) adenocarcinoma, 5 (2.6%) large cell carcinoma, 2 (1%) mesothelioma, 3 (1.5%) small cell carcinoma, and 3 (1.5%) lymphoma. Conclusions: Our study confirmed that the cell block method increases the diagnostic yield with exudative pleural effusions accompanying lung cancer.

• Radiation Oncology Journal
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• v.37 no.2
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• pp.101-109
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• 2019

Purpose: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). Materials and Methods: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. Results: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). Conclusion: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.

• Tuberculosis and Respiratory Diseases
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• v.71 no.5
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• pp.355-358
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• 2011

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful, safe diagnostic modality for evaluating mediastinal and hilar lymphadenopathy. We report a 51-year-old male who presented with a left renal mass and multiple pleural masses without lung parenchymal lesions. The pleural masses were thought to be metastatic tumors or malignant mesothelioma. The patient underwent two percutaneous needle biopsies of the pleural mass, but the specimens were insufficient for a histopathological diagnosis. Because one pleural mass was adjacent to the right main bronchus, we decided to perform EBUS-TBNA for the pleural mass. As a result, sufficient core tissue was obtained with no complications, and the histopathological findings were consistent with metastatic papillary renal cell carcinoma. To our knowledge, this is the first case of using EBUS-TBNA for a pleural mass.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.664-668
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• 1996

Malignant mesothelioma has been considered a uniformly fatal disease associated with a median survival of 4 to 18 months. However, a multimodality approach toward therapy may Increase the length of palliation when a maximal resection of tumor is achieved. Recently we have experienced a 49 years-old male patient who had d ffuse malignant mesothelioma. The patient has complained of blood-tinged sputum and right chest pain for several months. Chest x-rays and CT scans showed compact haziness in the right entire thorax with massive bloody elusion, diffuse pleural thickening and collapsed underlying lung. We performed extrapleural pneumonectomy, and postoperative chemotherapy with cisplatin and mltomycin (Memorial Sloan-fettering Cancer Center method) was done. We are observing him for months now and there is no evidence of local recurrence.

• Journal of Veterinary Clinics
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• v.41 no.3
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• pp.170-177
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• 2024

An adult male dog was presented for hemorrhagic pericardial effusion. Echocardiography and computed tomography revealed nodule-like lesions on the pericardium. Cytology of pericardial effusion and excisional pericardial lesions indicated neoplastic effusion. Histopathology indicated an inflamed neoplasm with a primary differential diagnosis of hemangiosarcoma and malignant mesothelioma (MM). Immunohistochemistry showed that atypical cells were positive for cytokeratin and vimentin, but negative for CD31, strongly favoring pericardial MM. Postoperative NT-proBNP level remained increased, which led to the administration of epirubicin to minimize potential cardiotoxicity. During the 4 cycles of epirubicin treatment, a total cumulative dose of 108 mg/m² was administrated and no effusion recurrence was observed. After a month post-completion of chemotherapy, however, pleural effusion was detected with cardiac masses. The owner requested no further diagnostic investigations and chemotherapy. Due to deteriorating conditions, the dog died 132 days after the first presentation. Our case is the first notable attempt to treat canine malignant mesothelioma with epirubicin, providing the clinicopathologic, diagnostic routine, and clinical course of the affected dog.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.112-114
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• 1996

Localized fibrous tumor of the pleura (LFTP) is of submesothelial fibrous origin, which has been called pleural fibroma and has been confused with mesothelioma. We experienced a case of LFTP in a twenty nine year old man. The tumor arose from the right parietal pleura with long stalk. Chest X-ray and CT scan showed a 6$\times$5$\times$4cm well-defined mass in the right costophrenic angle. Wo evidence of metastasis was noted. Exploratory thoracotomy with enbloc excision of 6$\times$5$\times$4cm mass was done. The fine needle aspiration cytology and histopathologic features indicated the tumor to be malignant, and biologic behavior was discussed.

