THORACIC CLUB MEETING

AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA

PLEURAL TUMORS

• Case presentation• Introduction• Epidemiology• Classification• Aetiology• Clinical presentation• Investigation• treatment• conclusion

CASE PRESENTATION

• A. R.

• 55yr, H/Wife.

• Refered Yusuf Dantsoho Hospital.

• PC-Cough x5/12

• -Haemoptysis x5/12

• -Dyspnoea x5/12

• -Lt Chest pain x4/12

• Cough-distressing, non paroxysmal,• mucoid sputum,• -not posture related• Associated with –• - haemoptysis 50ml/day• -low grade fever, night sweat.• -no weight loss, contact with PTB pt.• -Lt chest pain• Dyspnoea-progressive .

• No history of exposure to Asbestosis, irradiation.

• Does not smoke cigarret.

• No FHx .

• Other systemic review not contributory.

• PMHx- admitted 2ce, chest tube.

-anti TB for 3/12

• Not a known Hypertensive, Diabetic.

FSHx

• General physical examination.

• Chest-RR-20/min SPO2 97%• -Chest tube insitu Rt 5ICS• -Deviated trachea Rt • -decreased Lt chest expansion, tactile fremitus• -dull Lt PN,decreased BS.

• Other Systemic Review-

• Assessment-Lt haemorrhagic pleural Effusion due to -PTB

• -mesothelioma

• -Bronchogenic Ca

Available Investigation results

• CXR-

• Sputum AFB- -ve

• Pleural fluid.

• Pleural biopsy.

• Abdominal USS.

• ESR-60mm/hr

• Pcv-36%.

• WBC-9x10 N-60% L-34% M-6%.

LITERATURE REVIEW

PLEURAL TUMORS

INTRODUCTION

• Most common primary tumor of Pleura are benign and malignant Mesothelioma.

• Mesothelioma are malignancy of mesothelia cells lining pleural cavity.

• Often present as malignant effusion.• Less common are sarcoma, lymphoma,

etc.• Virtually all cancers metastasize to pleura.• Asbestos exposure implicative.

Epidemiology

• 2500-3000 cases /day. (US)• 0.1-0.2 /100,000 population.• 3-4 cases /yr in ABUTH• 2-10 folds in Asbestos polluted area.• Race-no predilection.• Sex- M:F 3:1• Age-5-7 decade.• -20-40yr post exposure.

Classification of Pleural tumors

• Primary tumors.

• Metastatic.

Mesothelioma-Benign localised M.

-Malignant localised M.

-Malignant epithelial M.

AETIOLOGY

• Asbestos- amphibole, crocidolite

• Erionite.

• Radiation, thorium dioxide.

• Loss of one copy of chromosome 22.

• SV40 Virus

Clinical features

• Asymptomatic.

• Cough.

• Chest pain.(50-90%)

• Dyspnoea.

• Haemptysis.

• +/- weight loss.

• Exposure to Asbestos.

• Fever, night sweat, Hyperglycemia.

• Metastatic disease uncommon at presentation.

• Physical Examinaton.

• Chest-Pleural effusion.

• Systemic examination –primary site.

Investigations• Diagnostic Imaging studies-

– CXR

– CT scan

– Ultra sonography – abdomino-pelvic.

• VATs and biopsy.

• Pleural fluid-typically not diagnostic.

• Pleural biopsy-diagnostic in 98%.

• immunohistochemistry.

• Lung function test.

• Ancillary investigation.

Staging

TNM

Brigham-

• Stage I - Completely resected within the capsule of the parietal pleura without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites)

• Stage II - All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination

• Stage III - Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes

• Stage IV - Distant metastatic disease

TREATMENT

• Surgery-Extrapleural pneumonectomy.

-Decortication.

Radiotherapy.

Chemotherapy.

Trimodality.

Prognosis

Conclusion

Pleural tumors are rare and patients present late due to late diagnosis and referal from peripheral Hospitals, therefore overall prognosis is poor.