Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non‑Hodgkin's lymphoma

Wang,Zhen; Wu,Yan‑Bing; Xu,Li‑Li; Jin,Mu‑Lan; Diao,Xiao‑Li; Wang,Xiao‑Juan; Tong,Zhao‑Hui; Shi,Huan‑Zhong

doi:10.3892/ol.2017.7226

Diagnostic value of medical thoracoscopy in malignant pleural effusion induced by non‑Hodgkin's lymphoma

Authors:
- Zhen Wang
- Yan‑Bing Wu
- Li‑Li Xu
- Mu‑Lan Jin
- Xiao‑Li Diao
- Xiao‑Juan Wang
- Zhao‑Hui Tong
- Huan‑Zhong Shi
View Affiliations

Affiliations: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China, Department of Pathology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
Published online on: October 19, 2017 https://doi.org/10.3892/ol.2017.7226
Pages: 8092-8099

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Malignant pleural effusion (MPE) appears in up to 20% of patients with non‑Hodgkin's lymphoma (NHL). The present study aimed to assess the efficacy of medical thoracoscopy (MT) in the diagnosis of patients with MPE induced by NHL. Between July 2005 and June 2014, 833 patients with pleural effusions of unknown etiology underwent MT in Beijing Chaoyang Hospital (Beijing, China), where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, thoracoscopic, histological and immunophenotyping data of 10 NHL patients with MPE were then retrospectively analyzed. Under medical thoracoscopy, pleural nodules (in n=6 patients), hyperemia (n=5), plaque‑like lesions (n=4), pleural thickening (n=3), cellulose (n=3), ulcer (n=2), adhesion (n=2), and scattered hemorrhagic spots (n=1) were observed on the surface of parietal pleura. Histopathological and immunohistochemical analysis of pleural biopsy samples led to a correct diagnosis of B‑cell NHL in 7 patients and T‑lymphoblastic NHL in 2 patients. Data from the present study demonstrated that pleural biopsy through MT achieved a definite diagnosis of NHL in 9 out of 10 (90%) patients with MPE induced by NHL. Therefore, MT is a useful method for diagnosing MPE induced by NHL.

