• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.85-89
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• 2014

Pleural metastasis from breast cancer is a common manifestation. While pleural effusion is the most frequent finding, it is relatively rare for pleural nodularity and plaque that do not accompany pleural effusion. We report a patient with a rapidly growing huge pleural mass without pleural effusion caused by breast cancer. The patient was treated for severe dyspnea caused by the pleural mass. Along with the case report, we performed a systematic review of management of dyspnea in terminal cancer patients.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1109-1120
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• 2020

Pleural masses may be caused by various conditions, including benign and malignant neoplasms and non-neoplastic tumorlike conditions. Primary pleural neoplasms include solitary fibrous tumor, malignant mesothelioma, and primary pleural non-Hodgkin's lymphoma. Metastatic disease is the most common neoplasm of the pleura and may uncommonly occur in patients with hematologic malignancy, including lymphoma, leukemia, and multiple myeloma. Pleural effusion is usually associated with pleural malignancy. Rarely, pleural malignancy may arise from chronic empyema, and the most common cell type is non-Hodgkin's lymphoma (pyothorax-associated lymphoma). Non-neoplastic pleural masses may be observed in several benign conditions, including tuberculosis, pleural plaques caused by asbestos exposure, and pleural loose body. Herein, we present a review of benign and malignant pleural neoplasms and tumorlike conditions with illustrations of their computed tomographic images.

• The Korean Journal of Cytopathology
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• v.6 no.2
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• pp.125-132
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• 1995

Cytodiagnosis of pleural and ascitic fluid is a commonly performed laboratory examination. Especially, positivity for malignant cells in effusion cytology is very effective and also presents the first sign of malignancy in unknown primary site of the tumor. We examined each 34 cases of pleural and ascitic fluid cytologic specimen diagnosed as metastatic tumor, which was selected among 964 pleural fluid cytology cases and 662 ascitic fluid cytology cases from September 1989 to June 1995. Among the pleural fluid cytology specimens examined, 34 specimens were positive in 27 patients. The lung was the most frequent primary site(44%), followed by the stomach (12%), lymphoreticular neoplasm(12%), pancreas(3%) and colon(3%). And the cases of unknown primary site with positive pleural biopsy alone were 24%. Among trio ascitic fluid cytology specimens examined, 34 specimens were positive in 29 patients. The most common primary neoplasms. were carcinomas of ovary(32%), stomach(22%), colon(6%), breast(3%), pancreas(3%), and lung(3%) and lymphoreticular neoplasms(3%) The metastatic tumor was predominantly adenocarcinoma type in both pleural(82%) and ascitic(91%) fluid. The study of metastatic adeno- carcinoma in effusion from lung, ovary, and stomach was undertaken to find distinctive features for the identification of the primary site. The smears of metastatic pulmonary adenocarcinoma had a tendency to show high grade pleomorphism and many large tight cell clusters, whereas that of the ovarian adenocarcinoma showed low grade pleomorphism with abundant intracytoplasmic vacuoles in relatively clear background. That of the stomach revealed the intermediate features.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.74-78
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• 2011

Herein, we report a case of recurrent pleural metastasis after complete resection of invasive thymoma that was successfully treated with surgical resection. Thymoma and thymic carcinoma are uncommon neoplasms derived from the epithelial cells of the thymus. Approximately 30% to 50% of thymomas are asymptomatic at the time of diagnosis. However, these cancers may present with constitutional or local pressure symptoms and sometimes with paraneoplastic syndromes, especially myasthenia gravis. Surgical resection is the mainstay of thymoma treatment and has been shown to remarkably improve long-term survival. Despite complete resection, local recurrences are frequent, and surgery is the cornerstone of therapy even in cases of recurrent thymoma. We experienced a 67-year-old male patient with pleural metastasis that developed 6 years after complete surgical resection of invasive thymoma. The pleural mass was excised by video-assisted thoracoscopic surgery. Histopathological examination revealed an invasive World Health Organization (WHO) type B2 thymoma.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.382-385
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• 2004

Non-typhoid salmonella infection frequently associated with bacteremia rarely been reported in immunocom-promized patients with malignant neoplasms, diabetes or extended use of corticosteroids. Especially, concomitant pleural empyema and pericarditis due to non-typhoid salmonella. infection is extremely rare. Here, we report a case of concomitant empyema and pericarditis in malignant thymoma with pleural. metastasis complicated by salmonella group D infection with brief review of literature.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.543-553
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• 2005

Radiological analysis of chest lesions detected on chest radiographs or CT scans begins with their classification into parenchymal, pleural, or extrapleural lesions according to their presumed origin. The mediastinum is divided anatomically into the anterior, middle, and posterior mediastinal compartments, and localizing a mediastinal mass to one of these divisions can facilitate their differential diagnosis. A differential diagnosis of a mediastinal mass is usually based on a number of findings, including its location; the structure from which it is arising; whether it is single, multifocal (involving several different areas or lymph node groups), or diffuse; its size and shape; its attenuation (fatty, fluid, soft-tissue, or a combination of these); the presence of calcification along with its characteristics and amount; and its opacification following the administration of contrast agents.

• Tuberculosis and Respiratory Diseases
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• v.77 no.4
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• pp.188-192
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• 2014

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.

• 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.53 no.3
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• pp.114-120
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• 2020

Background: Evidence is lacking on whether the resection of lung parenchymal cancer improves the survival of patients with unexpected pleural metastasis encountered during surgery. We conducted a single-center retrospective study to determine the role of lung resection in the long-term survival of these patients. Methods: Among 4683 patients who underwent lung surgery between 1995 and 2014, 132 (2.8%) had pleural metastasis. After excluding 2 patients who had incomplete medical records, 130 patients' data were collected. Only a diagnostic pleural and/or lung biopsy was performed in 90 patients, while the lung parenchymal mass was resected in 40 patients. Results: The mean follow-up duration was 29.8 months. The 5-year survival rate of the resection group (34.7%±9.4%) was superior to that of the biopsy group (15.9%±4.3%, p=0.016). Multivariate Cox regression analysis demonstrated that primary tumor resection (p=0.041), systemic treatment (p<0.001), lower clinical N stage (p=0.018), and adenocarcinoma histology (p=0.009) were significant predictors of a favorable outcome. Interestingly, primary tumor resection only played a significant prognostic role in patients who received systemic treatment. Conclusion: When pleural metastasis is unexpectedly encountered during surgical exploration, resection in conjunction with systemic treatment may improve long-term survival, especially in adenocarcinoma patients without lymph node metastasis.

• Tuberculosis and Respiratory Diseases
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• v.76 no.1
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• pp.38-41
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• 2014

Immunoglobulin G4 (IgG4)-related disease is a newly recognized condition characterized by fibroinflammatory lesions with dense lymphoplasmacytic infiltration, storiform-type fibrosis and obliterative phlebitis. The pathogenesis is not fully understood but multiple immune-mediated mechanisms are believed to contribute. This rare disease can involve various organs and pleural involvement is even rarer. We report a case of IgG4-related disease involving pleura. A 66-year-old man presented with cough and sputum production for a week. Chest radiography revealed consolidation and a pleural mass at right hemithorax. Treatment with antibiotics resolved the consolidation and respiratory symptoms disappeared, but the pleural mass was unchanged. Video-assisted thoracoscopic surgery was performed. Histopathology revealed dense lymphoplasmacytic infiltration and storiform fibrosis with numerous IgG4-bearing plasma cells. The serum IgG4 level was also elevated. Further examination ruled out the involvement of any other organ. The patient was discharged without further treatment and there is no evidence of recurrence to date.