1
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Ferreiro L, Landín Rey E, Carreiras Cuiña M, Gude F, Antúnez JR, Suárez-Antelo J, Toubes ME, Rodríguez Núñez N, Golpe A, Riveiro V, Valdés L. Non-specific pleuritis: long-term follow-up outcomes. Expert Rev Respir Med 2024; 18:333-339. [PMID: 38877875 DOI: 10.1080/17476348.2024.2368610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The definitive etiology of nonspecific pleuritis (NSP), the influence of the type of pleural biopsy on clinical results and the minimum duration of follow-up is controversial. RESEARCH DESIGN AND METHODS A retrospective, observational study of patients ≥ 18 years with NSP confirmed by closed pleural biopsy (CPB), local anesthesia pleuroscopy (LAP), or video-assisted thoracic surgery (VATS). RESULTS A total of 167 patients were included (mean follow-up, 14.4 months), of which 25 (15%) were diagnosed within one month; [15 (60%) malignant]. Of the remaining 142 pleural effusions (PEf), 69 (48.6%) were idiopathic; 49 (34.5%) not-malignant and 24 (16.9%) malignant (4 mesotheliomas and 20 metastasic). The diagnosis of NSP was established by CPB (7; median time to diagnosis, 9.4 months), LAT (5; 15.8 months), and VATS (8; 13.5 months) (p = 0.606). Sixty-eight patients (40.7%) died during follow-up (mean time, 12 months). CONCLUSIONS In a substantial percentage of patients diagnosed with NSP, a definitive diagnosis will not be obtained, a relevant number of patients will develop a malignant PEf. The diagnostic procedure used for the diagnosis of NSP does not seem to influence delay in the diagnosis of malignant PEf. The data obtained suggest that follow-up should be maintained for at least 24 months.
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Affiliation(s)
- Lucía Ferreiro
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Elisa Landín Rey
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Carreiras Cuiña
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Unidad de Epidemiología Clínica, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - José R Antúnez
- Servicio de Anatomía Patológica, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez Núñez
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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2
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Karpathiou G, Péoc’h M, Sundaralingam A, Rahman N, Froudarakis ME. Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology. Cancers (Basel) 2022; 14:1415. [PMID: 35326567 PMCID: PMC8946533 DOI: 10.3390/cancers14061415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Anand Sundaralingam
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LE, UK; (A.S.); (N.R.)
| | - Marios E. Froudarakis
- Pneumonology and Thoracic Oncology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
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3
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Lin J, Sabath BF. Chronic Pleuritis and Recurrent Pleural Effusion After Atezolizumab for Small Cell Lung Cancer. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933396. [PMID: 34606491 PMCID: PMC8503793 DOI: 10.12659/ajcr.933396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient: Female, 65-year-old
Final Diagnosis: Pleural effusion • small cell lung cancer
Symptoms: Shortness of breath
Medication:—
Clinical Procedure: —
Specialty: Pulmonology
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Affiliation(s)
- Julie Lin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce Fernando Sabath
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Gu Q, Deng X, Li Z, Wang J, Hu C, Lei S, Cai X. The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion. Int J Gen Med 2021; 14:1429-1435. [PMID: 33907447 PMCID: PMC8068496 DOI: 10.2147/ijgm.s299606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Simple signs of local pleural adhesion are often found in people during a physical examination. In the present study, we aimed to clarify whether the merely localized pleural adhesion was just caused by previous pleural inflammation or physiological variation. Materials and Methods Chest X-ray image materials were collected to analyze the incidence of simple pleural adhesions. Moreover, the causes of these simple pleural adhesions were further analyzed using thoracoscopy under direct vision and biopsy data. Results In all 2218 chest X-ray images, 68 cases were found to have pleural lesions (3.07%), including 15 cases of localized pleural adhesion only. Subsequently, we analyzed the characteristics of 70 cases of pleural lesions using thoracoscopy. In two lung cancer patients with pleural metastasis, we found an unusual pleural junction. This connective strip was smooth and free of inflammation, resembling the normal pleura. Conclusion Some of these purely localized pleural adhesions might be attributed to previous inflammation. However, there was still at least a possibility that there must be a physiological pleural junction, which could be the cause of the purely localized pleural adhesion shown in the chest radiograph.
