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Pleural tumours 

Pleural tumours

Chapter:
Pleural tumours
Author(s):

Robert J.O. Davies

and Y.C. Gary Lee

DOI:
10.1093/med/9780199204854.003.181903_update_001

Update:

Biomarkers—discussion of utility of serum mesothelin level.

Treatment—(1) increasing usage of indwelling pleural catheters for control of pleural fluid; (2) revised comments on use of radiotherapy and multimodality treatment.

Relevant case histories from Oxford Case Histories in Respiratory Medicine has been added to this chapter.

Updated on 30 May 2013. The previous version of this content can be found here.
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date: 28 March 2017

Benign tumours are rare in the pleural cavity, with solitary fibrous tumour of the pleura, the most frequent of these rarities.

Malignant pleural tumours are common and can arise from the pleura (most commonly mesothelioma) or as metastases from extrapleural malignancies (especially lung and breast cancer). They typically present with breathlessness, chest pain, and a pleural effusion. Diagnosis requires histocytological confirmation of malignant cells from pleural fluid and/or pleural biopsies.

Mesothelioma—most cases are due to asbestos exposure, characteristically after a latent period of more than 20 years, with risk related to the duration and intensity of asbestos exposure and the fibre type (worst with needle-like amphiboles). The condition is incurable, with overall median survival of about 9 months. Care involves control of pain and pleural effusion, chemotherapy with multitargeted antifolate agents in combination with cisplatin, and radiotherapy for symptom palliation.

Metastatic pleural malignancy—most tumours that have spread to the pleura are incurable. For tumours that are highly responsive to chemotherapy (e.g. lymphoma or small cell carcinoma) treatment may control pleural fluid re-accumulation. Definitive treatment for fluid control (e.g. pleurodesis) should be performed in patients with symptomatic recurrence of malignant pleural effusions. Indwelling pleural catheters (IPCs) provide an effective alternative to pleurodesis or when the latter fails. Surgical pleurodesis may be considered in selected patients.

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