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Lung Cancer |

Etiology of Isolated Malignant Pleural Effusion

Ravi Chandran, MD; Raghav Vadhul; Keshav Chandran
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Oconee Medical Center, Seneca, SC


Chest. 2015;148(4_MeetingAbstracts):563A. doi:10.1378/chest.2251824
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Abstract

SESSION TITLE: Lung Cancer Screening & Diagnosis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Isolated malignant pleural effusion of lung origin (IMPE) without obvious radiological evidence of lung lesion is a rare presentation of lung cancer. At the present time, IMPE is designated as stage IV lung cancer under the TNM classification. Clinical experience by the author shows the prognosis of IMPE is better than the stage IV lung cancer. The purpose of the study is to assess the pathology of IMPE.

METHODS: We retrospectively reviewed the cytopathology results of pleural effusion sent to the lab from 2010 to 2014 in our hospital pathology department. Patients with malignant pleural effusion were separated from patients with non-malignant pleural effusion. We reviewed the CT scan and X-ray chest report of the patients with malignant pleural effusion post thoracentesis and their medical records. Malignant pleural effusion of pulmonary origin were separated from malignant pleural effusion of non-pulmonary origin. Subsequently, IMPE was isolated from malignant pleural effusion with lung and/or mediastinal mass.

RESULTS: A total of 139 patients were found to have pleural effusion sent for cytopathology analysis. Of those 139 pleural effusion, 23 were diagnosed as malignant pleural effusion. 6 of those were non-pulmonary malignant pleural effusion (3 breast cancer, 1 peritoneal cancer, 1 renal cancer, and 1 colon cancer). 5 of the malignant pleural effusion were associated with a pulmonary mass on presentation (3 adenocarcinoma, 1 squamous cell carcinoma, and 1 non-small cell carcinoma). 12 of the malignant pleural effusion were IMPE (without any lung lesions on presentation). All 12 were found to be adenocarcinoma of lung origin.

CONCLUSIONS: The most common cause of IMPE is adenocarcinoma of lung origin.

CLINICAL IMPLICATIONS: Adenocarcinoma has the advantage of molecular testing based targeted chemotherapy. IMPE should be considered as a distinct clinical entity because of the availability of molecular testing based chemotherapy. Further studies are required to assess the prognosis of IMPE compared to stage IV lung carcinoma.

DISCLOSURE: The following authors have nothing to disclose: Ravi Chandran, Raghav Vadhul, Keshav Chandran

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