View Figures

View References

1	Marel M, Stastny B, Melínová L, Svandová E and Light RW: Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990. Chest. 107:1598–1603. 1995. View Article : Google Scholar : PubMed/NCBI
2	Johnston WW: The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer. 56:905–909. 1985. View Article : Google Scholar : PubMed/NCBI
3	Das DK: Serous effusions in malignant lymphomas: A review. Diagn Cytopathol. 34:335–347. 2006. View Article : Google Scholar : PubMed/NCBI
4	Alexandrakis MG, Passam FH, Kyriakou DS and Bouros D: Pleural effusions in hematologic malignancies. Chest. 125:1546–1555. 2004. View Article : Google Scholar : PubMed/NCBI
5	Hunter BD, Dhakal S, Voci S, Goldstein NP and Constine LS: Pleural effusions in patients with Hodgkin lymphoma: Clinical predictors and associations with outcome. Leuk Lymphoma. 55:1822–1826. 2014. View Article : Google Scholar : PubMed/NCBI
6	Wong FM, Grace WJ and Rottino A: Pleural effusions, ascites, pericardial effusions and Edema in Hodgkin's disease. Am J Med Sci. 246:678–682. 1963. View Article : Google Scholar : PubMed/NCBI
7	Manoharan A, Pitney WR, Schonell ME and Bader LV: Intrathoracic manifestations in non-Hodgkin's lymphoma. Thorax. 34:29–32. 1979. View Article : Google Scholar : PubMed/NCBI
8	Berkman N, Breuer R, Kramer MR and Polliack A: Pulmonary involvement in lymphoma. Leuk Lymphoma. 20:229–237. 1996. View Article : Google Scholar : PubMed/NCBI
9	Cordier JF, Chailleux E, Lauque D, Reynaud-Gaubert M, Dietemann-Molard A, Dalphin JC, Blanc-Jouvan F and Loire R: Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest. 103:201–208. 1993. View Article : Google Scholar : PubMed/NCBI
10	Nador RG, Cesarman E, Chadburn A, Dawson DB, Ansari MQ, Sald J and Knowles DM: Primary effusion lymphoma: A distinct clinicopathologic entity associated with the Kaposi's sarcoma-associated herpes virus. Blood. 88:645–656. 1996.PubMed/NCBI
11	Hengge UR, Ruzicka T, Tyring SK, Stuschke M, Roggendorf M, Schwartz RA and Seeber S: Update on Kaposi's sarcoma and other HHV8 associated diseases. Part 2: Pathogenesis, Castleman's disease, and pleural effusion lymphoma. Lancet Infect Dis. 2:344–352. 2002. View Article : Google Scholar : PubMed/NCBI
12	Aozasa K: Pyothorax-associated lymphoma. J Clin Exp Hematop. 46:5–10. 2006. View Article : Google Scholar : PubMed/NCBI
13	Steiropoulos P, Kouliatsis G, Karpathiou G, Popidou M and Froudarakis ME: Rare cases of primary pleural Hodgkin and non-Hodgkin lymphomas. Respiration. 77:459–463. 2009. View Article : Google Scholar : PubMed/NCBI
14	Oikonomou A, Giatromanolaki A, Margaritis D, Froudarakis M and Prassopoulos P: Primary pleural lymphoma: Plaque-like thickening of the pleura. Jpn J Radiol. 28:62–65. 2010. View Article : Google Scholar : PubMed/NCBI
15	Giardino A, O'Regan KN, Hargreaves J, Jagannathan J, Park D, Ramaiya N and Fisher D: Primary pleural lymphoma without associated pyothorax. J Clin Oncol. 29:e413–e415. 2011. View Article : Google Scholar : PubMed/NCBI
16	Wang XJ, Yang Y, Wang Z, Xu LL, Wu YB, Zhang J, Tong ZH and Shi HZ: Efficacy and safety of diagnostic thoracoscopy in undiagnosed pleural effusions. Respiration. 90:251–255. 2015. View Article : Google Scholar : PubMed/NCBI
17	Wang Z, Tong ZH, Li HJ, Zhao TT, Li XY, Xu LL, Luo J, Jin ML, Li RS and Wang C: Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: A comparative study. Chin Med J (Engl). 121:1384–1389. 2008.PubMed/NCBI
18	Wang Z, Xu LL, Wu YB, Wang XJ, Yang Y, Zhang J, Tong ZH and Shi HZ: Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion. Respir Med. 109:1188–1192. 2015. View Article : Google Scholar : PubMed/NCBI
19	Zelenetz AD, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Bellam N, Byrd JC, Czuczman MS, Fayad LE, Glenn MJ, et al: Non-Hodgkin's lymphomas. J Natl Compr Canc Netw. 9:484–560. 2011. View Article : Google Scholar : PubMed/NCBI
20	Tan D, Tan SY, Lim ST, Kim SJ, Kim WS, Advani R and Kwong YL: Management of B-cell non-Hodgkin lymphoma in Asia: Resource-stratified guidelines. Lancet Oncol. 14:e548–e561. 2013. View Article : Google Scholar : PubMed/NCBI
21	Moy MP, Levsky JM, Berko NS, Godelman A, Jain VR and Haramati LB: A new, simple method for estimating pleural effusion size on CT scans. Chest. 143:1054–1059. 2013. View Article : Google Scholar : PubMed/NCBI
