Malignant pleural effusion

Case contributed by Dr Pranav Sharma

Presentation

Shortness of breath in a smoker.

Patient Data

Age: 75 years
Gender: Male
X-ray

Large right pleural effusion extends to the level of the 2nd rib anteriorly. Left lung remains clear.

CT

CT Chest

There is a fairly large right pleural effusion. This has caused almost total collapse of the right lung. A pleural mass is no appreciated. No pleural thickening is demonstrated. The distal aspect of the right lower lobe bronchus is collapsed. Aeration of a part of the right upper lobe is seen. No mediastinal abnormality.

Case Discussion

This is a case of a 75-year-old male who presented to our hospital with a three month history of worsening shortness of breath and reduced exercise tolerance. He described a 25kg weight loss and had a 65-pack-year history of smoking.

This gentleman underwent a pleuritic tap which confirmed malignant adenocarcinoma.

MACROSCOPIC:

  • Received 50ml of cloudy yellow fluid with clots.

MICROSCOPIC:

  • Moderate cellularity
  • Malignant cells are present in a background of leukocytes (predominantly lymphocytes), histiocytes and blood
  • Malignant cells have markedly pleomorphic, hyperchromatic nuclei and moderate amounts of cytoplasm

IMMUNOHISTOCHEMISTRY:

  • Positive: AE1/3, CEA, TTF1
  • Negative: BerEp4, calretinin, WT1, CK5/6  

Features are consistent with metastatic adenocarcinoma of pulmonary origin.

He has now been referred to medical oncologists for ongoing treatment.

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Case information

rID: 88270
Published: 7th Apr 2021
Last edited: 8th Apr 2021
System: Chest
Inclusion in quiz mode: Excluded
Institution: Princess Alexandra Hospital, Brisbane

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