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Radiology Case Reports Nov 2020A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed...
A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and radiology imaging with computed tomography (CT). Management included image-guided chest drain and retrograde ureteric stent insertion to divert the urine from entering the pleural cavity. CT images demonstrated a fistula between the site of renal puncture and the pleural cavity, indicating that the cryoprobes traversed the diaphragm during the procedure. This case highlights urinothorax as an unusual complication of cryoablation of renal cell carcinoma. Prompt diagnosis by interventional radiologists is crucial to avert from this potentially life-threatening complication.
PubMed: 32994839
DOI: 10.1016/j.radcr.2020.09.013 -
International Journal of Nanomedicine 2019Intrapleural administration of compounds is a lung targeted, innovative therapeutic strategy for mesothelioma, which can be refined as a route for drug delivery that...
Intrapleural administration of compounds is a lung targeted, innovative therapeutic strategy for mesothelioma, which can be refined as a route for drug delivery that minimizes the potential for systemic toxicity. However, little is currently known about the retention of liposomal drugs at the site, after such topical administration. To evaluate the retention of liposomes in lungs following intrapleural injection, and how this might be modulated by liposome properties and disease progression. DiR-incorporating liposomes with various lipid compositions and sizes were prepared, characterized (for size distribution and zeta potential) and injected intrapleurally in normal mice and mice with malignant pleural effusion (MPE). DiR retention in pleural cavity was followed by biofluorescence imaging. Experimental results demonstrate that liposome size and PEG-coating, have a significant effect on residence time in the pleural cavity; negative surface charge does not. More than 20% liposomal-DiR is retained 24 d post-injection (in some cases), indicating the high potential towards localized diseases. Ex-vivo liposomal-DiR signal in tumors of MPE mice was similar to signal in liver, suggesting high tumor targeting potential of intrapleurally injected liposomes. Finally, no difference was noticed in liposomal-DiR retention between tumor-inoculated (MPE) and healthy mice, indicating the stability of liposomes in the presence of effusion (in MPE mice). The current study provides novel insights for using liposomes by intrapleural administration for the treatment of lung diseases.
Topics: Animals; Cell Line, Tumor; Cholesterol; Female; Humans; Injections; Kinetics; Liposomes; Male; Mice, Inbred C57BL; Optical Imaging; Phosphatidylglycerols; Pleural Cavity; Pleural Effusion, Malignant
PubMed: 31213801
DOI: 10.2147/IJN.S202568 -
Cancer Science Jul 2016Fiber-shaped particles of potassium octatitanate (tradename TISMO; chemical formula K2 O·6TiO2 ), which are morphologically similar to asbestos particles, were shown to...
Fiber-shaped particles of potassium octatitanate (tradename TISMO; chemical formula K2 O·6TiO2 ), which are morphologically similar to asbestos particles, were shown to induce severe proliferative reactions in the pleural mesothelium in a previous experiment carried out over 21 weeks. The present study aims to determine whether these fibers induce malignant mesotheliomas in rodents, and to examine chronic toxicity induced. Additionally, we investigated the specific differences observable between the biological responses to the direct infusion of the fibers alone into the pleural cavity and those induced by the co-administration of the fibers with a known carcinogen. To detect the induction of malignant pleural mesotheliomas, two experiments were undertaken. In Experiment 1, four strains of mice, A/J, C3H, ICR, and C57BL, were examined for 52 weeks after experimental treatment with TISMO. In Experiment 2, the F344 rats were treated with TISMO alone, the lung carcinogen N-bis (2-hydroxypropyl) nitrosamine (DHPN) alone, both TISMO and DHPN, or left untreated and were then examined for 52 weeks. In this experiment, malignant lesion induction was expected in the co-administration group. TISMO fibers were observed in the alveoli, indicating penetration through the visceral pleura in mice and rats. The histopathological detection of TISMO fibers in the liver and kidneys of mice and rats indicated migration of the fibers out of the pleural cavity. Atypical mesothelial cells with severe pleural proliferation were observed, but malignant mesotheliomas were not detected. Among the rats, there were no observed malignant alterations in the mesothelium induced by DHPN-TISMO co-administration.
