Background: As many as 25% patients with a histological diagnosis of NSP at a thoracoscopic biopsy are eventually diagnosed with a malignancy, mostly mesothelioma, over the following months. Aim: to evaluate the value of pleural effusion levels of soluble mesothelin-related peptides (PE-SMRP) as a diagnostic tool in patients with histological diagnosis of NSP. Methods: All patients with an exudative pleural effusion and a histological diagnosis of NSP at thoracoscopic biopsies performed between Jenuary 2008 and December 2020 were followed for 18 months. A predefined cut-off level of 20 nM PE-SMRP, based on published data, was used to distinguish high- from low- PE-SMRP patients. A binary logistic regression was used to measure the relative risk of a later diagnosis of cancer. Results: Of the 185 patients with a diagnosis of NSP, 17 (9.2%) were diagnosed with cancer during follow-up (mean 6.38 months). A malignancy was diagnosed in 9 of the 15 high-PE-SMRP patients (60%), and in 8 of the 170 low-PE-SMRP patients (4.7%) (p<0.0001). High-PE-SMRP patients had a higher risk of being diagnosed with mesothelioma at follow-up (OR 31.2, 95% IC 8.5-114.7) (table 1).). Each nM increase in PE-SMRP increased the risk of a final diagnosis of mesothelioma by 1.07-fold (p<0.001). Conclusions: Patients with high levels of PE-SMRP are at increased risk of cancer after an initial histological diagnosis of NSP and might benefit from a closer follow-up.

Donna di 83 anni, ex fumatrice da 10 anni (30 packs/year), ex insegnante di lettere, con storia di quadrantectomia mammaria sinistra per adenocarcinoma ER e Pgr positivo nel 2010, seguita da CT e RT. Ripresa di malattia in sede linfonodale e scheletrica nel 2016, ha fatto terapia con fulvestrant e acido zoledronico e poi vinorelbina e capecitabina. Nel 2017 in seguito a riscontro di CEA serico molto elevato (oltre 200 ng/mL) ha eseguito ulteriori accertamenti e la colonscopia ha evidenziato lesione a manicotto del sigma, con diagnosi istologica di adenocarcinoma. Nel frattempo dispnea ingravescente con riscontro di versamento pleurico a destra (Figura 1A) e PaO2 di 60 mmHg, per cui e stata ricoverata in Pneumologia il 24 novembre 2017 ed e stata sospesa la decisione terapeutica, protesi endo-intestinale, relativa all’adenocarcinoma del sigma. (...)

Background. Pleural effusions are frequently the presenting symptom of neoplastic disease. The cytological examination of pleural effusion is recognized as being the most commonly used investigation in the diagnosis of malignancy. Objectives. The aim of this study was to assess the sensitivity and specificity of cytology in pleural exudate effusions compared to the histology obtained by medical thoracoscopy as the diagnostic gold standard examination. Methods. We assessed 256 consecutive thoracoscopies performed between 2006 and 2010 in the Pneumology ward of the Sarzana Hospital (Italy). Pleural disease was diagnosed based on histological criteria. Results. We had 80 mesotheliomas, 52 pleural metastasis and 124 non malignant pleural diseases. Cytologic examination permitted the diagnosis of 35 mesotheliomas (28 epithelioid, 2 sarcomatoid, 2 desmoplastic, 3 biphasic), 37 pleural metastasis (21 lung, 8 breast, 1 lymphoma, 3 ovary, 1 stomach, 1 liver, 2 uterus). Cytology remained negative in 45 mesotheliomas (28 epithelioid, 11 sarcomatoid, 2 desmoplastic, 4 biphasic) and in 15 pleural metastasis (6 lung, 4 breast, 3 lymphoma, 1 sarcoma, 1 thyme). The sensitivity of cytology was 53.8% and the specificity was 97.6%; the sensitivity of pleural metastasis was greater than the sensitivity of malignant mesothelioma (71.2% vs 43.7%). Conclusions. We conclude that sensitivity of first cytology samples in pleural effusion remains about 50% in the immunocytochemical era and that it is too low to avoid a diagnostic thoracoscopy. A negative cytologic examination of pleural effusion does not exclude a diagnostic thoracoscopy; a positive cytology for metastasis could exclude diagnostic thoracoscopy, even though thoracoscopy might be performed for talc poudrage. A positive cytology for mesothelioma requires confirmation by histology obtained by thoracoscopy.

Paziente donna di 82 anni, non fumatrice, ex contadina, marito carabiniere deceduto nel 1996 per mesotelioma pleurico epitelioide senza chiara esposizione lavorativa all’amianto; all’anamnesi patologica remota distacco bilaterale della retina a 41 anni con successiva cecita; nel 1995 operata per neoplasia mammella sn. (...)

