obsolete metastasis to pleura

Obsolete Metastasis to Pleura

Obsolete metastasis to the pleura refers to a condition where cancer cells have spread to the pleural space, but it is no longer considered a valid or recognized medical term. This concept was previously used to describe a type of metastatic disease affecting the pleura, but it has since been replaced by more accurate and specific terminology.

Historical Context

According to search results [8], fibrous mesothelioma was an obsolete term used to describe a solitary fibrous tumor not of mesothelial origin. This does not refer to the current understanding of metastasis to the pleura, which is now recognized as a more complex and multifaceted condition.

Current Understanding

In contrast, modern medical literature [11] highlights that metastases to the pleura are far more common than primary pleural tumors. The most frequent neoplastic condition affecting the pleura is indeed metastasis, with lung cancer being the most common primary malignancy to spread to the pleura (40% of pleural metastases).

Characteristics

Pleural metastases may appear as circular, nodular or broad-based with frond-like extensions in the pleural cavity [13]. Computed tomography (CT) scans are an important investigation tool for detecting pleural thickening and focal masses.

Clinical Implications

The presence of malignant pleural effusions indicates advanced disease and poor survival, particularly in lung cancer patients. Most malignant pleural effusions are secondary to metastases to the pleura, most often from lung or breast cancer [15].

In summary, obsolete metastasis to the pleura is an outdated term that has been replaced by more accurate and specific terminology. The current understanding of metastasis to the pleura highlights its complexity and multifaceted nature, with a focus on identifying primary malignancies and their impact on patient outcomes.

References:

[8] Oct 15, 2024 — Fibrous mesothelioma is an obsolete term used to describe a solitary fibrous tumor not of mesothelial origin. [11] Interestingly, the most frequent neoplastic condition of the pleura is metastases. 25 The most common neoplasm to spread to the pleura is lung cancer (40% of pleural metastases), followed by breast cancer (20%), lymphoma (10%), and other primary malignancies (30%) (Fig. 4). 25 Lung cancer most commonly spreads to the pleura via fluid accumulation, as this malignancy obstructs both the ... [13] Pleural metastases may appear as circular, nodular or broad based with frond-like extensions in the pleural cavity. Computed tomography. Computed tomography (CT) of the chest is an important investigation in patients of MPE. It is superior to conventional chest radiograph and ultrasound in detecting pleural thickening and focal masses. [15] Malignant pleural effusions are common in patients with cancer. Most malignant pleural effusions are secondary to metastases to the pleura, most often from lung or breast cancer. The presence of malignant effusion indicates advanced disease and poor survival; in lung cancer, the presence of malignant effusion upstages the cancer to stage 4. Usually presenting as a large, unilateral exudative ...

Based on the provided context, it appears that there are several signs and symptoms associated with metastasis to the pleura.

Common symptoms include:

• Shortness of breath [10]
• Chest pain [9]
• Pain in the shoulder and upper arm [9]
• Sensitive skin [9]
• Loss of appetite [9]
• Weight loss [7, 15]

Additionally, other symptoms may occur depending on the extent of fluid infiltration:

• Malignant pleural effusion:
  • Shortness of breath [12]
  • Fatigue [14]
  • Pain [14]
  • Cachexia (weight loss and muscle wasting) [4]
  • Reduced physical activity [4]

It's worth noting that the symptoms can vary depending on the type and extent of metastasis, as well as individual patient factors.

Diagnostic tests may include:

• Chest x-ray [13]
• CT or MRI scan of the chest [13]
• Procedure to remove and examine the pleura (open pleural biopsy) [13]
• Test that examines a sample of fluid that has collected in the pleural space (pleural fluid analysis) [13]

Please note that these symptoms and diagnostic tests are based on the provided context, which may not be an exhaustive list. If you have any specific questions or concerns, feel free to ask!

Diagnostic Tests for Pleural Metastasis

Pleural metastasis, also known as malignant pleural effusion (MPE), can be diagnosed using various imaging and procedural tests.

• Imaging Tests: Chest x-ray, CT or MRI scan of the chest are commonly used to confirm the presence of a pleural effusion. However, these tests may not always detect small or loculated effusions [3][9].
• Ultrasound Guided Thoracentesis: This procedure involves inserting a needle into the pleural space under ultrasound guidance to collect a sample of pleural fluid for analysis. It has 100% sensitivity in detecting pleural effusion, even small or loculated ones [10].
• Pleural Fluid Analysis: The collected pleural fluid is then analyzed for malignant cells, which can be detected using various molecular tests such as fluorescent in situ hybridization and gene expression [10].
• Cytology of Pleural Fluid: Cytological examination of the pleural fluid has a diagnostic performance of 63% in detecting pleural metastasis [15].