Topics: Animals; Body Weight; Female; Kidney; Liver; Lung; Male; Mesothelioma; Mice; Mice, Inbred Strains; Nitrosamines; Organ Size; Particle Size; Pleural Cavity; Rats; Rats, Inbred F344; Species Specificity; Titanium
PubMed: 27088262
DOI: 10.1111/cas.12944 -
BMJ Case Reports Apr 2016Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited... (Review)
Review
Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited evidence to inform on its most effective management. We present two cases of large volume thoracocentesis resulting in acute respiratory decompensation that was treated by reintroducing the drained pleural fluid back into the pleural cavity. We also present a review of the literature specifically assessing the reported incidence rate of REPO after pleural fluid drainage. In both of our cases, symptoms and signs of respiratory instability were promptly reversed on reintroduction of the drained pleural fluid into the patient's pleural space-a therapy we have termed 'rapid pleural space re-expansion'. This was not associated with any short-term adverse outcomes. The occurrence of REPO is a rare event with most cohort studies reporting an incidence of between 0% and 1%.
Topics: Aged; Drainage; Dyspnea; Female; Humans; Incidence; Pleural Cavity; Pleural Effusion; Pneumothorax; Pulmonary Atelectasis; Pulmonary Edema; Thoracentesis
PubMed: 27122103
DOI: 10.1136/bcr-2016-215076 -
Annals of Agricultural and... Jun 2023Thoracocentesis is an invasive procedure routinely performed in the diagnosis of causes for the presence of pathological fluid in the pleural cavity. In many patients, a...
INTRODUCTION AND OBJECTIVE
Thoracocentesis is an invasive procedure routinely performed in the diagnosis of causes for the presence of pathological fluid in the pleural cavity. In many patients, a computed tomography scanning (CT) is also performed to diagnose the cause of the presence of fluid in the pleural cavity. The diagnostic value of CT is particularly high in situations in which performing thoracocenthesis could be associated with an increased risk of complications. The aim other study was to assess the relationship between the objective radiological features and the results of laboratory tests of fluid collected by thoracocenthesis in patients with pneumo-nias (n=18) and lung cancer (n=35).
MATERIAL AND METHODS
The examined group consisted of the patients with pneumonia (n=18) and lung cancer (n=35) which resulted in the presence of fluid in the pleural cavity. In the patients thoracocentesis, CT lung scanning was also performed, according to the medical indications. Three scans with the greatest amount of fluid were identified, and the mean density of the fluid expressed in Hounsfield units was calculated within the area. These calculations were compared with the results of laboratory fluid tests.
RESULTS
The maximum number of Hounsfield units (HU) was significantly lower in the group of lung cancer patients, compared to those diagnosed with pneumonia (74.3% sensi-tivity and 55.6% specificity). The pH of pleural fluid was significantly lower in patients with lung cancer, compared to those with pneumonia (74.3% sensitivity and 66.7% specificity).
CONCLUSIONS
According to the results, radiological differentiation of pneumonia and lung cancer resulting in pleural effusion, to some extent is possible; however, the needle is still needed.
Topics: Humans; Pleural Effusion; Lung Neoplasms; Tomography, X-Ray Computed; Pneumonia; Lung
PubMed: 37387370
DOI: 10.26444/aaem/159127 -
Lung Cancer (Amsterdam, Netherlands) Jan 2019A malignant pleural effusion (MPE) is a common complication in non-small cell lung cancer (NSCLC) with important staging and prognostic information. Patients with MPEs... (Observational Study)
Observational Study
OBJECTIVES
A malignant pleural effusion (MPE) is a common complication in non-small cell lung cancer (NSCLC) with important staging and prognostic information. Patients with MPEs are often candidates for advanced therapies, however, the current gold standard, cytological analysis of pleural fluid samples, has limited sensitivity. We aimed to demonstrate the feasibility of non-invasive enumeration and immunophenotyping of EpCAM-positive cells in pleural fluid samples for the diagnosis of a MPE in NSCLC patients.
MATERIALS AND METHODS
Pleural fluid specimens were prospectively collected from patients with NSCLC and the CellSearch® technology was utilized for the enumeration of pleural EpCAM-positive cells (PECs) and determination of PD-L1 expression on PECs from pleural fluid samples. The diagnostic performance of the enumeration of single PECs and PEC clusters was assessed using receiver operating characteristic (ROC) curves. The Kaplan-Meier method and Cox proportional hazards model was used to assess the impact of PECs and PEC clusters on overall survival (OS).
RESULTS
101 NSCLC patients were enrolled. The median number of PECs was significantly greater in the malignant (n = 84) versus non-malignant group (n = 17) (730 PECs/mL vs 1.0 PEC/mL, p < 0.001). The area under the ROC curve was 0.91. A cutoff value of 105 PECs/mL had a sensitivity and specificity of 73% and 100% for the diagnosis of a MPE, respectively. Among 69 patients with a pathology-confirmed MPE and tissue immunohistochemistry (IHC) results, 15 (22%) had greater than 50% PD-L1+ PECs. Overall concordance between tissue and PEC PD-L1 expression was 76%. Higher numbers of pleural effusion single PECs were associated with inferior overall survival (Cox adjusted HR 1.8, 95% CI: 1.02-3.05 p = 0.043).
CONCLUSION
Non-invasive measurement of PECs in NSCLC patients, using an automated, clinically available approach, may improve the diagnostic accuracy of a MPE, allow for immunophenotyping of PECs, and provide prognostic information.
Topics: Adult; Aged; Aged, 80 and over; B7-H1 Antigen; Carcinoma, Non-Small-Cell Lung; Cohort Studies; Epithelial Cell Adhesion Molecule; Feasibility Studies; Female; Humans; Immunophenotyping; Lung Neoplasms; Male; Middle Aged; Pleural Cavity; Pleural Effusion, Malignant; Prognosis; Prospective Studies
PubMed: 30642547
DOI: 10.1016/j.lungcan.2018.11.020 -
Nature Communications May 2017Malignant pleural effusion (MPE) is the lethal consequence of various human cancers metastatic to the pleural cavity. However, the mechanisms responsible for the...
Malignant pleural effusion (MPE) is the lethal consequence of various human cancers metastatic to the pleural cavity. However, the mechanisms responsible for the development of MPE are still obscure. Here we show that mutant KRAS is important for MPE induction in mice. Pleural disseminated, mutant KRAS bearing tumour cells upregulate and systemically release chemokine ligand 2 (CCL2) into the bloodstream to mobilize myeloid cells from the host bone marrow to the pleural space via the spleen. These cells promote MPE formation, as indicated by splenectomy and splenocyte restoration experiments. In addition, KRAS mutations are frequently detected in human MPE and cell lines isolated thereof, but are often lost during automated analyses, as indicated by manual versus automated examination of Sanger sequencing traces. Finally, the novel KRAS inhibitor deltarasin and a monoclonal antibody directed against CCL2 are equally effective against an experimental mouse model of MPE, a result that holds promise for future efficient therapies against the human condition.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Animals; Antineoplastic Agents; Benzimidazoles; Cell Line, Tumor; Chemokine CCL2; Chickens; Chorioallantoic Membrane; Female; HEK293 Cells; Humans; Lung Neoplasms; Male; Mice; Mice, Inbred C57BL; Mice, Inbred NOD; Myeloid Cells; Pleural Cavity; Pleural Effusion, Malignant; Proto-Oncogene Proteins p21(ras); RNA, Small Interfering; Spleen; Up-Regulation; Xenograft Model Antitumor Assays
PubMed: 28508873
DOI: 10.1038/ncomms15205 -
Journal of Thoracic Disease Oct 2020The prognosis of non-small-cell lung cancer (NSCLC) patients with pleural dissemination is poor, and pleural dissemination is generally considered a contraindication for...