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Affiliation(s)
- Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xinhao Deng
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Zhao Li
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Jing Wang
- Department of Pathology, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Shuhua Lei
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
| | - Xiaoling Cai
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South University, Changsha, Hunan Province, 410008, People's Republic of China.,Key Cite of National Clinical Research Center for Respiratory Disease, Changsha, Hunan Province, 410008, People's Republic of China
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5
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Abstract
Advanced malignancy is a prevalent cause of exudative pleural effusion. The management of malignant pleural effusion (MPE) has been the subject of several recent randomized controlled trials and excellent reviews. Less attention has been focused on another controversial and challenging aspect of MPE: establishing the diagnosis. Before selecting the optimal management strategy, the presence of an MPE must first be correctly identified with an emphasis on minimizing invasiveness and discomfort in a patient with late-stage cancer. The aim of the present review is to summarize the current knowledge about MPE diagnostics and to propose an algorithm for the diagnosis of MPE in established or suspected malignancy.
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6
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Vaury C, Macaire P, Goirand F, Coudert B, Guérard P, Schmitt A. Lack of everolimus diffusion in pleural fluid during pleural progression of breast cancer: A case report. J Oncol Pharm Pract 2020; 27:235-237. [PMID: 32493163 DOI: 10.1177/1078155220927771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We report here a case where no everolimus pleural diffusion was evidenced at the same time of pleural progression of a metastatic breast cancer treated with everolimus and exemestane. CASE DESCRIPTION A 69-year-old woman was diagnosed in October 2006 with stage III invasive ductal breast adenocarcinoma. After nine months of everolimus and exemestane treatment, she presented with a pleural progression. Everolimus concentration was measured in blood and in pleural fluid. Residual blood concentration was at 9.1 ng/mL, while no everolimus was observed in the pleural fluid. MANAGEMENT AND OUTCOME Due to inefficacy of everolimus in this patient, she was switched to palbociclib and fulvestrant. CONCLUSION Everolimus seems to have a poor diffusion in the pleural fluid.
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Affiliation(s)
- Célia Vaury
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Pauline Macaire
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Françoise Goirand
- Pharmacology and Toxicology Laboratory, Dijon University Hospital, Dijon, France
| | - Bruno Coudert
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - Pascal Guérard
- Pharmacology and Toxicology Laboratory, Dijon University Hospital, Dijon, France
| | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
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7
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Karpathiou G, Anevlavis S, Tiffet O, Casteillo F, Mobarki M, Mismetti V, Ntolios P, Koulelidis A, Trouillon T, Zadel N, Hathroubi S, Peoc'h M, Froudarakis ME. Clinical long-term outcome of non-specific pleuritis (NSP) after surgical or medical thoracoscopy. J Thorac Dis 2020; 12:2096-2104. [PMID: 32642113 PMCID: PMC7330408 DOI: 10.21037/jtd-19-3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Thoracoscopy, either “medical” or “surgical”, is the gold standard to reveal the cause of pleural effusion by taking large biopsies. However, in some cases, the histology of pleural biopsies is inconclusive for a specific cause, describing a variable process of inflammation, encompassing for non-specific pleuritis (NSP). Questions are raised whether the surgical (or video-assisted thoracoscopic surgery, VATS) is doing better than the medical thoracoscopy (MT or pleuroscopy), but no direct comparison between the two techniques exist in the current bibliography. The aim of our retrospective study was to compare these two techniques to find whether there is any difference in the false negative cases of NSP. Methods We included in our study 295 patients with NSP, 179 patients who underwent VATS comparing to 116 patients who underwent MT for pleural effusion of initially undetermined cause, having a follow-up of at least one year. Analysis of patients’ files, history, clinical examinations, further tests, and follow-up were recorded. Results The mean age of our patients was 58.5±19.1 and M/F gender was 216/79; no difference was observed between the two groups. The mean follow-up period was 47.3±20.7 months. After VATS, only one patient (0.55%) was finally diagnosed with pleural malignancy (false negative) while after MT 2 patients (1.7%). Negative predictive value for pleura-related malignancy for VATS was 0.994 and for MT 0.982. Conclusions In patients with histological diagnosis of NSP both VATS and MT showed similar and excellent results of false negative cases and negative predictive value in excluding malignant pleural disease.