• Journal of Chest Surgery
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• v.33 no.2
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• pp.203-206
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• 2000

A 44-year-old man was transferred to our department for mediastinal mass. He had suffered from only an easily fatiguable condition for 1 month. A physical examination and laboratory finding of the patient disclosed no abnormality. A chest radiograph showed a soft tissue tumor in the posterior mediastinum. It was well circumscribed and ovoid. Invasions to adjacent organs were not seen. Therefore it was though the 5th intercostal space. The tumor mass was attached to the visceral pleura of the right upper lobe by a pedicle and this pedunculated tumor laid entirely within the pleural cavity. Excision of the tumor which measured 7$\times$7$\times$3cm was done easily. Pathologic studies confirmed the diagnosis of localized fibrous tumor of the pleura. Localized fibrous tumor of the pleura is rare, This tumor along ith the evidence from ultrastructural and immunohistochemical studies has led most researchers to conclude that localized fibrous tumor is not of the mesothelial origin but arises in the submesothelial connective tissue.

• The Korean Journal of Cytopathology
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• v.14 no.1
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• pp.36-41
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• 2003

Epithelioid hemangioendothelioma is a rare vascular tumor of borderline malignancy which is characterized by the presence of "epithelioid" or "histiocytoid" endothelial cells. Superficial and deep tumors have been recognized in the extremities, head, neck, chest, and mediastinum of adult patients. It may also occur as a primary tumor of liver, bone, and other visceral organs. Few effusion cytologic findings of epithelioid hemangioendothelioma have been reported. We report a case of composite epithelioid hemangioendothelioma with focal epithelioid angiosarcomatous areas of the iliac bone and adjacent soft tissue in a 38-year-old female, which, during its metastatic course, was presented as a pleural effusion. The effusion was cellular with epithelioid cells presenting both singly and in clusters. The tumor cells were round to ovoid shewing cytoplasmic vacuolization, variability in cell size, and prominent nucleoli. The effusion smears and cell block sections revealed strong positive staining for CD31 and vimentin, weak positive for CD34 and Factor VIII-related antigen, and negative for cytokeratin, CEA, and calretinin. The cytologic findings in this case were similar to that of metastatic adenocarcinoma or malignant mesothelioma. Therefore, immunocytochemical staining in smear and cell block is a helpful tool to differentiate malignant 'epithelioid' cells in effusion.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.35-40
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• 2018

Background: The treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery. Methods: The records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared. Results: The overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23). Conclusion: Multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

• Journal of the Optical Society of Korea
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• v.20 no.5
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• pp.607-613
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• 2016

The pleura is known as an end target organ of exposure to toxic environmental materials such as fine particulate matter and asbestos. Moreover, long-term exposure to hazardous materials can eventually lead to fatal lung disease such as diffuse pleural fibrosis or mesothelioma. Chest computed tomography (CT) and ultrasound are gold standard imaging modalities for detection of advanced pleural disease. However, a diagnostic tool for early detection of pleural reaction has not been developed yet due to difficulties in imaging ultra-fine structure of the pleura. Optical coherence tomography (OCT), which provides cross-sectional images of micro tissue structures at a resolution of 2-10 μm, can image the mesothelium with a thickness of ~100 μm and therefore enables investigation of the early pleural reaction. In this study, we induced the early pleural reaction according to a time sequence after pleurodesis using talc, which has been widely used in the clinical field. The pleural reaction in talc grouped according to the time sequence (1st, 2nd, 4th weeks) showed a significant thickening (average thickness: 45 ± 7.5 μm, 80 ± 10.7 μm, 90 ± 12.5 μm), while the pleural reaction in sham and normal groups showed pleural change from normal to minimal thickening (average thickness: 16 ± 5.5 μm, 17 ± 4.5 μm, 15 ± 6.5 μm, and 12 ± 7.5 μm, 13 ± 2.5 μm, 12 ± 3.5 μm). The measurement of pleural reaction by pathologic examinations was well-matched with the measurement by OCT images. This is the first study for measuring the thickness of pleural reactions using a biophotonic modality such as OCT. Our results showed that OCT can be useful for evaluating the early pleural reaction.