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Thoracic Surgery Clinics Feb 2013Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the... (Review)
Review
Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. The parietal pleura has a more significant role in pleural fluid homeostasis. Its vessels are closer to the pleural space compared with its visceral counterpart; it contains lymphatic stomata, absent on visceral pleura, which are responsible for a bulk clearance of fluid. The diagnosis and successful treatment of pleural effusions requires a mixture of imaging techniques and pleural fluid analysis.
Topics: Body Fluids; Exudates and Transudates; Humans; Pleura; Pleural Cavity; Pleural Effusion
PubMed: 23206712
DOI: 10.1016/j.thorsurg.2012.10.008 -
Human Pathology Jun 2023Liposarcoma rarely occurs in the pleura or thoracic cavity, and few reports appear in the literature. We hypothesized that combining clinicopathologic,...
Liposarcoma rarely occurs in the pleura or thoracic cavity, and few reports appear in the literature. We hypothesized that combining clinicopathologic, immunohistochemical, and fluorescence in situ hybridization methods would allow definite diagnoses. Using formalin-fixed, paraffin-embedded blocks, we examined 6 atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDLPS), 5 dedifferentiated liposarcomas (DDLPSs), 2 pleomorphic liposarcomas, and 1 myxoid liposarcoma (MLPS). We used the Kaplan-Meier method and the Wilcoxon test for survival analysis for prognostic factor evaluation. Histologically, ALT/WDLPS was composed of a relatively mature adipocytic proliferation, accompanied by some lipoblasts. DDLPS exhibited round-to-oval tumor cells with a high nucleus-to-cytoplasm ratio that had proliferated in nests, accompanied in case 10 by some giant cells but no fatty cells. The pleomorphic type contained a varying proportion of pleomorphic lipoblasts. MLPS displayed uniform round- to oval-shaped cells and small signet-ring lipoblasts in a myxoid stroma. Immunohistochemically, 11 (79%), 11 (79%), and 10 (71%) of 14 cases were positive for S-100, p16, and CDK4, respectively. Six of the 14 cases (43%) were positive for MDM2 and adipophilin. One case of ALT/WDLPS and 3 cases of DDLPS exhibited MDM2 amplification by fluorescence in situ hybridization (Vysis LSI MDM2 SpectrumGreen Probe plus Vysis CEP 12 SpectrumOrange probe). ALT/WDLPS was the most favorable type for survival, while adipophilin tended to be a negative prognostic factor for pleural liposarcoma. For a firm diagnosis of liposarcoma in the pleura, immunohistochemistry for CDK4, MDM2, and adipophilin together with MDM2 gene amplification by fluorescence in situ hybridization may be an important diagnostic tool.
Topics: Adult; Humans; Pleural Cavity; In Situ Hybridization, Fluorescence; Perilipin-2; Liposarcoma; Lipoma; S100 Proteins; Proto-Oncogene Proteins c-mdm2; Gene Amplification; Biomarkers, Tumor
PubMed: 37023867
DOI: 10.1016/j.humpath.2023.03.009 -
Nature Nanotechnology Feb 2022Malignant pleural effusion (MPE) is indicative of terminal malignancy with a uniformly fatal prognosis. Often, two distinct compartments of tumour microenvironment, the...
Malignant pleural effusion (MPE) is indicative of terminal malignancy with a uniformly fatal prognosis. Often, two distinct compartments of tumour microenvironment, the effusion and disseminated pleural tumours, co-exist in the pleural cavity, presenting a major challenge for therapeutic interventions and drug delivery. Clinical evidence suggests that MPE comprises abundant tumour-associated myeloid cells with the tumour-promoting phenotype, impairing antitumour immunity. Here we developed a liposomal nanoparticle loaded with cyclic dinucleotide (LNP-CDN) for targeted activation of stimulators of interferon genes signalling in macrophages and dendritic cells and showed that, on intrapleural administration, they induce drastic changes in the transcriptional landscape in MPE, mitigating the immune cold MPE in both effusion and pleural tumours. Moreover, combination immunotherapy with blockade of programmed death ligand 1 potently reduced MPE volume and inhibited tumour growth not only in the pleural cavity but also in the lung parenchyma, conferring significantly prolonged survival of MPE-bearing mice. Furthermore, the LNP-CDN-induced immunological effects were also observed with clinical MPE samples, suggesting the potential of intrapleural LNP-CDN for clinical MPE immunotherapy.
