Öz
Background: Pathologies associated with pleural thickening are presented along with
similar clinical and radiological findings. The present study highlights the
importance of the differential diagnosis verification of patients with pleural
thickening. Video-assisted thoracoscopic surgery (VATS) is one of the most
common diagnostic and therapeutic method used for this purpose. In this study,
we aim to deliver our clinical investigation results on patients diagnosed with
pleural pathology in the light of recent literature.
Methods: During the period of May 2012-June 2014, single port VATS pleural biopsy
were successfully performed on 40 patients (25 male and 15 female) in our
hospital. Thoracic CT and pathology
results were compared. Clinical diagnosis, radiologic findings, and biopsy
results were evaluated retrospectively.
Results: The average age of the patients is 59.15 ±12.13 (age range 23, 82). There
was an environmental exposure to asbestos in 14 patients (35%). 25 patients
(62.5 %) was followed with clinical pre-diagnosis of mesothelioma, 8 patients
(20%) of tuberculosis, 4 patients (10%) of pleural metastasis and 3 patients
(7.5 %) of pleuritis. Histopathologically 8 patients (20%) were diagnosed with
malignant mesothelioma, 1 patient (2.5 %) was localized fibrous tumor, 2
patients were (5%) diagnosed with reactive mesothelial hyperplasia, 6 patients
(15%) were malignant epithelial tumor metastasis, 16 patients (40%) were
fibrinous pleuritis, 6 patients (15%) were chronic granulomatous inflammation,
and 1 patient (2.5%) was chronic lymphocytic inflammation.
Conclusions: The present study demonstrates insufficency of
thoracic CT for diagnosis and differential diagnosis due to similar clinical
and radiological findings associated with pathological pleural thickening. Histopathologic
examination is required for diagnosis. However, thoracic CT is still a method of
radiographic imaging that is actively used in determination of pleural biopsy
position, evaluation, and clinical monitoring of response to treatment.
Anahtar Kelimeler
fibrinous pleuritis chronic granulomatous reaction mesothelioma pleural thickening thoracic CT
Kaynakça
- References 1. Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, Zellos L (eds). Adult Chest Surgery. New York: The McGraw-Hill Company, 2009.
- 2. Kaynak K. Plevra hastalıklarında torakoskopi(VATS) ve torakotomi. Solunum 2002;4(1): 116-21.
- 3. Caccavale RJ, Lewis RJ. Video-assisted thoracic surgery as a diagnostic tool. In: Shields TW, Lo Cicero III J, Ponn RB eds. General Thoracic Surgery 5th edition LWW 2000: Volume 1 Ch 18; 285-293.
- 4. Zielinski M, Hauer J, Hauer L et-al. Staging algorithm for diffuse malignant pleural mesothelioma. Interact Cardiovasc Thorac Surg. 2010;10 (2): 185-9.
- 5. Robins SL., Cotran RS. Pathologic Basis of Disease 7th edition 712-772.
- 6. Webb WR, Higgins CB. Thoracic İmaging. Pulmonary and Cardiovascular radiology. Lippincott Williams and Wilkins. 2011, pp 625-647.
- 7. Soomin Ahn, In Ho Choi and Myung-Ju Ahn. Pleural Mesothelioma: An Instıtutional Experience of 66 cases. Korean J Pathol, 2014 Apr; 48(2):91-99.
- 8. Okten F, Köksal D, Onal M, Ozcan A, Simşek C, Ertürk H. Computed tomography findings in 66 patients with malignant pleural mesothelioma due to environmental exposure to asbestos. ClinImaging. 2006 May-Jun;30(3):177-80.
- 9. Wang ZJ, Reddy GP, Gotway MB et-al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics.2004; 24 (1): 105-19.
- 10. Cagle PT, Allen TC. Pleuritis and pleural plaque. Frozen Section Library. Volume 3, 2010, pp 57-74.
- 11. Çelik B, Sürücü ZP, Barış YS. Plevranın soliter fibröz tümörü. Türk Toraks Dergisi 2013;14:75-7.
- 12. McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am. 1995; 33: 655–77.
- 13. Patel A, Choudhury S. Pleural tuberculosis presented as multiple pleural masses: An atypical presentation. Lung India : Official Organ of Indian Chest Society. 2013; 30(1):54-56.
- 14. Rzyman W, Skokowski J, Romanowicz G, Lass P, Dziadziuszko R. Decortication in chronic pleural empyema - effect on lung function. Eur J Cardiothorac Surg 2002; 21:502-7.
Öz
Amaç: Plevral kalınlaşma ile ilişkili akciğer patolojileri
benzer klinik ve radyolojik bulgular göstermektedir. Bu çalışmada, plevral
kalınlaşması olan hastaların ayırıcı tanısının yapılmasının önemini
vurgulamaktadır. Bu amaçla en yaygın kullanılan tanı ve tedavi yöntemi video
yardımlı torakoskopik cerrahi (VATS)’dır. Bu çalışmada, plevral kalınlaşması
olan hastalarda klinik araştırma sonuçlarımızı güncel literatür ışığında
sunmayı amaçladık.