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Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Stavros Anevlavis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Olivier Tiffet
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Francois Casteillo
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Mousa Mobarki
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Valentine Mismetti
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Paschalis Ntolios
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Andreas Koulelidis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Tiffany Trouillon
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Nicolas Zadel
- Department of Thoracic Surgery, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Sirine Hathroubi
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Department of Pneumonology, University Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of St-Etienne, Saint-Priest-en-Jarez, France
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8
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Terashima T, Iwami E, Shimada T, Kuroda A, Matsuzaki T, Nakajima T, Sasaki A, Eguchi K. IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report. BMC Pulm Med 2020; 20:104. [PMID: 32334571 PMCID: PMC7183131 DOI: 10.1186/s12890-020-1150-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are the standard treatment for non-small cell lung cancer. The unique adverse events that can arise after treatment with ICIs are known as immune-related adverse events (irAE). As the number of cases under treatment with ICIs increases, new types of characteristics of irAE have emerged. This case report suggests that IgG4-related pleural disease could occur as an irAE. Case presentation A 64-year-old man was diagnosed with pulmonary adenocarcinoma stage IIIB. Following concurrent chemoradiotherapy, durvalumab was administered every two weeks. The patient complained of dyspnea on effort 4 months after the initiation of durvalumab therapy. Chest CT scans showed mild bilateral pleural effusion 4 months after the initiation of durvalumab therapy, and the amount of pleural effusion increased further at 7 months. Durvalumab was thought to be a potential cause of pleural effusion and was withdrawn after 13 courses of administration over 7 months. The level of serum IgG4 was 2750 mg/dL. The levels of IgG4 of the pleural fluids were 2790 mg/dL on the right side and 2890 mg/dL on the left side at 7 months. Microscopic examination of the pleural biopsy revealed lymphoplasmacytic infiltration with storiform fibrosis. Immunohistochemical examinations showed that the number of IgG4-positive cells was > 20/high power field and the percentage of IgG4-positive to IgG-positive plasma cells was > 50%. Oral prednisolone at a dose of 30 mg/day was initiated, and remarkable clinical improvements were achieved. After 4 months of prednisolone therapy, the level of serum IgG4 decreased to 370 mg/dL and chest CT revealed the disappearance of bilateral pleural effusion. Conclusion This was a case of IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment. To our knowledge, this is the first case report of IgG4-related pleural disease as an irAE. It is important to consider the possibility of IgG4-related pleural disease in cases of pleural effusion during the treatment with ICIs.
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Affiliation(s)
- Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan.
| | - Eri Iwami
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Takashi Shimada
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Aoi Kuroda
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Tatsu Matsuzaki
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Takahiro Nakajima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
| | - Keisuke Eguchi
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-0824, Japan
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9
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Karpathiou G, Hathroubi S, Patoir A, Tiffet O, Casteillo F, Brun C, Forest F, Rahman NM, Peoc'h M, Froudarakis ME. Non-specific pleuritis: pathological patterns in benign pleuritis. Pathology 2019; 51:405-411. [DOI: 10.1016/j.pathol.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/06/2019] [Accepted: 01/13/2019] [Indexed: 01/02/2023]
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10
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Yousem SA. Chronic follicular pleuritis: a B cell-rich form of nonspecific pleuritis/fibrosis. Hum Pathol 2019; 90:14-19. [PMID: 31054896 DOI: 10.1016/j.humpath.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 11/19/2022]
Abstract
The parietal pleura is often biopsied in patients with idiopathic pleural effusion, and in up to 40% of cases, a diagnosis of nonspecific pleuritis/fibrosis (NSP) is rendered. The histology of this reaction has not been well described including a pattern of B cell lymphoid hyperplasia described as "chronic follicular pleuritis (CFP)". Thirty-two cases of NSP were studied, of which 13 (41%) corresponded to CFP with the remainder displaying a fibrinous and organizing pleuritis with varying degrees of collagenization. CFP had similar etiologies as NSP with long term follow-up, including cardiac disease, pericarditis, asbestos exposure, and occult malignancy. The importance of recognizing a previously undescribed B cell/plasma cell pleural inflammatory response in reactive pleural disease is discussed.
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Affiliation(s)
- Samuel A Yousem
- Department of Pathology, University of Pittsburgh Medical Center - Presbyterian Campus, Pittsburgh, PA 15213.
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11
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Steinfort DP. ACCESS ALL AREAS: Electromagnetic navigation and the pulmonologist. Respirology 2019; 24:406-407. [PMID: 30803118 DOI: 10.1111/resp.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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12
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Conway FM, Garner JL, Orton CM, Srikanthan K, Kemp SV, Shah PL. Contemporary Concise Review 2018: Lung cancer and pleural disease. Respirology 2019; 24:475-483. [PMID: 30772946 DOI: 10.1111/resp.13499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Francesca M Conway
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Justin L Garner
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Christopher M Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Karthi Srikanthan
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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13
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D’Andréa A, L. Peillet D, Serratrice C, Petignat PA, Prendki V, Reny JL, Serratrice J. Diagnosis of systemic lupus erythematosus by presence of Hargraves cells in eosinophilic pleural effusion: Case report. Medicine (Baltimore) 2018; 97:e12871. [PMID: 30335001 PMCID: PMC6211931 DOI: 10.1097/md.0000000000012871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections. PATIENT CONCERNS In rare cases, pleural eosinophilia is associated with connective tissue disease. DIAGNOSES Presence of Hargraves cells, also called lupus erythematosus (LE) cells (polynuclear cells that have engulfed denatured nuclear material), was a key point of American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) until 1997. Now replaced by serology for autoantibodies, LE cells characterization remains useful in guiding the diagnostic strategy towards autoimmune diseases. INTERVENTIONS An 82-year-old woman complained about anorexia, weight loss, fatigue, and mild night fever. Clinical examination disclosed a left pleural effusion without parenchymal lesion on high contrast thoraco-abdomino-pelvic computed tomography scan. A thoracocentesis revealed an exudate with eosinophilia. Direct cytological examination showed LE cells. SLE was rapidly considered. Antinuclear antibodies were subsequently found in the serum and in the pleural effusion. Anti-nucleosome antibodies were also present without antiphospholipid antibodies. Her condition rapidly improved after initiation of prednisone and hydroxychloroquine. OUTCOMES Six months later, the patient had no particular complain, clinical examination was strictly normal biological parameter were in normal range. LESSONS The assessment of an eosinophilic pleural effusion allowed to find LE cells, which rapidly suggested the diagnosis of SLE, and early initiation of appropriate treatment. LE cells are no longer a criterion for the diagnosis of SLE, but their presence in serosa is most helpful in guiding the diagnostic strategy, and specifically in atypical forms often seen in older patients.
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Affiliation(s)
- Alexia D’Andréa
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Geneva
| | - Damien L. Peillet
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Geneva
| | - Christine Serratrice
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Geneva
| | - Pierre-Augute Petignat
- Department of Internal Medecine, Hospital of Valais, Sion
- Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Geneva
| | - Jean-Luc Reny
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Geneva
| | - Jacques Serratrice
- Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland
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14
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Janssen J, Maldonado F, Metintas M. What is the significance of non-specific pleuritis? A trick question. CLINICAL RESPIRATORY JOURNAL 2018; 12:2407-2410. [DOI: 10.1111/crj.12940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Julius Janssen
- Department of Pulmonary Diseases B70; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Fabien Maldonado
- Vanderbilt-Ingram Cancer Center; Division of Allergy, Pulmonary and Critical Care Medicine; Nashville Tennessee
| | - Muzaffer Metintas
- Lung and Pleural Cancers Research and Clinical Center; Eskisehir Osmangazi University; Eskisehir Turkey
- Medical Faculty Department of Pulmonology; Eskisehir Turkey
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Fielding D. Tissue is the issue to confirm benign disease at pleuroscopy in lung cancer. Respirology 2017; 23:126-127. [PMID: 29168601 DOI: 10.1111/resp.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- David Fielding
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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