Pleural Effusion, Pleuritis, and Tumors of the Pleura

Question 1

What is a pleural effusion?

Answer 1

An excess of fluid in the pleural cavity

Question 2

What is a hydrothorax? What can cause it?

Answer 2

Edema of the pericardium

• Increased Hydrostatic Pressure (CHF)
• Low Serum Protein (Nephrotic Syndrome, Cirrhosis, Starvation)
• Collagen Vascular Disease
• Asbestos

Question 3

What is a Pyothorax?

Answer 3

Turbid effusion containing many PMNs resulting from infection of the pleura

Question 4

What is a hemothorax? What is it caused by?

Answer 4

Blood in the pleural cavity as a result of trauma or rupture of a vessel (aortic dissection, tuberculosis)

Question 5

What is a chylothorax?

Answer 5

Accumulation of lipid rich fluid (chyle) in the pleural cavity due to lymphatic obstruction

Question 6

What is the most striking Syx of pleuritis?

Answer 6

Sharp, stabbing chest pain on inspiration

Question 7

A tumor removed from a patient’s pericardium is shown below. It is whorled and has a tan cut surface. What is the Dx?

Answer 7

Pleural localized (solitary) fibrous tumor

Question 8

The histologic section below is of a pleural localized fibrous tumor. Describe the histology. What is the tumor typically immunopositive for?

Answer 8

The histology is described as the “pattern-less pattern” containing disordered mixtures of fibroblast-like cells and connective tissue; CD34 and bcl-2

Question 9

What is the median age of Localized Solitary Fibrous Tumor Dx?

Answer 9

55 yo

Question 10

A patient has a tumor excised from their pericardium. The tumor shows markers for carcinoembryonic antige, Leu-M1, B72.3 and BER-EP4. What is the Dx?

Answer 10

Adenocarcinoma

Question 11

A tumor is excised from the pericardium and shows calretinin, WT-1 and D240 on IHC. The tumor is also positive for cytokeratin. Histological section shows biphasic pattern of epithelial and sarcomatous elements. What is the Dx? Which marker helps least with differentiating this tumor? What two cancers have this marker?

Answer 11

Pleural Malignant Mesothelioma; Cytokeratin because adenocarcinoma and PMM both have it.

Question 12

What causes pleural malignant mesothelioma?

Answer 12

Asbestos exposure

Question 13

This lung is encased by a dense pleural tumor that extends along the interlobar fissures but does not involve the underlying lung parenchyma. It is described as having a pleural rind. What is the Dx?

Answer 13

Pleural malignant mesothelioma