Yöntem: Mayıs 2012-Haziran 2014 tarihleri arasında
kliniğimizde tek port VATS plevral biyopsisi uygulanan 40 hastanın verileri
retrospektif olarak değerlendirildi. Torasik BT ve patoloji sonuçları
karşılaştırıldı. Klinik tanı, radyolojik bulgular ve biyopsi sonuçları
retrospektif olarak değerlendirildi.
Bulgular: Hastaların yaş ortalaması 59,15 ± 12,13'tü (yaş
aralığı 23-82). 14 hastada (%35) çevresel asbest maruziyeti vardı. Klinik ve
radyolojik bulgularına göre, 25 hasta (%62,5) mezotelyoma, 8 hasta (%20)
tüberküloz, 4 hasta (%10) plevral metastaz ve 3 hasta da (%7,5) plörit ön
tanısı ile takip edildi. Histopatolojik olarak ise 8 (%20) malign mezotelyoma,
1 (%2,5) lokalize fibröz tümör, 2 (%5) reaktif mezotel hiperplazisi, 6 (%15)
malign epitelyal tümör metastazı, 16 (%40) fibrinöz plörit, 6 (%15) kronik
granülomatöz inflamasyon ve 1 hastada da (%2,5) kronik lenfositik inflamasyon
saptandı.
Sonuç: Bu çalışma, benzer klinik ve radyolojik bulgulara
bağlı olarak plevral kalınlaşma ile ilişkili hastalıklarda toraks BT'nin tanı
ve ayırıcı tanıda yetersiz olduğunu göstermektedir. Tanı için histopatolojik
inceleme gereklidir. Bununla birlikte toraks BT, halen plevral biyopsi yerinin
belirlenmesinde, değerlendirilmesinde ve tedaviye yanıtın klinik olarak
izlenmesinde aktif olarak kullanılan bir radyografik görüntüleme yöntemidir.
Anahtar Kelimeler
Fibrinöz plörit kronik granülomatöz reaksiyon mezotelyoma plevral kalınlaşma toraks BT;
Kaynakça
- References 1. Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, Zellos L (eds). Adult Chest Surgery. New York: The McGraw-Hill Company, 2009.
- 2. Kaynak K. Plevra hastalıklarında torakoskopi(VATS) ve torakotomi. Solunum 2002;4(1): 116-21.
- 3. Caccavale RJ, Lewis RJ. Video-assisted thoracic surgery as a diagnostic tool. In: Shields TW, Lo Cicero III J, Ponn RB eds. General Thoracic Surgery 5th edition LWW 2000: Volume 1 Ch 18; 285-293.
- 4. Zielinski M, Hauer J, Hauer L et-al. Staging algorithm for diffuse malignant pleural mesothelioma. Interact Cardiovasc Thorac Surg. 2010;10 (2): 185-9.
- 5. Robins SL., Cotran RS. Pathologic Basis of Disease 7th edition 712-772.
- 6. Webb WR, Higgins CB. Thoracic İmaging. Pulmonary and Cardiovascular radiology. Lippincott Williams and Wilkins. 2011, pp 625-647.
- 7. Soomin Ahn, In Ho Choi and Myung-Ju Ahn. Pleural Mesothelioma: An Instıtutional Experience of 66 cases. Korean J Pathol, 2014 Apr; 48(2):91-99.
- 8. Okten F, Köksal D, Onal M, Ozcan A, Simşek C, Ertürk H. Computed tomography findings in 66 patients with malignant pleural mesothelioma due to environmental exposure to asbestos. ClinImaging. 2006 May-Jun;30(3):177-80.
- 9. Wang ZJ, Reddy GP, Gotway MB et-al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics.2004; 24 (1): 105-19.
- 10. Cagle PT, Allen TC. Pleuritis and pleural plaque. Frozen Section Library. Volume 3, 2010, pp 57-74.
- 11. Çelik B, Sürücü ZP, Barış YS. Plevranın soliter fibröz tümörü. Türk Toraks Dergisi 2013;14:75-7.
- 12. McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am. 1995; 33: 655–77.
- 13. Patel A, Choudhury S. Pleural tuberculosis presented as multiple pleural masses: An atypical presentation. Lung India : Official Organ of Indian Chest Society. 2013; 30(1):54-56.
- 14. Rzyman W, Skokowski J, Romanowicz G, Lass P, Dziadziuszko R. Decortication in chronic pleural empyema - effect on lung function. Eur J Cardiothorac Surg 2002; 21:502-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Haziran 2018 |
| Kabul Tarihi | 12 Mart 2018 |
| Yayımlandığı Sayı | Yıl 2018 |