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM PURPOSE: To describe endoscopic and histopathological findings in patients with evidence of cardiac disease (BNP plasma values >500 pg/ml) and an exudative pleural effusion (PE) . METHODS: We evaluated 257 patients from January 2008 to December 2014, with undetermined exudative PE and with a BNP serum determination, who underwent medical thoracoscopy with a minimum of ten parietal pleural biopsies. Plasma BNP concentrations were measured at admission. We included only patients with BNP plasma levels > 500 pg/ml and an explorable pleural cavity. The final diagnosis of pleural disease was assessed by histological criteria. Endoscopic finding (TF) were graded as Type 1: faint pleural thickening (Fig.1) without focal lesions or change of the endoscopic pleural pattern Type2: thickening with significantly change of the pleural endoscopic pattern with or without nodules and plaques, Type 3: normal pleura. At least 10 biopsies were taken from each patient. RESULTS: Of 257 patients with exudative PE, 16 (6.2%,) had a BNP plasma level > 500 pg/ml and explorable pleural cavity. Type 1 TF were observed in 7 patients (44%), Type 2 in 9 cases (56%). All patients with Type 1 TF had an histological diagnosis of chronic pleurisy characterized by mesothelial cell hyperplasia, polymorphic flogistic infiltration with lymphocyte predominance. (Fig.2) Patients with Type 2 TF had different histological diagnosis: 2 diagnosis of pleural tuberculosis, 1 pleural localization of Small Cell Cancer, 1 Mesothelioma, 1 Eosinophilic Pleuritis associated to eosinophilic pneumonia, 4 cases of Asbestosis associated to congestive heart failure. CONCLUSIONS: A diagnosis of cardiac pleurisy is characterized by endoscopic evidence of diffuse faint pleural thickening and histopathological findings of mesothelial cell hyperplasia with polymorphic flogistic infiltration. CLINICAL IMPLICATIONS: Suggeste medical thoracoscopy in indetermined exudative pleural effusion associated to congestive heart failure (plasma BNP concentration > 500 pg/ml). DISCLOSURE: The following authors have nothing to disclose: Valentina Pinelli, Fiorenza Marugo, Donatella Intersimone, Franco Fedeli, Daniele Bertoli, Massimiliano Sivori, Pier Aldo Canessa No Product/Research Disclosure Information

Si tratta di uomo di 69 anni, non fumatore, ex tecnico impianti TV senza esposizione all’amianto che riferisce in anamnesi patologica remota nefrotomia sinistra per calcolosi nel 2004. Dall’inizio di settembre del 2013 comparsa di dispnea ingravescente per cui il medico curante lo invia in PS (11 settembre) dove una radiografia del torace (Figura 1) evidenzia la presenza di abbondante versamento pleurico a sinistra con spostamento del mediastino controlaterale; la EGA evidenzia ipossiemia (PaO2 59 mmHg); il BNP serico (23 pg/ml) e l’ECG sono nella norma; viene ricoverato in Pneumologia. (...)

Background: PE due to congestive heart failure is not always a transudate, almost 12% of patients with cardiac disease have an exudative PE. Serum BNP > 500 pg/ml has high diagnostic accuracy in recognizing PE of cardiac origin nevertheless in some cases only more invasive procedures such as medical thoracoscopy (MT) can make a final etiological diagnosis. To our knowledge there are not report about the endoscopic and histological pattern of an exudative PE of cardiac origin Aim: to describe endoscopic and histopathological findings in patients with evidence of cardiac disease (BNP plasma values >500 pg/ml) and an exudative PE. Methods: We carry out a retrospective study of 202 MT performed in our hospital for undetermined exudative PE. Only patients with BNP > 500 pg/ml were included. Thoracoscopic findings (TF) were graded as Type 1 : diffuse pleural thickening, Type2 : non-specific pleural inflammation with or without nodules, Type 3 : normal pleura. At least 10 pleural biopsies were taken from each patient. Results: of 202 patients with exudative PE, 15 (7.4%) had a BNP plasma level > 500 pg/ml (Mean, SE: 891±204). Type 1 TF were observed in 13 patients (87%), Type 2 in 2 cases (13%). All patients with Type 1 TF had a faint pleural thickening and histopathological changes characterized by mesothelial cell hyperplasia, polymorphic flogistic infiltration with lymphocyte predominance. The 2 patients with type 2 TF had a final diagnosis of pleural tuberculosis Conclusion: A diagnosis of cardiac pleurisy is characterized by endoscopic evidence of diffuse faint pleural thickening and histopathological findings of mesothelial cell hyperplasia with polymorphic flogistic infiltration.

Si tratta di uomo di 42 anni, nazionalita marocchina e da 20 anni in Italia, mai fumatore, manovale nell’edilizia senza esposizione all’amianto. L’anamnesi patologica remota e negativa. (...)

This report discusses the association of ovarian lymphoma and hydroureteronephrosis managed by laparoscopic surgery and endoscopy.