Title: Clinical Profile of Patients with Malignant Pleural Effusion

Authors: Smit Janrao, Rahul Rathod,, Pranav Deore, Sayali Bhambar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.17

Abstract

Introduction: Pleural effusion (PE) refers to the excessive or abnormal accumulation of fluid in the pleural space. Approximately one-fourth of all PE and 30 - 70% of all exudative effusions in hospital settings are secondary to cancer. The present study was conducted with the objective of identifying the relative proportion of different malignancies and clinical profile of patients with malignant PE.

Materials & Methods: A total of 89 consecutive cases ≥ 18 years having pleural effusion with proven underlying malignancy were included in a hospital based observational study. Detailed clinical history, general and systemic examination was done in all patients. A chest radiograph was done and the size of effusion was estimated in all cases.A diagnostic thoracentesis was then performed on all patients and biochemical and cytological examination was done on the aspirated pleural fluid.

Results: The mean age of study subjects was 59.06± 15.53 years with male to female ratio was 1.02:1. Most common organ involved was lung (43.8%), carcinoma breast (15.73%) and carcinoma ovary (14.6%). Histopathologically adenocarcinoma was most common accounting for 28.1%, followed by squamous cell carcinoma were 22.5%. All malignant pleural effusion were exudative in nature. Large effusion was seen in 53.9% cases. Pleural fluid appearance was more commonly found to be haemorrhagic (50.56%). Pleural fluid cytology was positive for malignant cells in 68.5% cases. 

Conclusion: Malignant effusions are more common in age group of above 50 years and are mostly exudative effusions. These are most commonly associated with malignancies of lung followed by breast, ovary, cervix and lymphomas.

Keywords: Clinical Profile, Lung Carcinoma, Malignant Pleural effusion, Pleural fluid cytology.

References

1.      Mark S Chesnult MD, Thomas J Prender-gast MD. Pleural disease: Current medical diagnosis and treatment. 2004; 350-356.

2.      Light RW. Management of pleural effusions. J Formos Med Assoc 2000;99:523‑31.

3.      Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ; BTS Pleural Disease Guideline Group. Management of malig-nant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(Suppl 2):ii32‑40.

4.      Johnston WW. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer1985; 56:905‑9.

5.      Moffett PU, Moffett BK, Laber DA. Diagnosing and managing suspected malignant pleural effusions. J Support Oncol 2009;7:143‑6.

6.      Putnam JB Jr, Light RW, Rodriguez RM, Ponn R, Olak J, Pollak JS, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer 1999;86:1992‑9.

7.      Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic pleural effusions: An assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest 2000;117:73‑8.

8.      Jobin Joy.Etiological study of exudative pleural effusion by conventional method its clinical presentation along with radiological,biochemical and cytological correlation.2013;72-76.

9.      Zay Soe, ZawAung,KhinDarliTun et al. A clinical study on malignant pleural effusion. International journal of collaborative research on internal medicine and public health 2012; vol.4 (5):762.

10.  Sharma SK, Suresh V, Mohan et al. Prospective study of sensitivity and specificity of adenosine deaminase in diagnosis of tubercular pleural effusion. Indian J Chest Dis Allied Sci 2001;45:149-155.

11.  Jose manuel; Etiology and pleural fluid characteristics of large and massive  effu-sion, Chest journal; sept. 2003: vol.12 4(3)

12.  Chernow B, Sahn SA. Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med 1977;63:695–702.

13.  Cantó A, Ferrer G, Romagosa V, Moyya J, Bernat R. Lung cancer and pleural effusion: clinical significance and study of pleural metastatic locations. Chest 1985;87:649–652.

14.  Mayer GG,Berger JW et al.Massive pleural effusion and non malignant causes in 46 patients. Am Rev Resp Dis 1972;105:458-460.

15.  Martinez Moragon E, AparicioUrtasun J, Sanchis Aldas J, et al. Pleurodesis contetraciclinas en el tratamientod-elderrame pleural maligno. Estudioretro-spectivo de 91 casos [Tetracycline pleurodesis for treatment of malignant pleural effusions. Retrospective study of 91 cases]. Med Clin 1993;101:201–4.

Corresponding Author

Dr Smit Janrao

Resident, Department of Medicine, MVP’s Dr.Vasantrao Pawar Medical College,

Hospital and Research Centre, Adgaon, Nashik

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.