Rural Emergency Medicine

Continuing on from Pulmonary Tumours, this week we take a quick look at Pleural Tumours. To review any normal histology or anatomy go to the Pulmonary Tumours week. An understanding of the clinical examination of the respiratory system may also be useful.

Another gem from Eleytherius.

Malignant Mesothelioma
Arises from serosal membrane lining, including pleural, cardial, peritoneal and scrotal cavities. In this case the pleural type is of interest.
  • 90% are associated with asbestos exposure
  • Clinical Features: chest pain,  dyspnoea, recurrent pleural effusions
  • Classification: Epithelioid, Sarcomatoid and Desmoplastic (e.g. mixed)
  • Tumour with a predominantly papillary pattern
  • Abundant and acidophilic  cytoplasm.
  • Pattern of chromatin (clumped, hyperchromatic)
  • large amounts of keratin proteins
  • Diffusely spread over lung surface (i.e. pleura)
  • Thick layer of gelatinous, grayish-pink tissue

Solitary Fibrous Tumour or Pleural Fibroma
  • Essentially benign Mesothelioma
  • No relationship to asbestos exposure
  • Soft tissue tumour
  • Resection is curative

    Solitary fibrous tumor of pleura by Pulmonary Pathology
    This tumor presented as a pedunculated intrapleural mass arising from the visceral pleura. Although most of these tumors are benign, microscopic features such as mitotic activity, necrosis, cellular atypia and size greater than 10 cm. may correlate with malignant behavior.

    Secondary Tumours
    Metastases can also spread to the lung pleural (e.g. lung, breast, ovary).

    Further Resources

    Videos are thanks to  . Material is sourced from my notes from pathology tutorials at UQ, and Robbin's Pathologic Basis of Disease. References for images are underneath the image.

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