No abstract available.
Picibanil* ; Pleural Effusion, Malignant*

Background: The etiology of pleural effusion remains unclear in nearly 20% of cases. One way to diagnose malignancy is by doing pleural fluid cytology. There are factors that influence the yield of pleural fluid cytology and one of them is appropriate and timely fixation of samples. Currently, there is no local consensus regarding the timing with which the specimen should be fixed. Objective: The study aims to compare the yield of malignancy between early fixation versus usual fixation of pleural fluid samples, meaning there is no set time for fixation to be done. Methodology: The study employed a prospective cross-sectional research design. All patients with pleural effusion who fulfilled the criteria set by the study were included. Two sets of pleural fluid samples were collected amounting to 20cc each. First sample was assigned as Bottle #1 and placed immediately with fixative while the second sample was assigned as Bottle #2. Bottle #2 underwent routine fixation which follows no fixed or standard time of fixation. The time difference between the fixation of two sample groups greatly varied with Bottle #1 fixed immediately right after collection while Bottle#2 depends on the time it will be processed by the laboratory personnel. Both samples were submitted for cell block and cell cytology reading. Results: Characteristics of the 55 patients included in the study showed age group range from 41 to 65 years of age, with 27 male and 28 female patients. Only one third had history of smoking. There were 21.82% who had family history of cancer and with and suspicious mass on chest radiograph. Out of 55 patients, 29 patients had history of previous diagnosis of cancer, 23 had recurrent pleural effusion, and 28 had chest radiograph with suspicious nodules. Based on gross appearance, there were 20 serous and 21 sanguineous pleural fluid noted. Mean cell count was high (1,115.50 ± 741.02) with lymphocytic predominance (82.56 ± 24.46). Elevated protein concentration (5,388.25 ± 8,230.46) and LDH (484.17 ± 248.72) were noted. Glucose (8.78 ± 6.68 mmol/L) was low. There were 21 patients who had high WBC, 24 with high protein and 16 with elevated LDH. There were 3 patients who were positive for AFB and none for KOH. Comparative analysis showed that the pleural fluid samples assigned to the routinely fixed group which were handed to the nurse after thoracentesis, then forwarded to the laboratory through a ward laboratory aide or patient watcherfor fixation with with 95% alcoholby thelaboratory personnel significantly had a longer duration of 406.62 minutes as compared to immediately fixed at 12.27 minutes (P<0.01). For diagnosis of malignancy, significantly more cases were diagnosed in the immediately fixed group with 36.36% cases versus 18.18% (p=0.016). Conclusion Among patients with suspected malignant pleural effusions, early fixation of pleural fluid samples resulted in higher histopathology yields as compared to those fixed after going through the routine fixation.
Pleural Effusion, Malignant

Malignant pleural effusions (MPEs) are the second leading cause of exudative pleural effusions after parapneumonic effusions. In the vast majority of cases, a MPE signifies incurable disease associated with high morbidity and mortality. Considerable advances have been made for the diagnosis of MPEs, through the development of improved methods in the specialized cytological and imaging studies. The cytological or histological confirmation of malignant cells is currently important in establishing a diagnosis. Furthermore, despite major advancements in cancer treatment for the past two decades, management of MPE remains palliative. This article presents a comprehensive review of the medical approaches for diagnosis and management of MPE.
Diagnosis* ; Disease Management ; Mortality ; Pleural Effusion ; Pleural Effusion, Malignant*

BACKGROUND: Most of malignant pleural effusions are serous but 8-33% of them are bloody. We wanted to evaluate the relationships between gross appearance and pleural CEA level or results of histocytology in malignancy associated pleural effusions. We also tried to reevaluate the meaning of CEA measurement in histocylogically proved or unproved malignancy associated pleural effusions. METHODS: We studied 98 cases of malignancy associated pleural effusions, 50 cases of histocylologically proven malignant effusions and 48 cases of histologically unproven paramalignant effusions. We had observed gross appearance and conventional laboratory values and CEA levees for pleural effusions. RESULTS: 44.9% of malignancy associated effusions were bloody(63.6% of bloody effusions were histstocytologically proven malignant effusion). 65.0% of malignancy associated pleural effusions which have RBCs numbers over 100,000/mm3 were cytologically proven malignant effusions. 72.7% of cytologically proven malignant effusions had increased pleural fluid CEA level over 10 ng/ml. 58.2% of cases with pleural CEA over 10ng/ml had positive results in pleural histocytology. There was no definable relationships between pleural fluid CEA elevation and RBCs numbers and results of pleural fluid cytology. CONCLUSION: About half of the cases with malignancy associated pleural effusions were bloody. Histocytologically proven malignant effusions were more common in bloody effusion than non-bloody effusion (63.6% Vs 38.9%). But increased red blood cell numbers was not associated with positivity of pleural histocytology. Pleural fluid CEA elevation(over 10 ng/ml) was not correlated with positive pleural histocytology. But pleural fluid CEA elevation was rare In nonmalignant pleural effusions, and than pleural CEA measurement in uncertain pleural effusions maybe helpful to distinguishes its origin.
Carcinoembryonic Antigen* ; Erythrocytes ; Pleural Effusion* ; Pleural Effusion, Malignant

No abstract available.
Pleural Effusion ; Pleural Effusion, Malignant ; Thoracoscopy ; Thyroid Gland ; Thyroid Neoplasms

We report a case of adenocarcinoma detected in the right pleural effusion of a 75-year-old woman. Investigations failed to reveal the site of the primary lesion, and the case was treated as primary unknown cancer. The pleural effusion disappeared after chemotherapy; however, as there was serious bone marrow suppression, the clinical course was observed at an outpatient clinic without chemotherapy. A search for the primary lesion was repeated, but it was not found. One year after first admission, a chest X-ray showed left pleural effusion. Adenocarcinoma was detected in the effusion and a tumor mass obtained from the pleural cavity. Ovarian cancer was diagnosed based on the histological, serological and MRI findings. Thus, this was a rare case of ovarian cancer in which the diagnosis was confirmed by repeated evaluation and in which the initial diagnosis had been primary unknown cancer with malignant pleural effusion only.
Ovarian Cancer ; Pleural Effusion, Malignant ; Pleural Effusion ; Unknown ; Beginning

Humans ; Mesothelioma/pathology* ; Mesothelioma, Malignant ; Pleural Neoplasms/diagnosis* ; Pleural Effusion, Malignant ; Pleural Effusion/pathology*

No abstract available.
Cisplatin* ; Cytarabine* ; Drug Therapy* ; Pleural Effusion, Malignant*

BACKGROUND: pH measurement is an important test in assessing the etiology of pleurisy and in identifying complicated parapneumonic effusion. Although the blood gas analyzer is the' gold standard method' for pleural pH measurement, pH meter & pH strip methods are also used for this purpose interchangably. However, the correlation among the pH data measured by the three different methods needs to be evaluated. In this study, we measured the pH of pleural fluid with the three different methods respectively and evaluated the correlation among the measured data. METHODS: From August 1999 to March 2000, were measured the pleural fluid pH in 34 clinical samples with three methods-blood gas analyzer, pH meter, and pH strip. In the blood gas analyzer and pH meter methods, the temperature of plerual fluid was maintained around 0℃ in air-tight condition before analysis and measurement was performed within 30 minutes after collection. As for the pH strip method, the pleural fluid pH was checked in the ward immediately after tapping and in the clinical laboratory of our hospital. This part is unclear. RESULTS: The causes of pleural effusion were tuberculosis pleurisy in 16 cases, malignant pleural effusion 5 cases, parapneumonic effusion 9 cases, empyema 3 cases, and congestive heart failure 1 case. The pH of pleural fluid (mean±SD) was 7.34±0.12 with blood gas analyser, 7.52±0.25 with pH meter, 7.37±0.16 with pH strip of immediate measurement and 6.93±0.201 with pH strip of delayed measurement. The pH measured by delayed pH strip measurement was lower than those of other methods(p<0.05). The correlation of the results between the blood gas analyzer and pH meter(p=0.002, r=0.518) and the blood gas analyzer and pH strip of immediate measurement(p<0.001, r=0.607). CONCLUSION: In the determination of pH of pleural fluid, pH strip method could be a simple and reliable method under immediate measurement conditions after fluid tapping.
Empyema ; Heart Failure ; Hydrogen-Ion Concentration* ; Methods* ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis

BACKGROUND: Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-alpha), which is the one of proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF-alpha activity in distinguishing tuberculous from malignant effusions. METHODS: 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF-alpha concentrations were measured in the pleural fluid and serum samples using an enzyme- linked immunosorbent assay (ELISA). In addition, TNF-alpha ratio (pleural fluid TNF-alpha : serum TNF-alpha) was calculated. RESULTS: TNF-alpha concentration and TNF-alpha ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p<0.05). However, the serum levels of TNF-alpha in the malignant and tuberculous pleural effusions were similar (p>0.05). The cut off points for the pleural fluid TNF-alpha level and TNF-alpha ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF-alpha level (p<0.005) and 76%, 70% and 0.72 for the TNF-alpha ratio (p<0.05). CONCLUSION: We conclude that pleural fluid TNF-alpha level and TNF-alpha ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF-alpha in the pleural fluid could be a more efficient marker than the TNF-alpha ratio.
Biopsy ; Cytokines ; Diagnosis, Differential* ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis ; Tumor Necrosis Factor-alpha*