BACKGROUND
The prognosis of non-small-cell lung cancer (NSCLC) patients with pleural dissemination is poor, and pleural dissemination is generally considered a contraindication for radical surgery. However, if pleural dissemination is missed intraoperatively, patients with false-negative stage IV NSCLC cannot receive appropriate chemotherapy, and their prognosis might worsen.
METHODS
In the present study, we enrolled 144 patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUV) on positron emission tomography (PET) with lesions adjacent to the visceral pleura and without lesions invading the chest wall.
RESULTS
Seven patients who had pleural dissemination were compared with 137 patients who had not pleural dissemination. The relationships between pleural dissemination and the clinicopathological variables were analyzed, and significant differences in the histopathological type (P=0.03), and differentiation (P<0.01) were noted. It was suggested that squamous cell carcinoma tended not to show dissemination to the pleural cavity. The logistic regression analyses of the predictive factors related to pleural dissemination in non-squamous cell carcinoma patients were analyzed, and the age (P=0.01) and differentiation (P<0.01) were identified as significant predictive factors related to pleural dissemination.
CONCLUSIONS
Cases with non-squamous cell carcinoma, a young age, and poor differentiation of undifferentiated grade of histological differentiation are factors associated with early pleural cavity dissemination.
PubMed: 33209397
DOI: 10.21037/jtd-20-1543 -
The Journal of Clinical Investigation Jun 2015Mast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial. Here, we quantified MCs in human and...
Mast cells (MCs) have been identified in various tumors; however, the role of these cells in tumorigenesis remains controversial. Here, we quantified MCs in human and murine malignant pleural effusions (MPEs) and evaluated the fate and function of these cells in MPE development. Evaluation of murine MPE-competent lung and colon adenocarcinomas revealed that these tumors actively attract and subsequently degranulate MCs in the pleural space by elaborating CCL2 and osteopontin. MCs were required for effusion development, as MPEs did not form in mice lacking MCs, and pleural infusion of MCs with MPE-incompetent cells promoted MPE formation. Once homed to the pleural space, MCs released tryptase AB1 and IL-1β, which in turn induced pleural vasculature leakiness and triggered NF-κB activation in pleural tumor cells, thereby fostering pleural fluid accumulation and tumor growth. Evaluation of human effusions revealed that MCs are elevated in MPEs compared with benign effusions. Moreover, MC abundance correlated with MPE formation in a human cancer cell-induced effusion model. Treatment of mice with the c-KIT inhibitor imatinib mesylate limited effusion precipitation by mouse and human adenocarcinoma cells. Together, the results of this study indicate that MCs are required for MPE formation and suggest that MC-dependent effusion formation is therapeutically addressable.
Topics: Adenocarcinoma; Animals; Benzamides; Cell Line, Tumor; Colonic Neoplasms; Humans; Imatinib Mesylate; Interleukin-1beta; Lung Neoplasms; Male; Mast Cells; Mice; Mice, Inbred NOD; Mice, SCID; Mice, Transgenic; Piperazines; Pleural Cavity; Pleural Effusion, Malignant; Protein Kinase Inhibitors; Proto-Oncogene Proteins c-kit; Pyrimidines; Tryptases
PubMed: 25915587
DOI: 10.1172/JCI79840 -
Journal of Thoracic Oncology : Official... Jul 2007The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure... (Review)
Review
The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure that provides access to the pleural space, parietal pleura, lung, and other structures within the thoracic cavity. Pleuroscopy is a more exact term for describing visualization of the pleura and contents of the pleural cavity using an endoscope. This procedure provides physicians a window into the pleural space, to perform biopsy of the parietal pleura under direct visual guidance, particularly for biopsies in cases of exudative effusions with unclear origin, chest tube placement, and pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients. In this state-of-the-art review, we discuss the indications, contraindications, and complications of pleuroscopy, and its role in thoracic oncology.
Topics: Biopsy; Equipment Design; Humans; Lung Diseases; Thoracoscopes; Thoracoscopy
PubMed: 17607126
DOI: 10.1097/JTO.0b013e318070ccaf