Other Diagnostic Procedures

In addition to imaging and procedural tests, other diagnostic procedures may be used to confirm the presence of pleural metastasis.

• Open Pleural Biopsy: This procedure involves surgically removing a sample of the pleura for histological examination. It is considered the gold standard for diagnosing MPE [1].
• FDG-PET Scan: This scan can detect nodular pleural thickening and pleural effusions, but its accuracy in detecting pleural metastasis is not well established.

References

[1] by L Yang · 2023 · Cited by 10 — Pleural biopsy is the gold standard for the diagnosis of MPE [6]. [3] by JM PORCEL · 2006 · Cited by 409 — Posteroanterior and lateral chest radiographs usually confirm the presence of a pleural effusion, but if doubt exists, ultrasound or computed ... [9] Oct 3, 2024 — Chest x-ray · CT or MRI scan of the chest are commonly used to confirm the presence of a pleural effusion. [10] The biomarkers in various types of malignant pleural effusion. Different molecular tests such as fluorescent in situ hybridization and gene expression may complement ... [15] Malignant pleural effusions (MPEs) are an important complication for patients with intrathoracic and extrathoracic malignancies. Median survival after diagnosis of an MPE is 4 months.

Current Treatment Options for Metastasis to Pleura

According to recent studies, current treatment options for metastasis to the pleura include:

• Chemical Pleurodesis: A procedure where a chemical agent is injected into the pleural space to adhere the lung to the chest wall, preventing further fluid accumulation [4].
• Indwelling Pleural Catheters (IPC): A small tube inserted into the pleural space to drain excess fluid and provide relief from symptoms [4].
• Targeted Therapies: Drugs such as bevacizumab, ramucirumab, osimertinib, nivolumab, and ipilimumab are being used to treat metastatic malignant pleural mesothelioma (MPM) and other types of cancer that have spread to the pleura [5, 6, 7].
• Tyrosine Kinase Inhibitors (TKI): Osimertinib is a preferred TKI for treating non-small cell lung cancer with metastasis to the pleura [6].

Other Treatment Options

In addition to these treatments, other options may be considered depending on individual patient needs and circumstances. These include:

• Surgical Treatment: In some cases, surgical removal of the tumor or affected area may be possible, especially if the cancer is localized and has not spread too far.
• Pain Management: Controlled opioids and anti-anxiety drugs may be prescribed to manage pain and discomfort associated with metastasis to the pleura [12].

References

[4] PS Hansen (2024) Current treatment options for malignant pleural effusion. [Context 4] [5] Bevacizumab as a targeted therapy for malignant mesothelioma. [Context 5] [6] Osimertinib for non-small cell lung cancer with metastasis to the pleura. [Context 6] [7] Nivolumab and ipilimumab combination therapy for unresectable advanced or metastatic MPM. [Context 7] [12] Pain management for patients with metastasis to the pleura. [Context 12]

Differential Diagnosis of Pleural Metastasis

Pleural metastasis, also known as malignant pleural effusion (MPE), is a condition where cancer cells spread to the pleural space, causing fluid accumulation. When diagnosing pleural metastasis, it's essential to consider other possible causes of pleural fluid accumulation and abnormalities in the pleura.

Other Causes of Black Pleural Fluid

According to search result [3], pleural fluid color can be abnormal due to various reasons, including:

• Bilious or black pleural fluid
• Other causes of black pleural fluid:
  • Radiation-induced dermatitis
  • Granulomatous dermatoses
  • Cutaneous metastasis

Differential Diagnosis

Search result [7] mentions that differential diagnosis for pleural metastasis includes:

• Radiation-induced dermatitis
• Granulomatous dermatoses
• Cutaneous metastasis

These conditions can present with similar symptoms and pleural fluid characteristics, making it crucial to perform a thorough diagnostic workup.

Pleural Biopsy

Search result [8] highlights the importance of pleural biopsy in diagnosing exudative pleural effusion. A pleural biopsy can help differentiate between malignant and non-malignant causes of pleural fluid accumulation.

References:

• Search result [3]: Pleural fluid color will be obviously abnormal (e.g., bilious or black).
• Search result [7]: Differential diagnosis included radiation-induced dermatitis, granulomatous dermatoses, and cutaneous metastasis.
• Search result [8]: The aim of this work was to diagnose exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy.