Malignant pleural effusions

Pleural fluid cytology of Hodgkin's disease: cytomorphologic features and the value of immunohistochemical studies

Two cases in which Hodgkin's disease (HD) was cytologically diagnosed in pleural effusions are presented. The presence of Reed-Sternberg (R-S) cells was confirmed by positive staining for both CD15 and CD30, and negative staining for leukocyte common antigen. In addition, the differential diagnosis of HD in effusion cytology is presented, including look-alikes of R-S cells that can potentially lead to an incorrect diagnosis. To the best of our knowledge, we believe this is only the second cytologic report of HD diagnosed in a pleural effusion using immunohistochemistry to confirm the diagnosis.

Closed percutaneous pleural brushing: a new method for diagnosis of malignant pleural effusions

Pleural fluid cytology and pleural biopsy are the two most commonly employed diagnostic tests for malignant pleural effusions. Here, we have introduced a new diagnostic method, namely closed percutaneous pleural brushing, and have compared its diagnostic yield with those of pleural fluid cytology and pleural biopsy in patients with suspected malignant pleural effusion. Forty-three consecutive patients with suspected malignant pleural effusion underwent thoracentesis, closed pleural brushing and closed pleural biopsy using Cope's pleural biopsy needle and a cytological brush (BC-10C) which was introduced into the pleural cavity through the cannula of the same needle. All the samples were sent for bacteriological and cytological studies. Patients had a mean follow-up period of 9.28 +/- 1.87 months during which seven cases whose entire studies were non-diagnostic underwent thoracotomy and open pleural biopsy. Thirty-four cases were finally documented to have malignancy. Closed pleural brushing was positive in 31 (91%) of cases. This was superior to that achieved by either pleural fluid cytology (67%) (P = 0.01) or pleural biopsy (58%) (P = 0.002). No pneumothorax or other major complications were encountered with this method. Closed pleural brushing via Cope's needle is a relatively safe, simple and well-tolerated technique with a high diagnostic yield for patients with malignant pleural effusion. It may substitute for other more invasive and more expensive procedures such as thoracoscopy and thoracotomy in this group of patients.

Clinical manifestations of lung cancer

The initial clinical manifestations of lung cancer are diverse and may occur with or without symptoms. Manifestations of pulmonary malignant lesions are produced by local growth or invasion, metastatic disease, or paraneoplastic processes. Patterns of local invasion such as Pancoast's syndrome or the superior vena cava syndrome are relatively uncommon but well recognized. Metastatic lung cancer can involve almost any anatomic area by hematogenous, lymphatic, or, occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte disturbances, and coexisting diseases influence the initial manifestations. Although individual tumor cell types are associated with characteristic features, no constellation of findings is pathognomonic for a specific histologic variant. Because successful treatment of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is important.