Carcinomatous involvement of the pleura: An analysis of 96 patients

doi:10.1016/0002-9343(77)90154-1

The American Journal of Medicine

Volume 63, Issue 5, November 1977, Pages 695-702

https://doi.org/10.1016/0002-9343(77)90154-1 Get rights and content

Abstract

To better define the prevalence, presentation, primary sites and survival of patients with Carcinomatous involvement of the pleura, we reviewed 96 cases of carcinoma of the pleura diagnosed by cytopathology or closed pleural biopsy at Colorado General Hospital from 1960 to 1975. Carcinomatous pleura) metastasis was present in 43/100,000 persons admitted to the hospital. The most common primary sites were lung in 32 of 96 (33 per cent), breast in 20 of 96 (20.9 per cent), ovary in nine of 96 (9.3 per cent) and stomach in seven of 96 (7.3 per cent). The incidence of pleural metastasis per type of carcinoma was lung in 32 of 459 (7.0 per cent), stomach in seven of 195 (3.6 per cent), breast in 20 of 645 (3.1 per cent) and ovary in nine of 303 (2.9 per cent). Chief presenting symptoms included dyspnea (57 per cent), cough (43 per cent) and chest pain (26 per cent); however, 22 of 96 subjects (23 per cent) were asymptomatic. Ninety-two per cent of the lung, breast and ovarian malignant effusions were ipsilateral to the primary lesion. The malignant pleural effusions were usually clear or serosanguineous exudates with a protein content of 3.7 ± 0.2 g/100 ml (mean ± standard error of the mean (SEM); lactic dehydrogenase 134 ± 15 lU/liter; glucose 120 ± 13 mg/100 ml, white blood cell count 2,250 ± 400/mm³. Mean survival was 3.1 ± 0.5 months (after diagnosis of pleural metastasis) with 54 per cent mortality within one month and 84 per cent mortality by six months. A malignant pleural effusion provided the basis for the first diagnosis of cancer in 44 of 96 patients (46 per cent).

Pleural involvement, although often asymptomatic, is an ominous finding usually representing widespread metastases. Lung, breast, ovary and stomach were the most frequent primary sites, with carcinoma of the lung being the most common to involve the pleura; however, its incidence was relatively low. A malignant pleural effusion frequently represents the first evidence of cancer.

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^☆: This study was supported by NHLBI Grants HL 05933 and HL 07085.

^∗: Present address: Internal Medicine Service, National Naval Medical Center, Bethesda, Maryland 20014.

¹: From the Division of Pulmonary Sciences, Department of Medicine, University of Colorado Medical Center, Denver, Colorado.

^†: Recipient of NHLBI Young Pulmonary Investigator Research Grant 17237.

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Clinical studyCarcinomatous involvement of the pleura: An analysis of 96 patients☆

Abstract

Chest

Br J Dis Chest

Chest

Lancet

Chest

Chest

J Thorac Surg

Ann Thorac Surg

Surg Clin North Am

J Thorac Cardiovasc Surg

Pleural effusions. The diagnostic separation of transudates and exudates

Ann Intern Med

A critical evaluation of 3,000 cytologic analyses of pleural fluid, ascitic fluid and pericardial fluid

Acta Cytol

Valeur de la biopsie pleurale à l'aiguille dans le diagnostic des épanchements pleuraux

Lille Med

Les épanchements pleuraux d'étiologie imprécise. Apport des méthodes récentes de diagnostic

Lille Med

Confronto fra risultati dell esame citologico del versamento e dell esame isotologico dell agobiopsia nella pathologia pleurica

Arch del Vecchi Anat Pat

The cytological diagnosis of cancer in serous effusions

Acta Cytol

Diagnosis and differential diagnosis in tuberculous pleurisy

Scand J Respir Dis

Pleural biopsy in diagnosis of thoracic disease

Br Med J

Needle biopsy of the parietal pleura in patients with pleural effusion

Br Med J

Needle biopsy of the pleura in the diagnosis of pleural effusion. A report of 118 cases

Q J Med

Needle biopsy of the pleura. An evaluation in patients with pleural effusion of neoplastic origin

Cancer

Pleural biopsy as an aid in the etiologic diagnosis of pleural effusion. Review of literature and report of 132 biopsies

Ann Intern Med

Clinical study
Carcinomatous involvement of the pleura: An analysis of 96 patients☆