Topics: Adaptive Immunity; Animals; B7-H1 Antigen; Cell Line, Tumor; Cell Proliferation; Dendritic Cells; Drug Delivery Systems; Humans; Immune Checkpoint Inhibitors; Immunity, Innate; Immunotherapy; Interferons; Mice; Nanoparticles; Pleural Cavity; Pleural Effusion, Malignant; Tumor Microenvironment; Xenograft Model Antitumor Assays
PubMed: 34916656
DOI: 10.1038/s41565-021-01032-w -
Archivos de Bronconeumologia Aug 2012
Topics: Humans; Pleura; Pleural Cavity; Pleural Diseases; Pleural Effusion; Ultrasonography, Interventional
PubMed: 22464045
DOI: 10.1016/j.arbres.2012.02.005 -
Cellular Immunology Aug 2018For decades, it has been known that the serous cavities, which include the peritoneal, pleural and pericardial cavities, harbour large numbers of macrophages. In... (Review)
Review
For decades, it has been known that the serous cavities, which include the peritoneal, pleural and pericardial cavities, harbour large numbers of macrophages. In particular, due to the ease of isolating these cells, the peritoneal cavity has been used as a convenient source of macrophages to examine many facets of macrophage biology over the last 50-60 years. Despite this, it is only recently that the true heterogeneity of serous cavity mononuclear phagocyte compartment, which includes macrophages and dendritic cells, has been revealed. Advances in technologies such as multi-parameter flow cytometry and the 'OMICs' revolution have uncovered the presence of distinct populations of mononuclear phagocytes in the serous cavities. Given that peritoneal macrophages have been implicated in many pathologies, including peritonitis, pancreatitis, endometriosis and acute liver injury, it is imperative to understand the biology of these cells. Here, we review the recent advances in understanding the identity, origin and function of discrete serous cavity mononuclear phagocyte subsets in homeostasis and how these may change when homeostasis is perturbed, focusing on peritoneal and pleural cavities and highlighting differences in the mononuclear phagocytes found in each.
Topics: Animals; Homeostasis; Humans; Macrophages; Pericardium; Peritoneum; Peritonitis; Phagocytes; Pleural Cavity
PubMed: 29397065
DOI: 10.1016/j.cellimm.2018.01.003 -
ANZ Journal of Surgery Oct 2021
Topics: Breast; Foreign-Body Migration; Humans; Pleura; Pleural Cavity
PubMed: 33709506
DOI: 10.1111/ans.16695 -
Acta Physiologica (Oxford, England) Feb 2013The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the... (Review)
Review
The pleural space plays an important role in respiratory function as the negative intrapleural pressure regimen ensures lung expansion and in the mean time maintains the tight mechanical coupling between the lung and the chest wall. The efficiency of the lung-chest wall coupling depends upon pleural liquid volume, which in turn reflects the balance between the filtration of fluid into and its egress out of the cavity. While filtration occurs through a single mechanism passively driving fluid from the interstitium of the parietal pleura into the cavity, several mechanisms may co-operate to remove pleural fluid. Among these, the pleural lymphatic system emerges as the most important one in quantitative terms and the only one able to cope with variable pleural fluid volume and drainage requirements. In this review, we present a detailed account of the actual knowledge on: (a) the complex morphology of the pleural lymphatic system, (b) the mechanism supporting pleural lymph formation and propulsion, (c) the dependence of pleural lymphatic function upon local tissue mechanics and (d) the effect of lymphatic inefficiency in the development of clinically severe pleural and, more in general, respiratory pathologies.
Topics: Animals; Humans; Lymphatic System; Pleura; Pleural Cavity
PubMed: 23009260
DOI: 10.1111/apha.12016 -
Annals of Diagnostic Pathology Apr 2023Primary effusion lymphoma (PEL) is a rare neoplasm that arises in the context of severe immunosuppression. Acquired immunodeficiency syndrome (AIDS) as a result of human... (Review)
Review
Primary effusion lymphoma (PEL) is a rare neoplasm that arises in the context of severe immunosuppression. Acquired immunodeficiency syndrome (AIDS) as a result of human immunodeficiency virus (HIV) infection is the most common cause of immunodeficiency in patients who develop PEL. These neoplasms usually involve one or more body cavities, so-called classic PEL. The pleural cavity is most often involved, followed by the peritoneal and pericardial cavities. Involvement of the cerebrospinal fluid (CSF) and meninges is rare. A subset of patients can present with a tissue-based mass, known as the extracavitary variant. We encountered a patient with HIV infection and severe immunosuppression who presented initially with mediastinal, retroperitoneal mass and bilateral pleural effusions. He subsequently developed CSF involvement. Despite therapy, the patient relapsed with chest wall disease 6 months later and died shortly thereafter. Our literature review yielded about 400 cases of PEL reported previously. About 65 % of PEL patients have had AIDS, but a subset of patients had immunosuppression attributable to organ transplantation or physiological immunosenescence. CSF involvement has been reported in ~2 % of patients, and about 10 % of patients had both body cavity and extracavitary disease. The pathologic findings in this case were typical of extracavitary PEL. The neoplastic cells had features of plasmablasts and were positive for HHV-8, Epstein-Barr virus encoded RNA (EBER) and plasma cell associated markers, and were negative for B-cell antigens. The prognosis of patients with PEL is usually poor with a median survival less than one year in most studies. We use this patient's case as an illustration of PEL and we review the clinicopathologic findings and differential diagnosis of PEL.