22	Light RW, Macgregor MI, Luchsinger PC and Ball WC Jr: Pleural effusions: The diagnostic separation of transudates and exudates. Ann Intern Med. 77:507–513. 1972. View Article : Google Scholar : PubMed/NCBI
23	Parnell AP and Frew I: Case report: Non-Hodgkin's lymphoma presenting as an encasing pleural mass. Br J Radiol. 68:926–927. 1995. View Article : Google Scholar : PubMed/NCBI
24	Barahona ML, Dueñas VP, Sánchez MT and Plaza BV: Case report. Primary mucosa-associated lymphoid tissue lymphoma as a pleural mass. Br J Radiol. 84:e229–e231. 2011. View Article : Google Scholar : PubMed/NCBI
25	Aquino SL, Chen MY, Kuo WT and Chiles C: The CT appearance of pleural and extrapleural disease in lymphoma. Clin Radiol. 54:647–650. 1999. View Article : Google Scholar : PubMed/NCBI
26	Maskell NA, Gleeson FV and Davies RJ: Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: A randomised controlled trial. Lancet. 361:1326–1330. 2003. View Article : Google Scholar : PubMed/NCBI
27	Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, Gleeson FV, Howes TQ, Treasure T, Singh S, et al: Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 65 Suppl 2:ii54–ii60. 2010. View Article : Google Scholar : PubMed/NCBI
28	Celikoglu F, Teirstein AS, Krellenstein DJ and Strauchen JA: Pleural effusion in non-Hodgkin's lymphoma. Chest. 101:1357–1360. 1992. View Article : Google Scholar : PubMed/NCBI
29	Bangerter M, Hildebrand A and Griesshammer M: Immunophenotypic analysis of simultaneous specimens from different sites from the same patient with malignant lymphoma. Cytopathology. 12:168–176. 2001. View Article : Google Scholar : PubMed/NCBI
30	Xaubet A, Diumenjo MC, Maŕin A, Montserrat E, Estopá R, Llebaría C, Austí A and Rozman C: Characteristics and prognostic value of pleural effusions in non-Hodgkin's lymphomas. Eur J Respir Dis. 66:135–140. 1985.PubMed/NCBI
31	Pietsch JB, Whitlock JA, Ford C and Kinney MC: Management of pleural effusions in children with malignant lymphoma. J Pediatr Surg. 34:635–638. 1999. View Article : Google Scholar : PubMed/NCBI
32	Clarkson B: Relationship between cell type, glucose concentration, and response to treatment in neoplastic effusions. Cancer. 17:914–928. 1964. View Article : Google Scholar : PubMed/NCBI
33	Froudarakis ME: Diagnostic work-up of pleural effusions. Respiration. 75:4–13. 2008. View Article : Google Scholar : PubMed/NCBI
34	Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, Erginel S, Alatas F and Metintas S: Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: A randomized, controlled trial. Chest. 137:1362–1368. 2010. View Article : Google Scholar : PubMed/NCBI
35	Koegelenberg CF, Bolliger CT, Theron J, Walzl G, Wright CA, Louw M and Diacon AH: Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis. Thorax. 65:857–862. 2010. View Article : Google Scholar : PubMed/NCBI
36	He J, Gu D, Wu X, Reynolds K, Duan X, Yao C, Wang J, Chen CS, Chen J, Wildman RP, et al: Major causes of death among men and women in China. N Engl J Med. 353:1124–1134. 2005. View Article : Google Scholar : PubMed/NCBI
37	Haas AR, Sterman DH and Musani AI: Malignant pleural effusions: Management options with consideration of coding, billing, and a decision approach. Chest. 132:1036–1041. 2007. View Article : Google Scholar : PubMed/NCBI
38	Vega F, Padula A, Valbuena JR, Stancu M, Jones D and Medeiros LJ: Lymphomas involving the pleura: A clinicopathologic study of 34 cases diagnosed by pleural biopsy. Arch Pathol Lab Med. 130:1497–1502. 2006.PubMed/NCBI
39	Bangerter M, Hildebrand A and Griesshammer M: Combined cytomorphologic and immunophenotypic analysis in the diagnostic workup of lymphomatous effusions. Acta Cytol. 45:307–312. 2001. View Article : Google Scholar : PubMed/NCBI
40	Matolcsy A, Nádor RG, Cesarman E and Knowles DM: Immunoglobulin VH gene mutational analysis suggests that primary effusion lymphomas derive from different stages of B cell maturation. Am J Pathol. 153:1609–1614. 1998. View Article : Google Scholar : PubMed/NCBI
41	Dynes MC, White EM, Fry WA and Ghahremani GG: Imaging manifestations of pleural tumors. Radiographics. 12:1191–1201. 1992. View Article : Google Scholar : PubMed/NCBI