Topics: Male; Humans; Lymphoma, Primary Effusion; HIV Infections; Epstein-Barr Virus Infections; Pleural Cavity; Acquired Immunodeficiency Syndrome; Herpesvirus 4, Human; Herpesvirus 8, Human
PubMed: 36577188
DOI: 10.1016/j.anndiagpath.2022.152084 -
Khirurgiia 2021To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery.
OBJECTIVE
To analyze the anatomometric characteristics of post-pneumonectomy cavity and their changes at various times after surgery.
MATERIAL AND METHODS
The study included 47 patients aged 39-75 years after pneumonectomy (right-sided - 23 cases, left-sided - 24 cases). Computed tomography was performed prior to surgery, in 10-12 days, 6 and 12 months after intervention. Transverse, anteroposterior dimensions, height and volume of pleural cavity were evaluated using CT scans and 3D models.
RESULTS
Post-pneumonectomy cavity decreases and changes own shape in postoperative period. Reduction is mainly caused by decrease in its height. The volume of post-pneumonectomy cavity was decreased in early postoperative period by 1.8 times compared to preoperative values (from 3351.5±150.0 cm to 2112.1±152.6 cm on the right side and from 2674.3±125.2 cm to 1460.1±84.1 cm on the left side). After 12 months, this value was reduced by 3.68 times compared to early postoperative period (714.3±100.7 cm on the right and 401.5±42.5 cm on the left). The shape changes consist of flattening and sinus depth reduction. Exudate density was similar throughout a year. The capsule was formed in 74.1% of patients after 12 months. There was no correlation between the cavity reduction and patient constitution.
CONCLUSION
Post-pneumonectomy cavity is a dynamically changing anatomical formation participating in the mechanisms of compensation for changes after pneumonectomy. The most significant collapse of post-pneumonectomy cavity occurs in early postoperative period. Cavity reduction degree does not depend on individual characteristics of patients.
Topics: Adult; Aged; Humans; Middle Aged; Pleural Cavity; Pneumonectomy; Postoperative Period; Tomography, X-Ray Computed
PubMed: 33977696
DOI: 10.17116/hirurgia202105132 -
Revue de Pneumologie Clinique Jun 2013The pleural lymphatic system has a great absorption capacity. Its most known function is fluid resorption. The pleura which cover the lungs (visceral pleura), the... (Review)
Review
The pleural lymphatic system has a great absorption capacity. Its most known function is fluid resorption. The pleura which cover the lungs (visceral pleura), the mediastinum, diaphragm and thoracic wall (parietal pleura) are formed by a mesothelial cell layer (mesothelium). This permeable layer is in direct contact with the vascular endothelium. The mesothelium is based over a connective tissue (interstitium) containing the blood and lymphatic vessels. The primary lymphatic vessels drain interstitium but are also in direct contact with pleural space by the stoma or openings, situated in the lower parts of parietal pleura, i.e: diaphragm, over lower ribs and mediastinum but not existing in the adjacent visceral pleura. In addition, a part of interstitial pulmonary fluid entered in the pleural cavity by passing the visceral pleura would be absorbed by these openings. The resorption process is active and directly related to the function of smooth muscles of lymphatic vessels. Besides resorption, we must emphasize that this "pumping" activity is permanent and the origin of negative pressure (the pleural void) in pleural cavity, a unique property. The other resorbed elements are molecules, bacterial and cellular debris, cells, red blood and cancer cells.
Topics: Chylothorax; Exudates and Transudates; Humans; Lymphatic System; Pleura; Pleural Cavity; Pneumothorax
PubMed: 23523230
DOI: 10.1016/j.pneumo.2013.01.006